• Having Trouble Catching Those Z's?

    IMAGE If you have 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. However, 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 has 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 many Americans 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.

    What Are the Symptoms?

    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:
    • Taking a long time to fall asleep
    • Trouble with memory and concentration
    • Irritability
    • Decreased work productivity
    • Waking up fatigued, with a headache and feeling unrefreshed
    • Waking up frequently and having trouble falling back to sleep
    With sleep apnea, the sleep partner often reports loud snoring and pauses in breathing followed by gasping, a choking sound, or coughing. Doug's wife complains about his loud snoring, but says he does not seem to gasp or cough at night. Even so, he does not feel refreshed when he gets up in the morning and wonders if he should have it checked out. Sleep apnea may be associated with a number of chronic conditions like cardiovascular disease and high blood pressure.

    What Are the Causes?

    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. Jawbone abnormalities that impair airflow at rest, even in people who are thin, can also disrupt sleep.
    Other health problems that may disrupt sleep include restless leg syndrome, gastroesophageal reflux, and chronic pain.
    Taking certain medicine can also increase the risk of insomnia. Some examples include medicines used to treat high blood pressure, depression, Parkinson's disease, and thyroid disorder.

    Psychological Causes

    Dr. Gillin says that while sleep problems can be due to an underlying medical disorder, it is also important to consider a mental health condition. Psychological causes of sleep disorders include stress, depression, anxiety, and drug abuse.

    Lifestyle Causes

    Caffeine, alcohol, and smoking are common culprits in sleep disturbance. Dr. Gillin says that the habit of having 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 cannot 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. Working long hours and having jet lag can also lead to insomnia. A disrupted schedule often includes irregular diet and exercise, both of which are important for good rest.

    How Are Sleep Problems Diagnosed?

    Dr. Gillin says the following questions can help identify the severity of your sleep problem:
    • How long has this sleep problem lasted?
    • How much has it interfered with your normal day?
    • Are there any underlying problems—stress, relationship issues?
    • Do you have an odd work schedule?
    • Have you had recent or frequent travel?
    • Are you a smoker? How heavy?
    • Do you drink alcohol? How much and how often?
    If your doctor suspects a serious physiological cause, such as in sleep apnea, you should be referred to a sleep specialist.

    What Are the Treatments?

    There are a range of treatments for insomnia. For example, if you are like Doug and are diagnosed with sleep apnea, your doctor may recommend treatments like losing weight, using a continuous positive airway pressure (CPAP) machine, or undergoing surgery. For other causes of insomnia, your doctor may recommend that you make lifestyle changes, such as improving your "sleep hygiene." This involves strategies like:
    • Doing relaxation therapy
    • Getting regular exercise
    • Having regular bed- and wake-time hours
    • Keeping the bedroom dark and quiet
    • Limiting alcohol and caffeine consumption
    There are many other treatments to help you get a good night's rest. In some cases, medicines may be prescribed to aid you in falling asleep and staying asleep through the whole night. Also, if you have an underlying condition, like depression, getting proper treatment can improve insomnia.

    What Should You Do If You Have a Sleep Disorder?

    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 will find it helpful to keep a diary of your sleep habits for about 10 days to identify just how much sleep you are getting over a period of time and what you are doing that interferes with your sleep time.

    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%5Fbasics/understanding%5Fsleep.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.

    DynaMed Editorial Team. Diabetes mellitus type 2. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated April 7, 2011. Accessed April 12, 2011.

    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.

    Sleep apnea and cardiovascular disease. Journal of American College of Cardiology website. Available at: http://content.onlinejacc.org/cgi/content/full/j.jacc.2008.05.002. Published July 28, 2008. Accessed April 12, 2011.

    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.

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