Expert Tips for Sleep Problems

Everyone occasionally has trouble falling asleep. But when sleeping problems happen several times a night or during the week, it’s time to seek help so you can get some proper shut-eye. Here are common triggers and treatments for insomnia, along with questions to ask your physician. Plus, how smart are you about sleep? Take our quiz to find out… When your morning alarm clock buzzes, do you feel energized – or flattened, like you’ve been wrestling an invisible bear all night? Sleepless nights can do more than take the spring out of your step, doctors say. “Sleep is as important as eating and exercise,” says Michael Decker, Ph.D., associate professor at Georgia State University, College of Health and Human Services, in Atlanta. “It’s one of the cornerstones of good health.” When you don’t get enough, you’ll see results quickly, says Karl Doghramji, M.D., professor of psychology, neurology and medicine and medical director of the Sleep Disorders Center at Thomas Jefferson University in Philadelphia. “You won’t be able to stay awake and perform during the day, and your memory and focus will be affected, as well as your ability to complete tasks.” Over time, the results can become more serious, he says. “Chronic lack of sleep can lead to mood disorders, such as anxiety and depression,” he says. Long-term untreated sleep disorders are linked to medical conditions, including obesity, depression, high blood pressure, cardio-vascular disease and diabetes, he says. What makes this troublesome is that many Americans have sleep disorders and don’t realize it, says Decker. As a visiting scientist for the Centers for Disease Control and Prevention (CDC), he worked with a team that surveyed 6,530 adults in the state of Georgia. The findings: 33% had symptoms of a sleep disorder. And, says Doghramji, “when the question is asked in a broader fashion, as many as 50% of Americans say they have had trouble with sleep at one time or another.” If you’re suffering, read on for the key questions to ask your doctor. What should be my first step in insomnia treatment? The first thing is to learn good sleep practices – called “sleep hygiene,” says Donna Arand, Ph.D., clinical director at the Kettering Hospital Sleep Disorder Center in Dayton, Ohio. “You want to get to the source of the sleeping problems,” she says. “Just developing good sleep habits can help a good percentage of patients who complain about sleep insomnia.” What is sleep hygiene? Before you start treatment, try changing your bedtime habits. These simple changes can improve your sleep dramatically, says Doghramni. To practice good sleep hygiene: * Don’t go to bed unless you’re tired. * If you’re not asleep after 20 minutes, get up and do something else. * Create bedtime rituals — which can be as simple as brushing your teeth and combing your hair before bed. * Keep a regular schedule, going to bed and waking up at the same time each day. * Don’t read, write, watch TV or talk on the phone in bed. * For the six hours before bedtime, avoid alcohol and exercise. * Don’t consume anything with caffeine in the afternoon. * Stop smoking. Nicotine is a stimulant. * Avoid sleep medications. * Keep your room dark, quiet and a little cool. What effect does my diet have on sleep? You’ve probably heard that certain foods– a glass of warm milk, for example – can induce sleepiness. There’s not much evidence to support this, but you can eliminate foods to improve your sleep. “Caffeine and alcohol are two of the most common substances that impact sleep,” Arand says. Caffeine is a stimulant — and even if an afternoon cup of coffee didn’t bother you when you were younger, you’ll probably need to give it up now. That because “we become more sensitive to the effects of caffeine as we age,” Arand explains. She recommends no caffeine after noon. How do hormones change my sleep patterns? Hormones can affect your sleep during two different times in your life: pregnancy and menopause. During pregnancy, the quality of sleep worsens and pregnant women are likely to feel sleepy in the daytime, even after getting a full night’s rest. Also, as many as 25% of women develop restless leg syndrome in pregnancy, according to the of the American Academy of Sleep Medicine (AASM). And 40% develop sleep-related leg cramps. Both these conditions usually go away after delivery. For women in the early stages of menopause, hormonal hot flashes can disrupt their sleep. If a drink after dinner makes me feel sleepy, how can it cause sleep insomnia? Even an occasional drink can be an issue. “Alcohol is initially a depressant,” Arand says. “It slows everything down, relaxes you and can make it easier to fall asleep.” But several hours later, you may find yourself still tired, but wide awake, she says. “When alcohol is metabolized, the brain interprets that as stimulation,” Arand explains. “Your brain will keep you awake for a while, and if you do fall back to sleep, your sleep will be restless and fragmented.” If you do want an occasional drink, stick to one glass with a meal. “Also, drink at least one glass of water with each alcoholic drink,” Arand advises. “This will dilute the effects of the alcohol. If I’m tired, is it OK to take a short daytime nap? “Napping in the afternoon and early evening can really disrupt nighttime sleep,” Decker says. “And, if you feel you need to nap during the day, this may be a sign that you have a sleep disorder.” It’s natural to feel sleepier as the day wears on, he says. “The brain builds up pressure for sleep during the day,” he says. “If you nap, you release that pressure and that can make it difficult to fall asleep later in the evening.” What if I make all these changes and I still can’t sleep? What should my next step be? If you’ve been having trouble falling or staying asleep at night — or staying awake during the day — for several weeks, it’s a good idea to see a sleep specialist, says Doghramji. Only a sleep specialist can determine the exact cause of your sleeping problems. This may require a sleep study (polysomnography), which measures how much and how well you sleep. What’s involved in a sleep study? You’ll be asked to spend the night at a hospital or sleep center, where monitors will track your brain waves, blood oxygen levels, heart and breathing rates, and eye and leg movements during sleep. This information can determine if your sleeping problems are caused by: * A breathing disorder, such as sleep apnea * A limb movement disorder, such as restless leg syndrome * A disorder in your REM (rapid-eye movement) sleep * Unexplained insomnia Your doctor can then tailor your treatment to the cause of your sleep insomnia. How do I find a sleep center or specialist? Your doctor can refer you or there may be one at a large hospital in your area. If not, see the AASM website. What types of insomnia treatment will a sleep specialist recommend? If there's no physical cause for your sleeping problems, a specialist will probably recommend cognitive behavioral therapy (CBT), where you will learn behavioral techniques that help you sleep better. Why is CBT recommended for insomnia? Working with a cognitive behavioral therapist, you’ll gain a deeper understanding of how your lifestyle, stress and daily routine affect the sleep cycle. It’s a good long-term treatment, because “there are no side effects and you can use it whenever your sleeping problems recur,” Arand says. Studies show that CBT is as effective as medication, she says, and has a longer-lasting benefit. A 2001 study, published in the Journal of the American Medical Association (JAMA), looked at 75 adults, and concluded that CBT leads to “significant sleep improvements within six weeks” that lasted through six months of follow-up. “Medications can lose effectiveness over time, because you build up tolerance to them,” she says. A 2009 Canadian study, published in JAMA, compared patients who received CBT alone with another group that combined CBT with medication. Both groups saw significant improvement, but the best results were for patients who began treatment with both medication and CBT and then moved on to therapy alone. Will medication be part of my insomnia treatment? Medication can help by letting you get a good night’s sleep at the beginning of treatment, while you learn sleep hygiene and cognitive behavioral techniques that will help you long-term. “There’s a place for it if you just need a quick treatment while you are working out a long-term treatment plan,” Arand says. What kind of medication might help? There are two types of medications for sleeping problems: Those that help you fall asleep and others that help you stay asleep. Medications that may be prescribed to help you fall asleep include: * Eszopiclone (Lunesta) * Ramelteon (Rozerem) * Triazolam (Halcion) * Zaleplon (Sonata) * Zolpidem (Ambien, Edluar) Medications that help you stay asleep include: * Estazolam * Eszopiclone (Lunesta) * Temazepam (Restoril) * Zolpidem (Ambien CR) What if sleep apnea is the cause of my sleeping problems? Sleep apnea occurs when breathing stops or gets shallow during sleep. These periods last 10-20 seconds, and can occur as many as 30 times an hour. The most common form of sleep apnea is obstructive sleep apnea, caused when the throat muscles relax and block your airway during sleep. Another form is central sleep apnea, when the brain doesn’t send proper signals to control your breathing during sleep. You may not even be aware that your breathing is disrupted, but you may feel excessively drowsy during the day, and when you wake up you may not feel refreshed. Your doctor will discover it when he monitors your heart, lung and blood activity during the overnight sleep study. What health risks are associated with sleep apnea? Untreated sleep apnea puts you at greater risk of cardiovascular disease and stroke, and can cause problems due to excessive daytime fatigue. It can also lead to complications with medications or during surgery. What is the treatment for sleep apnea? Your doctor will tell you to use a machine that delivers continuous positive air pressure (CPAP) through a mask. You may need to work to adjust the mask to get a comfortable fit. There are also several different models of the machine. Most people get good results from this. What if the CPAP mask doesn’t work or is uncomfortable? Don’t give up on treatment, says Dogrhamji. “CPAP is the accepted initial technology,” he says. “About 70%-80% of people are able to use this device. For those still uncomfortable, there are other masks, tubes and delivery systems we can try.” There are also other devices, he says, including the variable/bilevel positive airway pressure (BiPAP), which uses different levels of pressure as you inhale and exhale. And people with an underbite can sometimes get relief from a dental appliance, he says. Some people wear a mouthpiece that opens their airway so they breathe better. “When people treat their disordered breathing, they are astounded by how much better they feel,” says Janet Mullington, Ph.D., associate professor of neurology at Harvard Medical School, in Boston. Is surgery an option? Rarely, surgery is recommended to remove tissue from the throat or correct the position of the jaw. What treatments are available if restless leg syndrome is the cause of my insomnia? Nobody knows what causes restless leg syndrome — a powerful urge to move your legs that can disrupt your sleep. Sometimes following good sleep hygiene practices — exercising regularly, learning relaxation techniques, and cutting out caffeine, tobacco and alcohol — can help. When they don’t, the next step is medication. The two medications approved by the FDA for use in restless leg syndrome, ropinirole (Requip) and pramipexole (Mirapex) are also used to treat involuntary movements of Parkinson’s disease. What lifestyle changes can I make to help my restless leg syndrome? Talk to your doctor about any vitamins or medications you’re taking, because they can influence your condition. Ask your doctor to check your iron, folic acid and vitamin-B levels — but don’t supplement these on your own, as you could worsen your sleeping problems. Also, ask if any medications you are taking could trigger restless leg syndrome. Medications that can worsen the condition include: * Antihistamines, found in over-the-counter allergy, cold and sleep medications * Anti-dizzy and anti-nausea medications, such as Comprazine, Phenergan, and Reglan * Antidepressants, such as Elavil, Prozac, Lexapro and Efflexor * Psychiatric medications, used to treat bipolar disorder and schizophrenia Can natural remedies or herbs solve my sleeping problems? The herb valerian root or the hormone melatonin have a reputation for inducing sleep. “The evidence for the use of valerian root isn’t convincing at this time,” Decker says. “But melatonin can help people fall and stay asleep.” As we age, our body manufactures less melatonin. For some people, it might help to take melatonin 3-4 hours before bedtime, Decker says. But consult your doctor first. Are You Smart About Sleep? Getting a good night's sleep affects every aspect of your day, including your mood and your ability to be productive. And if that doesn't get your attention, listen up: Your sleep habits can even affect the number on the scale. Find out if you're smart about sleep, or if you need to be schooled by the Sandman.