If you've spent a sleepless night, you know it can be debilitating. Most people get less sleep per night than is necessary to stay healthy and alert. But, you can get help catching those Z's. By improving your sleep hours, your waking hours should improve as well.
Doug, a teacher in his late 40's, complains of fatigue, dozing at his desk in the middle of the day, and practically falling asleep at the wheel. He admits he's never had "good sleep" and is fed up with his lack of energy and its impact on his work and social life.
Doug is one of about 60 million Americans a year who suffer with insomnia . J. Christian Gillin, MD, professor of psychiatry at the University of California, San Diego, says that though men complain of insomnia less often than women, men's sleep gets worse as they get older.
Many adults complain of excessive sleepiness and tiredness during the day, and they may readily fall asleep when reading or watching TV. Other symptoms include:
With sleep apnea , the sleep partner often reports loud snoring and pauses in breathing followed by gasping, a choking sound, or coughing. Kicking of legs may also be reported. Doug's wife complains about his loud snoring, but says he doesn't seem to gasp or cough at night. Even so, he doesn't feel refreshed when he gets up in the morning and wonders if he should have it checked out.
Also, untreated sleep apnea is associated with hypertension and other cardiovascular complications, like myocardial ischemia and infarction , acute coronary syndrome , stroke and transient ischemic attacks , cardiac arrhythmia , pulmonary hypertension , and heart failure .
Sleep problems may stem from a physical problem, a psychological problem or lifestyle patterns.
Physical Causes
Duane Slegel, PhD, clinical director of the Sleep Center of Texas, explains that the condition sleep apnea, often due to increased body weight, may also be due to problems with the airway, such as enlarged tonsils, uvula, or tongue. Jawbone abnormalities that impair airflow at rest, even in thin folks, can also disrupt sleep. Health problems that may disrupt sleep include heart disease, cancer , and chronic back pain .
Psychological Causes
Dr. Gillin says that while sleep problems can be due to an underlying medical disorder, it's also important to consider a psychological dysfunction. Psychological causes of sleep disorders include stress, depression , anxiety , and post traumatic stress disorder .
Lifestyle Causes
Caffeine , alcohol , and smoking are common culprits in sleep disturbance. Dr. Gillin says that the habit of downing a nightcap to relax in the evening can impair your sleep, and that "the combination of alcohol and coffee, like at dinner, is a huge problem." While a glass of wine or beer may seem to help you sleep, the caffeine in your cup of coffee rears its head just as your blood alcohol level drops.
The same can be said for nicotine. Dr. Gillin says, "Ask yourself how long you can go without a smoke after you wake up. If you can't go more than 30 minutes, you're likely to awaken at night to refurbish the falling level of nicotine."
Night-shift work or rotating shifts can throw off your normal sleep-wake rhythm. So can working long hours and jet lag. A disrupted schedule often includes irregular diet and exercise, both of which are important for good rest.
Dr. Gillin says the following questions can help identify the severity of your sleep problem:
If you or your doctor suspect a serious physiological cause, such as in sleep apnea, you should be referred to a sleep specialist. Lydia Wytrzes, MD, a neurologist in Sacramento and director of the Sutter Sleep Disorders Center, says a diagnostic test called a polysomnogram can help identify the cause of the sleep problem and determine the appropriate treatment.
Physical Factors
Treatment for sleep apnea typically involves one or more of the following approaches:
Dr. Wytrzes adds that laser surgery is another outpatient procedure geared toward helping those with snoring without apnea.
Psychological Factors
Sleep disruption caused by an underlying psychological disorder, Dr. Gillin says, can often be successfully managed with medication and/or psychotherapy.
Lifestyle Factors
Israel Lederhendler, PhD, director of the new Office of Electronic Research and Reports Management and coordinator for sleep research at the National Institute of Mental Health, suggests the following for cases where medical intervention is not required:
Try to limit your activities that fall within an hour of bedtime to those that induce sleep, like listening to soft music. Leave television, work, and Internet surfing to the family room or home office. Don't try to "force" yourself to sleep. You'll just lie awake staring at the clock. After 20 minutes of wakefulness, go to another room to read or watch TV. Go back to bed only when you're feeling sleepy.
As a rule, if you are not waking up as refreshed as you used to, pay attention. It is not normal to wake up tired and worn out. Will cutting back on caffeine and alcohol do the trick, or is something else—such as a physical problem—disrupting your sleep?
If your sleep problems persist for longer than a week and are bothersome, or if sleepiness interferes with the way you feel or function during the day, a doctor's help may be needed. To get the most out of your doctor's visit, you'll find it helpful to keep a diary of your sleep habits for about ten days to identify just how much sleep you're getting over a period of time and what you're doing that interferes with your sleep time.
If your doctor dismisses your concern, ask for a referral to a specialist. Dr. Wytrzes cautions that depending on where you live, some doctors are not well aware of sleep problems and may minimize your complaints.
Better quality sleep lends itself to better quality of life. Doug found out his nightly shots of cognac and the extra 20 pounds he'd put on in the past few years were the main causes of his sleep problems. He's cut out the alcohol and taken steps to lower his weight, and he is already catching a few more Z's each night.
RESOURCES
American Sleep Disorders Association
http://www.aasmnet.org/
National Sleep Foundation
http://www.sleepfoundation.org/
CANADIAN RESOURCES
Better Sleep Council of Canada
http://www.bettersleep.ca/
Canadian Sleep Society
http://www.css.to/
References:
Brain basics: understanding sleep. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm. Updated May 21, 2007. Accessed April 14, 2009.
Cardiovascular disease and obstructive sleep apnea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 13, 2009. Accessed April 14, 2009.
Division of nasal and sinus disorders. Department of Otolaryngology Head and Neck Surgery, Columbia University website. Available at: http://www.entcolumbia.org/somnop.html. Accessed June 17, 2009.
Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 24, 2009. Accessed April 14, 2009.
Obstructive sleep apnea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 3, 2009. Accessed April 14, 2009.
Phillips CL, Cistulli PA. Obstructive sleep apnea and hypertension: epidemiology, mechanisms and treatment effects [review]. Minerva Med. 2006;97:299-312.
Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease [review]. JAMA. 2003;290:1906-1914.
Snoring. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 23, 2009. Accessed April 14, 2009.
Somers VK, White DP, Amin R, et al. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement. Circulation. 2008;118:1080-1111.
Wolf J, Lewicka J, Narkiewicz K. Obstructive sleep apnea: an update on mechanisms and cardiovascular consequences. Nutr Metab Cardiovasc Dis. 2007;17:233-240. [Epub ahead of print]
Last reviewed April 2009 by Judy Chang, MD, FAASM
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.