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Having Trouble Catching Those Z's?

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IMAGE If you have spent a sleepless night, you know it can make the following day difficult. Most people get less sleep per night than is necessary to stay healthy and alert. However if you have ongoing issues, there is help. By improving your sleep hours, your waking hours should improve as well.

Many Americans suffer with transient or chronic insomnia, or other sleep disorders, such as sleep apnea.

What Are the Symptoms?

The most commonly reported symptoms of insomnia include:

  • Taking a long time to fall asleep at bedtime
  • Difficulty staying asleep, with frequent or early awakening
  • Daytime sleepiness or fatigue
  • 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. Daytime effects of sleep apnea may be more persistent. Symptoms last longer than those of occasional insomnia. Sleep apnea is associated with several health complications, such as high blood pressure, cardiovascular diseases, kidney disease, and early death.

What Are the Causes?

Physical Causes

Sleep apnea, often associated with obesity, is caused by periodic airway collapse. This may be linked to enlarged tonsils or weak throat muscles. 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 disease (GERD), and chronic pain.

Taking certain medications can also increase the risk of insomnia. Some examples include those used to treat high blood pressure, depression, Parkinson's disease, and thyroid disorders.

Psychological Causes

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 substance abuse (including alcohol).

Lifestyle Causes

Caffeine, alcohol, and smoking are common culprits in sleep disturbance as well. Even the habit of having a nightcap to relax in the evening can impair your sleep. Though it may help you fall asleep faster, alcohol actually interferes with restorative sleep phases later in the night.

The same can be said for nicotine. How long you can go without a smoke after you wake up? If you cannot go more than 30 minutes, you may awaken at night with nicotine withdrawal.

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?

Diagnosis of sleep problems are identified based on how you answer certain questions. Questions include:

  • 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 for further testing.

What Are the Treatments?

There are a range of treatments for insomnia. If you are diagnosed with sleep apnea, your doctor may recommend treatments like losing excess weight, using a continuous positive airway pressure (CPAP) machine, or undergoing surgery if other treatments fail.

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, medication 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.

  • American Academy of Sleep Medicine

    http://www.aasmnet.org

  • National Sleep Foundation

    http://www.sleepfoundation.org

  • Better Sleep Council of Canada

    http://www.bettersleep.ca

  • Canadian Sleep Society

    http://www.css-scs.ca

  • 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 July 25, 2014. Accessed March 6, 2015.

  • Insomnia. National Sleep Foundation website. Available at: http://sleepfoundation.org/sleep-disorders-problems/insomnia. Accessed March 6, 2015.

  • Insomnia in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 8, 2014. Accessed March 6, 2015.

  • Obstructive sleep apnea (OSA). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 19, 2015. Accessed March 6, 2015.

  • Phillips CL, Cistulli PA. Obstructive sleep apnea and hypertension: Epidemiology, mechanisms and treatment effects. Minerva Med. 2006;97(4):299-312.

  • Shamsuzzaman AS, Gersh BJ, et al. Obstructive sleep apnea: Implications for cardiac and vascular disease. JAMA. 2003;290(14):1906-1914.

  • Somers VK, White DP, et al. Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement. Circulation. 2008;118(10):1080-1111.

  • Somnoplasty. Department of Otolaryngology Head and Neck Surgery, Columbia University website. Available at: http://www.entcolumbia.org/somnop.html. Accessed March 6, 2015.

  • Wolf J, Lewicka J, et al. Obstructive sleep apnea: An update on mechanisms and cardiovascular consequences. Nutr Metab Cardiovasc Dis. 2007;17(3):233-240.

  • 8/11/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Molnar MZ, Mucsi I, Novak M, et al. Association of incident obstructive sleep apnoea with outcomes in a large cohort of US veterans. Thorax. 2015 Jun 2 [Epub ahead of print].