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Having Trouble Catching Those Z's?
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Having Trouble Catching Those Z's?

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 will 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 who suffer with a sleep problem. 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.

Symptoms of Sleep Disorders

Many adults complain of excessive sleepiness and tiredness during the day, and 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. 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 (silent or symptomatic), acute coronary events, stroke and transient ischemic attacks, cardiac arrhythmia, pulmonary hypertension, and heart failure.

Causes of Sleep Disorders Vary

Sleep problems may stem from a physical problem, a psychological problem or lifestyle patterns.

Physical Causes

Duane Slegel, Ph.D, 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 deprivation. 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, frequent travel, and jet lag. 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 you or your healthcare provider 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 Center, says a diagnostic test called a polysomnogram can help identify the cause of the sleep problem and determine the appropriate treatment.

Treatments Depend on the Source of the Problem

Physical Factors

Treatment for sleep apnea typically involves one of three approaches:

  • Surgical repair of airway or nasal impairment
  • An oral appliance worn over the teeth to open the jaw wider at night
  • Continuous positive airway pressure (CPAP) machine

Dr. Wytrzes adds that laser surgery and somnoplasty are new outpatient procedures geared toward helping those with a snoring problem.

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, chief of the Basic Behavioral & Systems Neuroscience Program and coordinator for sleep research at the National Institute of Mental Health, suggests the following for cases where medical intervention is not required:

  • Relaxation behaviors
  • Regular exercise
  • Regular bedtime and risetime hours
  • Limited alcohol and caffeine consumption
  • Optimization of the bedroom environment to be dark and quiet

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 tired enough to sleep.

What to Do If You Think You Have a Sleep Problem

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 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/

Canadain Sleep Society
http://www.css.to/

References:

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.

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 2007 by Marcin Chwistek, MD

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.


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