GETTING A GOOD NIGHT’S SLEEP
by Patti Kantor
While people tend to think of sleep disorders as more of an embarrassment than a health risk, sleep disorders can have a bad effect – even deadly. In fact a report in The New England Journal of Medicine (March 18, 1999) found that people suffering from sleep apnea were six times more likely to be involved in a car crash (as a result of drowsiness) than those without sleep disorders.
Unfortunately, the importance of sleep is often not appreciated until one cannot get enough. Excessive tiredness during the day, lack of energy, difficulty concentrating, and irritability can all be attributed to sleep deprivation. As a result of long-term problems sleeping, people can have difficulties with their job, social life, and recreational activities. There are a number of possible reasons for not getting a good night’s rest - like snoring, insomnia, restless legs syndrome, sleep apnea or even narcolepsy.
SNORING
According to the American Academy of Otolaryngology-Head and Neck Surgery, an estimated 45 percent of normal adults snore at least occasionally with 25 percent being habitual snorers. It occurs more frequently in males and those who are overweight. Snoring usually grows worse with age.
It is caused by a partial blockage to the free flow of air through the passages at the back of the mouth and nose. As the muscles of the tongue and back of the throat – which normally keep the airway open – relax during sleep, they fall toward each other and vibrate, causing the noise.
While mild cases of snoring may not cause a problem for the snorer, it can make it difficult for a spouse or roommate to sleep. If snoring is severe, it may be a sign of a condition that requires a doctor’s care.
INSOMNIA
Insomnia can affect men and women of all ages, although it seems to be more common in women (especially after menopause) and in the elderly. In fact, the ability to sleep - rather than the need for sleep - appears to decrease with advancing age.
Those with insomnia are evaluated with the help of their medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient’s bed partner concerning the quantity and quality of the patient’s sleep. A specialized sleep study may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder.
Insomnia may include:
- taking a long time to fall asleep
- awakening frequently during the night
- awakening too early in the morning
- feeling tired and dissatisfied with one’s sleep upon awakening
- the inability to sleep at all
There are many causes of insomnia, some of which may include:
- certain drugs
- physical ailments
- stress
- anxiety
- over active thinking
- poor diet
- and systemic disorders such as jet lag, poor sleeping environment, or bad head or leg position in bed.
In addition, the following behaviors have been shown to perpetuate insomnia for some people:
- expecting to have difficulty sleeping and worrying about it
- ingesting excessive amounts of caffeine
- drinking alcohol before bedtime
- smoking cigarettes before bedtime
- excessive napping in the afternoon or evening
- irregular or continually disrupted sleep/wake schedules
These behaviors can prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate insomnia altogether.
According to the National Institutes of Health - National Heart, Lung, and Blood Institute (NIH-NHLBI), treatment for chronic insomnia consists of diagnosing and treating underlying medical or psychological problems and identifying behaviors that may worsen insomnia and stopping (or reducing) them.
Sometimes sleeping pills may be considered, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again.
The NIH-NHLBI also suggests trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.
- Relaxation Therapy - There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person’s mind is able to stop “racing,” the muscles can relax, and restful sleep can occur. It usually takes practice to learn these techniques and to achieve effective relaxation.
- Sleep Restriction - Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night’s sleep is achieved.
- Reconditioning - Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the body will be conditioned to associate the bed and bedtime with sleep.
RESTLESS LEGS SYNDROME
Restless Legs Syndrome (RLS) is a sleep disorder in which one experiences unpleasant sensations in the legs often described as creeping, crawling, tingling, pulling, or painful. These sensations usually occur in the calf but may be felt anywhere from the thigh to the ankle. One or both legs may be affected; for some people, the sensations are also felt in the arms. These sensations occur when the person with RLS lies down or sits for long periods of time, such as at a desk, riding in a car, or watching a movie.
People with RLS describe an irresistible urge to move the legs when the sensations occur. Usually, moving the legs, walking, rubbing or massaging the legs, or doing knee bends can bring relief, at least briefly. RLS symptoms worsen when relaxing or during decreased activity. RLS symptoms also tend to follow a set daily cycle, with the evening and night hours being more troublesome than the morning hours.
People with Restless Legs Syndrome may find it difficult to relax and fall asleep because of their strong urge to walk or do other activities to relieve the sensations in their legs. Sleep is often best toward the end of the night or during the morning hours. Because of less sleep at night, those with RLS may feel sleepy during the day on an occasional or regular basis. The severity of symptoms varies from night to night and over the years as well.
Many people with RLS also have a related sleep disorder called periodic limb movements in sleep (PLMS). Involuntary jerking or bending leg movements during sleep characterizes PLMS. These typically occur every 10 to 60 seconds. Some people may experience hundreds of such movements per night, which can wake them, disturb their sleep, and awaken bed partners. People who have RLS and PLMS have trouble both falling asleep and staying asleep and may experience extreme sleepiness during the day.
Other possible characteristics of Restless Legs Syndrome include:
- Involuntary leg (and occasionally arm) movements while asleep;
- Difficulty falling asleep or staying asleep;
- Sleepiness or fatigue during the daytime;
- Cause of the leg discomfort not detected by medical tests;
- Family members with similar symptoms.
WHAT CAUSES RLS?
Although the cause is unknown in most cases, certain factors may be associated with RLS:
- Family history. RLS is known to run in some families - parents may pass the condition on to their children.
- Pregnancy. Some women experience RLS during pregnancy, especially in the last months. The symptoms usually disappear after delivery.
- Low iron levels or anemia. Persons with these conditions may be prone to developing RLS. The symptoms may improve once the iron level or anemia is corrected.
- Chronic diseases. Kidney failure quite often leads to RLS. Other chronic diseases such as diabetes, rheumatoid arthritis, and peripheral neuropathy may also be associated with RLS.
- Caffeine intake. Decreasing caffeine consumption may improve symptoms.
In mild cases of Restless Legs Syndrome, some people find that activities such as taking a hot bath, massaging the legs, using a heating pad or ice pack, exercising, and eliminating caffeine help alleviate symptoms. In more severe cases, medications may be considered to control symptoms. Unfortunately, no one drug is effective for everyone with RLS.
SLEEP APNEA
Sleep apnea is a serious breathing disorder that causes brief interruptions in a person’s breathing during sleep. (The word apnea is Greek meaning “without breath.”) According to the American Sleep Apnea Association, obstructive sleep apnea (OSA) is caused by a blockage of the airway that occurs as the throat muscles and tongue relax and sag during sleep. When breathing stops, the brain wakes up the sleeper reminding him to breathe.
The pauses in breathing, which are anywhere from 10 seconds up to a minute or longer, can occur 20 or 30 times per hour, several hundred times a night. These frequent interruptions in breathing with each apnea event then cause insomnia because they make it difficult to remain in a deep sleep.
Sleep apnea is very common and affects more than 26 million Americans, according to the National Institutes of Health. An estimated four-percent of middle-aged men and two percent of middle-aged women have sleep apnea. But the condition can occur in people of any age. In fact, in some cases of sudden infant death syndrome, sleep apnea was found to be the cause.
Symptoms of sleep apnea include snoring (although not everyone who snores has sleep apnea) and daytime sleepiness. It may also cause a choking sensation while sleeping. Those who snore loudly, are overweight, have high blood pressure or a physical abnormality of the nose may develop sleep apnea.
Risk factors for sleep apnea include:
- Obesity – 20 percent or greater of ideal body weight
- Larger neck girth – 17 inches in males, 16 inches in women
- Anatomic abnormalities: large tonsils, adenoids, small or recessed jaw line or chin
- Family history
- Alcohol or sedative use
- Lung disease
- Older than 65
If left untreated, sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle accidents.
NARCOLEPSY
Narcolepsy is the second leading cause of excessive daytime sleepiness diagnosed by sleep centers after sleep apnea. It is a disabling illness affecting more than one in every 2,000 Americans. The disease is principally characterized by the ability to fall asleep anywhere at any time - with a permanent and overwhelming feeling of day sleepiness and fatigue. Other symptoms involve abnormalities of dreaming sleep, such as dream-like hallucinations, and finding oneself physically weak or even paralyzed for a few seconds.
Studies on narcolepsy show its frequency at least as large as that of Multiple Sclerosis. In many cases, however, diagnosis is not made until several years after the onset of symptoms. This is often because patients consult a physician only after a number of years of excessive sleepiness, assuming that sleepiness is not indicative of a disease.
The effect of narcolepsy can be devastating. Studies have shown that even treated narcoleptic patients are often markedly psychosocially impaired in the area of work, leisure, interpersonal relations, and are more prone to accidents. These effects are even more severe than the well-documented effects of epilepsy. Since the symptoms of narcolepsy usually appear during adolescence, most narcoleptic patients are diagnosed too late to prevent the dramatic impact of the disease on their personal and professional development.
POSSIBLE CAUSES
The exact cause of narcolepsy is not known, but some cases are thought to be related to brain infection, head trauma and brain tumors. The condition is not tied in any way to insomnia or sleep deprivation – rather insomnia or sleep deprivation occurs as a result of narcolepsy. While there is currently no cure, individuals who suffer from the disorder can learn to manage their symptoms.
SYMPTOMS OF NARCOLEPSY
The main symptoms of narcolepsy are excessive daytime sleepiness, sleep attacks and abnormal REM sleep. Since the 1960s it has been known that several of the disabling symptoms of narcolepsy, such as sleep paralysis and hallucinations, are pathological equivalents of REM sleep.
A person with narcolepsy can suddenly fall into a deep sleep state with little or no warning. These attacks can happen at any time, last anywhere between a few minutes to an hour and can occur frequently (10 sleep attacks a day is not unheard of). In sleep paralysis, a frightening symptom considered to be an abnormal episode of REM sleep, the patient suddenly finds himself unable to move for a few minutes, most often upon falling asleep or waking up. Patients can experience dream-like hallucinations, while dozing or falling asleep.
Those suffering from narcolepsy also experience a striking, sudden episode of muscle weakness triggered by emotions. Typically, the patient’s knees buckle and may give way upon laughing, elation, surprise or anger. In other typical attacks the head may drop or the jaw may become slack. In severe cases, the patient might fall down and become completely paralyzed for a few seconds to several minutes. Reflexes are abolished during the attack.
Fortunately, most sleep disorders can be diagnosed and successfully treated. Several treatment options exist, and research into additional options continues.
TREATMENT OPTIONS
Treatment depends on the exact cause and severity of the sleep disorder. The most appropriate treatment depends on an individual’s medical history and the severity of the disorder. Oftentimes based upon a physician’s recommendation, a sleep study – six hours of recorded sleep - is ordered to determine the presence of any of the more severe sleep disorders, including sleep apnea and narcolepsy.
The actual sleep test involves a one-night hospital stay. Check-in is usually around 9 p.m. and since the tests are conducted while sleeping - by way of monitoring brain wave activity - it is possible to leave the hospital by 7 a.m. Eye activity, heart rate, airflow from the mouth and nose, chest and abdomen movement, oxygen levels in the blood, body position and muscle movements are also monitored - all with the use of patches and belts – thus no pain is involved.
Following the sleep study, treatment regimens are suggested which can include use of oral appliances; in more extreme cases - surgery; but more commonly, lifestyle changes such as avoiding alcohol and no smoking, are recommended.
One such oral appliance, often used for treatment of sleep apnea, is known as a C-PAP machine. Nasal continuous positive airway pressure (C-PAP) is applied, through the use of a tabletop machine, by way of a mask that fits over the patient’s nose and mouth while sleeping. It pushes air through the airway at a pressure high enough to keep the airway open during sleep – resulting in deep, uninterrupted sleep.
POSSIBLE LIFESTYLE CHANGES
Those affected by sleep disorders should eat a low-fat diet. It is best to eat protein in the middle of the day, due to their energy enhancing properties, and save complex carbohydrates, which tend to relax and promote sleepiness, for the evening. Avoid alcohol and sugar because their stimulating effects are fleeting. Strive to get some physical exercise every day to get the blood pumping. Try taking a 45-minute nap in the early afternoon to help ward off sleepiness. Keep the home and office brightly lit with either natural sunlight or overhead lighting to suppress drowsiness.
SUPPLEMENTS FOR SLEEP DISORDERS
As research of sleep disorders continue, a number of helpful supplements have emerged:
- Cayenne (Capsicum minimum) is considered by many to be the strongest stimulant known. It stimulates the blood and the heart, increasing and strengthening the pulse.
- Lecithin powder is one of the main substances that digests cholesterol in the human body.
- Chromium boosts energy and regulates sugar metabolism.
- Free-Form Amino increases energy levels needed for proper brain function.
- Multivitamins are helpful because all nutrients are needed to balance body functions.
- Flaxseed Oil protects cell membranes.
- Vitamin B Complex boosts metabolism and increases energy levels.
- Vitamin C increases energy.
- Vitamin D is essential for calcium absorption.
- Vitamin E increases circulation and protects heart and brain function.
Click here for more information on sleep disorders, including helpful products.
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