Sleep Awareness -- December 19, 2011 -- Dr. Kelly Carden and Dr. - NewsChannel5.com | Nashville News, Weather & Sports

Sleep Awareness -- December 19, 2011 -- Dr. Kelly Carden and Dr. Brevard Haynes

Brevard Haynes, MD: Sleep Specialist
BAPTIST HOSPITAL

TOPIC: Sleep Awareness
Monday, December 19, 2011
Kelly Carden, MD: Sleep Specialist

News notes provided by webmd.com

Sleep Myths

How much do you know about sleep disorders? Review these statements and learn which are true and which are not.

Health problems have no relation to the amount and quality of a person's sleep.

False: More and more scientific studies are showing correlations between poor quality sleep and/or insufficient sleep with a variety of diseases, including high blood pressure, diabetes, and depression. For example, insufficient sleep can impair the body's ability to use insulin, which can lead to the development of more severe diabetes. Patients with poorly controlled diabetes and sleep apnea have improvement of blood sugar control when treated for sleep apnea. This is also found in patients with high blood pressure and sleep apnea. When the sleep apnea is treated, the blood pressure also improves. In addition, too little sleep may decrease growth hormone secretion, which has been linked to obesity.

Older people need less sleep.

False: The average adult needs a total sleep time of seven to nine hours per day. While sleep patterns usually change as we age, the amount of sleep we generally need does not. Older people may sleep less at night due, in part, to frequent night waking, but their need for sleep is no less than that of younger adults.

Snoring can be harmful.

True: Aside from bothering other people, snoring is not harmful. However, it can be a sign of sleep apnea, a sleep disorder that is associated with significant medical problems such as cardiovascular disease and diabetes. Sleep apnea is characterized by episodes of reduced or no airflow throughout the night. People with sleep apnea may remember waking up frequently during the night gasping for breath.

You can "cheat" on the amount of sleep you get.

False: Sleep experts say that most adults need between seven and nine hours of sleep each night for optimal health. Getting fewer hours of sleep will eventually need to be replenished with additional sleep in the next few nights. Our body does not seem to get used to less sleep than it needs.

Teens need more sleep than adults.

True: Teens need at least 8.5 to 9.25 hours of sleep each night, compared to an average of seven to nine hours each night for most adults. The internal biological clocks of teenagers can keep them awake later in the evening and can interfere with waking up in the morning.

Insomnia is characterized only by difficulty falling asleep.

False: One or more of the following four symptoms are usually associated with insomnia:

• Difficulty falling asleep.
• Waking up too early and not being able to get back to sleep.
• Frequent awakenings.
• Waking up feeling unrefreshed.

Daytime sleepiness means a person is not getting enough sleep.

False: While excessive daytime sleepiness often occurs if you don't get enough sleep, it can also occur even after a good night's sleep. Such sleepiness can be a sign of an underlying medical condition or sleep disorder such as narcolepsy or sleep apnea.

Your brain rests during sleep.

False: The body rests during sleep, not the brain. The brain remains active, gets recharged, and still controls many body functions including breathing during sleep.

If you wake up in the middle of the night and can't fall back to sleep you should get out of bed and do something.

True: If you wake up in the night and can't fall back to sleep within about 15-20 minutes, get out of bed and do something relaxing. Do not sit in bed and watch the clock. Experts recommend going into another room to read or listen to music. Return to bed only when you feel tired.

Getting too little sleep may impact weight.

True: How much a person sleeps at night can impact their weight. This is because the amount of sleep a person gets can affect certain hormones, specifically the hormones leptin and ghrelin, that affect appetite. Leptin and ghrelin work in a kind of "checks and balances" system to control feelings of hunger and fullness. Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full. When you don't get enough sleep, it drives leptin levels down, which means you don't feel as satisfied after you eat, and increases ghrelin levels, stimulating your appetite so you want more food. The two combined can set the stage for overeating, which in turn may lead to weight gain.

Are You Getting Enough Sleep?

The amount of sleep a person needs depends on many factors, including age. For example, in general:

• Infants require about 16 hours a day
• Teenagers need about 9 hours on average
• Most adults need 7 to 8 hours a night for the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day
• Women in the first 3 months of pregnancy often need several more hours of sleep than usual

However, experts say that if you feel drowsy during the day, even during boring activities, you haven't had enough sleep.

Sleep Deprivation Debits

The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a "sleep debt," which is much like being overdrawn at a bank. Eventually, your body will demand that the debt be repaid. We don't seem to adapt to getting less sleep than we need, while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

Consequences of Too Little Sleep

Too little sleep may cause:

• Memory problems
• Depression
• A weakening of your immune system, increasing your chance of becoming sick
• Increase in perception of pain

The Dangers of Sleep Deprivation

Many studies make it clear that sleep deprivation is dangerous. Sleep-deprived people who are tested by using a driving simulator or by performing a hand-eye coordination task perform as badly as or worse than those who are intoxicated.

Sleep deprivation also magnifies alcohol's effects on the body, so a fatigued person who drinks will become much more impaired than someone who is well rested.

Driver fatigue is responsible for an estimated 56,000 motor vehicle accidents and 1,500 deaths each year, according to the National Highway Traffic Safety Administration. Since drowsiness is the brain's last step before falling asleep, driving while drowsy can -- and often does -- lead to disaster. Caffeine and other stimulants cannot overcome the effects of severe sleep deprivation.

The National Sleep Foundation says that if you: 

• have trouble keeping your eyes focused
• can't stop yawning
• can't remember driving the last few miles

you are probably too drowsy to drive safely.

What Are the Symptoms of Sleep Disorders?

Insomnia

Insomnia is itself often a symptom of other problems. Typical patterns of insomnia include the inability to fall asleep or stay asleep at night, waking up earlier than usual, and daytime fatigue. Most people with insomnia don't fall asleep in inappropriate situations, like driving. If this does occur, it may signal that a medical disorder (such as sleep apnea) is the cause of insomnia.

Sleep Apnea

Excessive daytime sleepiness is the primary symptom. Some people will deny sleepiness but feel fatigued. Other symptoms are snoring, snorting, and gasping sounds when you sleep -- often first noticed by a sleeping partner. Restless or unrefreshing sleep is also typical, as are headaches in the morning.

Narcolepsy

Excessive sleepiness during the day, alleviated by naps, is a symptom of narcolepsy. Dreaming during naps and experiencing dream-like hallucinations as you fall asleep are also warning signs. Loss of muscle control (called cataplexy) that occurs with emotion, such as laughing or anger, and the inability to move as you're going to sleep or waking up (called sleep paralysis) are also symptoms.

Restless Leg Syndrome

The primary warning sign is the irresistible urge to move your legs shortly after you get into bed, in the middle of the night after awakening, or even when wide awake during the day. It usually feels better if you get up to walk around or rub your leg. "Creepy-crawly" or twitching feeling in your calves, feet, thighs, or arms are symptoms of restless leg syndrome -- the sensations of discomfort can be quite varied. Kicking or twitching leg movements during sleep, and sometimes while awake, may be warning signs.

Call Your Doctor If:

• Your sleep does not improve with self-help techniques, such as establishing good sleep hygiene, cutting down on caffeine, exercising, and using relaxation techniques.
• You think your sleep problems may be related to an underlying condition, such as depression or heart failure.
• You snore loudly or make snorting or gasping noises while you sleep -- or your partner observes these things while you're asleep.
• You fall asleep doing normal activities, such as talking or driving.
• You regularly feel unrefreshed on awakening and are constantly fatigued. Sleep disorders are among the many possible causes for fatigue.
• You suspect your medication is causing your sleep problems.

What Is Insomnia: Symptoms and Causes

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

• Difficulty falling asleep
• Waking up often during the night and having trouble going back to sleep
• Waking up too early in the morning
• Feeling tired upon waking

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

• Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
• Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

Acute vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Treatment for Insomnia

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see below). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting medications can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.

Sleep Apnea 

Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times.

There are two types of sleep apnea:

• Obstructive sleep apnea (OSA): The more common of the two forms of apnea, it is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep.
• Central sleep apnea : Unlike OSA, the airway is not blocked but the brain fails to signal the muscles to breathe due to instability in the respiratory control center.

Am I at Risk for Sleep Apnea?

Sleep apnea can affect anyone at any age, even children. However, risk factors for sleep apnea include:

• Male gender
• Being overweight
• Being over the age of forty
• Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
• Having larger tonsils
• Having a family history of sleep apnea

What Are the Effects of Sleep Apnea?

If left untreated, sleep apnea can result in a growing number of health problems including:

• Hypertension
• Stroke
• Heart failure, irregular heart beats, and heart attacks

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, as well as academic underachievement in children and adolescents.

Sleep Apnea Treatments

Sleep apnea treatments range from conservative measures -- such as losing weight if you are overweight or changing sleep positions -- to surgery.

Behavioral Modifications for Sleep Apnea

In mild cases of sleep apnea, conservative therapy may be all that is needed. Conservative approaches include:

• Losing weight
• Avoiding alcohol and sleeping pills
• Changing sleep positions to promote regular breathing
• Stop smoking. Smoking can increase the swelling in the upper airway which may worsen both snoring and apnea.
• Avoid sleeping on your back

Continuous Positive Airway Pressure (CPAP)

Continuous positive airway pressure -- also called CPAP -- is a treatment in which a mask is worn over the nose and/or mouth while you sleep. The mask is hooked up to a machine that delivers a continuous flow of air into the nostrils. The positive pressure from air flowing into the nostrils helps keep the airways open so that breathing is not impaired. CPAP is considered by many experts to be the most effective treatment for sleep apnea.

Sleep Apnea and Dental Devices

Dental devices can be made that help keep the airway open during sleep. Such devices can be specifically designed by dentists with special expertise in treating sleep apnea.

Other Treatment Options for Sleep Apnea

There are minimally invasive office procedures -- such as the pillar palatal implant, somnoplasty, and injection snoreplasty -- that are designed to reduce and stiffen the soft tissue of the soft palate. While these procedures have been effective in treating snoring, their long-term efficacy in treating apnea has not yet been determined.

10 Tips FOR BETTER Sleep

We all have trouble sleeping from time to time. But you can make it easier to get a good night's sleep every night with these simple steps.

• Cut caffeine. Simply put, caffeine can keep you awake. It can stay in your body longer than you might think – the effects of caffeine can take as long as eight hours to wear off. So if you drink a cup of coffee in the afternoon and are still tossing at night, caffeine might be the reason. Cutting out caffeine at least four to six hours before bedtime can help you fall asleep easier.
• Avoid alcohol as a sleep aid. Alcohol may initially help you fall asleep, but it also causes disturbances in sleep resulting in less restful sleep. An alcohol drink before bedtime may make it more likely that you will wake up during the night.
• Relax before bedtime. Stress not only makes you miserable, it wreaks havoc on your sleep. Develop some kind of pre-sleep ritual to break the connection between all the day's stress and bedtime. These rituals can be as short as 10 minutes or as long as an hour.

Some people find relief in making a list of all the stressors of the day, along with a plan to deal with them this can act as "closure" to the day. Combining this with a period of relaxation perhaps by reading something light, meditating, aromatherapy, light stretching, or taking a hot bath can also help you get better sleep. And don't look at the clock! That "tick-tock" will just tick you off.

• Exercise at the right time for you. Regular exercise can help you get a good night's sleep. The timing and intensity of exercise seems to play a key role in its effects on sleep. If you are the type of person who gets energized or becomes more alert after exercise, it may be best not to exercise in the evening. Regular exercise in the morning even can help relieve insomnia, according to a study.
• Keep your bedroom quiet, dark, and comfortable. For many people, even the slightest noise or light can disturb sleep like the purring of a cat or the light from your laptop or TV. Use earplugs, window blinds or curtains, and an electric blanket or air conditioner everything possible to create an ideal sleep environment. And don't use the overhead light if you need to get up at night; use a small night-light instead. Ideal room temperatures for sleeping are between 68 and 72 degrees Fahrenheit. Temperatures above 75 or below about 54 can disrupt sleep.
• Eat right, sleep tight. Try not to go to bed hungry, but avoid heavy meals before bedtime. An over-full belly can keep you up. Some foods can help, though. Milk contains tryptophan, which is a sleep-promoting substance. Other foods that may help promote sleep include tuna, halibut, pumpkin, artichokes, avocados, almonds, eggs, bok choy, peaches, walnuts, apricots, oats, asparagus, potatoes, buckwheat, and bananas.

Also, try not to drink fluids after 8 p.m. This can keep you from having to get up to use the bathroom during the night.

• Restrict nicotine. Having a smoke before bed -- although it feels relaxing actually puts a stimulant into your bloodstream. The effects of nicotine are similar to those of caffeine. Nicotine can keep you up and awaken you at night. It should be avoided particularly near bedtime and if you wake up in the middle of the night.
• Avoid napping. Napping can only make matters worse if you usually have problems falling asleep. If you do nap, keep it short. A brief 15-20-minute snooze about eight hours after you get up in the morning can actually be rejuvenating.
• Keep pets off the bed. Does your pet sleep with you? This, too, may cause you to awaken during the night, either from allergies or pet movements. Fido and Fluffy might be better off on the floor than on your sheets.
• Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, you can end up associating the bed with distracting activities that could make it difficult for you to fall asleep.