Posts Tagged ‘sleep’

Sleep and How to Achieve It

It is estimated that about a third of our population suffers from some form of insomnia. For some, it is severe and chronic, and for others it is mild and due to obvious factors, such as pain, illness, anxiety or recent travel.

Insomnia can make us feel chronically tired, cranky and irritable. Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression.

Many insomnia sufferers will turn to drugs to help them sleep. Most begin with over-the-counter medications, which usually contain an antihistamine as the main ingredient. (Men with enlarged prostates should avoid use of antihistamines.) This ingredient causes drowsiness and may help one fall asleep. Such medicines are relatively safe but can cause a reduced level of alertness the next day.

Food supplements and herbal sleep remedies, such as melatonin and valerian, also may help, but they are unregulated and have unpredictable results.

If insomnia persists more than a week or two, you may want to consult with your doctor.

Before you do, it would be a good idea to keep a sleep log for a week. Here’s what you would want to record:

– The time you go to bed, the time you get up, and the approximate amount of time you were awake during the night

– Drugs you take, including use of alcohol, caffeine and tobacco

– Disturbing factors, such as pain, a newborn baby, a snoring bed partner or noise outside the bedroom

– Whether you feel rested upon arising

Treating insomnia with prescription medication is a common approach for sleep problems.

Common medications for the treatment of insomnia are called hypnotics and need to be prescribed by a doctor. They should only be taken when:

– The cause of your insomnia has been evaluated

– Sleep problems are causing difficulties with your daily activities

– Appropriate sleep-promoting behaviors have been tried

All hypnotics induce sleep, and some help maintain sleep. They work by acting on areas in the brain believed to be involved in sleep promotion. These are the drugs of choice, because they have the greatest benefit and lowest risk as sleep-promoting drugs.

Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

– Terry Hollenbeck, M.D., is an urgent-care physician at Palo Alto Medical Foundation Santa Cruz in Scotts Valley. Readers can view his previous columns on his website, valleydoctor.wordpress.com, or email him at valleydoctor@sbcglobal.net. Information in this column is not intended to replace advice from your own health care professional. For any medical concern, consult your own doctor.


Some additional tips for a good night’s sleep


These are some things you can do, aside from medication, to ensure a better sleep:

Try to maintain a routine sleep schedule, going to bed and arising at regular times.

Limit your use of alcohol, caffeine and tobacco.

Get regular daytime exercise, but don’t exercise at night.

Make your bedroom conducive to good sleep by having a comfortable mattress, keeping the room dark and cool and eliminating any extraneous noise.

Avoid excessive mental and physical activities before going to bed. Try reading a book, listening to music or meditating.

Use the bed only for sleep or sex; don’t do paperwork or eat in bed.

If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not particularly stimulating until you feel sleepy.

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Sleep Apnea

Sleep apnea is a common disorder in which one’s breathing pauses while one is asleep. These pauses last from seconds to minutes and can occur five to 30 times per hour.

Sleep apnea is a common condition affecting 12 million to 18 million Americans. It robs people of a good night’s sleep, causing excessive daytime drowsiness and a feeling of constant tiredness.

Most people with sleep apnea aren’t aware of the condition and might think they are getting a decent sleep. Many are tipped off by a family member or bed partner who is aware of the sleeper’s nocturnal breathing difficulties.

Sleep apnea occurs when the muscles in the back of the throat relax, which can temporarily narrow and even close off the airway. The brain then senses the lack of oxygen and awakens the sleeper enough to take a normal breath, and so the cycle continues.

Symptoms of sleep apnea are:

-Loud snorting or choking sounds during sleep.

– Loud snoring. (But not everyone who snores has sleep apnea.)

– Excessive daytime sleeping or drowsiness.

– Observed episodes of not breathing during sleep.

– Awakening with dry mouth or sore throat.

– Abrupt awakening, feeling short of breath.

Sleep apnea is found more commonly among people who are obese; men; the elderly; users of sleeping medications, tranquilizers, alcohol or tobacco; and patients with hypertension or hypothyroidism.

The condition is diagnosed on the basis of family and medical histories, a physical exam and sleep studies done at specialized sleep clinics. These sleep studies, some of which can also be done at home, monitor the sleeper and can definitively determine if one has sleep apnea and how severe it is.

Treatments for sleep apnea include lifestyle changes, such as avoiding alcohol and tobacco use, losing weight, sleeping on one’s side instead of on the back, and keeping nasal passages clear.

Some patients wear mouthpieces to keep their airways open while they sleep, and others use breathing devices, such as the continuous positive airway pressure machine. This machine uses a mask that fits over the mouth and nose, or just over the nose. It gently blows air into the throat, keeping the airway open.

In some cases, surgery may be used to widen breathing passages.

Sleep apnea needs to be taken seriously. Studies in recent years have shown that people with untreated sleep apnea have a three times greater chance of death, mostly from heart attacks, than people without the condition.

If you show signs and symptoms of sleep apnea, or if someone you love does, a visit to a primary-care physician is essential for a routine health check and referral to a sleep specialist.

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Many Plagued by Insomnia

It is estimated that about one-third of adults have difficulty sleeping and are thus sleep deprived.

Twenty percent of people get less than six hours of sleep. Adults need seven to nine hours of sleep a night. Any less than this can cause increased stress and a depressed immune system and can make one cranky and irritable. It also puts one at increased risk of obesity, diabetes and high blood pressure.

Insomnia becomes more prominent as we age, which is unfortunate, because older people still need as much sleep as younger people do. Aging causes a change of sleep patterns, leading to a lighter, less restful sleep. Decreasing physical and social activity and an increase in chronic health problems also contribute to less sleep.

These are some causes of insomnia:

– Stress

– Anxiety and depression

– Medications, such as heart and blood pressure drugs, steroids, decongestants and weight-loss products

– Caffeine, nicotine and alcohol

– Medical conditions, such as chronic pain, frequent urination and sleep apnea

– Changes in environment or work schedule

– Eating and drinking too much late in the evening

Nonprescription-medication remedies should be tried first.

Lifestyle changes

Be consistent with the time you go to bed and when you wake up. Don’t nap more than 30 minutes a day, and preferably do it before 3 p.m.

Make your bedroom conducive to sleep by keeping it dark, quiet and a comfortable temperature. Don’t linger in bed if you can’t sleep.

Limit or avoid caffeine, alcohol and nicotine. Avoid large late meals.

A recent study found that most adults who did aerobic exercise four times a week dramatically improved their sleep.

Behavioral therapies

Learn relaxation techniques.

Limit the time you spend in bed, and associate your bed and bedroom only with sleep.

See a therapist who specializes in insomnia, who may provide a cure for insomnia and not just treat the symptoms with medication.

Alternative medicine

Melatonin and valerian are over-the-counter supplements that are marketed as sleep aids. They may be worth a try; however, some studies have shown them to be no more effective than a placebo and their long-term safety record isn’t known.

Prescription medication

Prescription sleep aids can be very effective in many cases, but they should be used for as short a time as possible, because longer-term use is thought to contribute to other health problems.

Sleeping pills also have side effects, such as drowsiness, impaired judgment, depression, agitation and balance problems.

If you are not getting the good night’s rest you deserve, see a doctor who can help to treat and guide you to having a more restful and satisfying sleep.

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