Sleep Disorders Commonly Plague Many People
Everyone, at some time in their lives, has experienced problems with sleep. Insomnia is the most common of the sleep disorders. And, as we have all experienced, insomnia is usually affected by things occurring over the normal course of our lives. For example, feeling stressed, worried, anxious or depressed as a result of life events can have a detrimental effect on the quality of our sleep. Normal healthy sleep is usually in the six to nine-hour range daily and any disturbance in that, such as difficulty falling asleep, mid- cycle awakening or early morning awakening, is generally considered the condition of insomnia.
In addition to this common form of sleep deprivation, as a physician serving in Pinehurst, N.C., I often see sleep regulation problems as a secondary condition. For example, several disorders including major depression, bipolar disorder, anxiety disorders, substance abuse and pain disorders have associated sleep regulation problems. These secondary sleep disorders also respond to purposeful changes in sleep habits, which is called sleep hygiene. There are also medications which help with sleep regulation and should be considered if insomnia becomes a persistent problem.
There are several changes in our sleep habits which will improve the quality of our sleep. These sleep hygiene tips include:
- Establish a sleep schedule. Going to bed and waking up at an established time helps regulate the body’s sleep-wake cycle. The circadian cycle, as this is called, is the brain’s internal clock which regulates the amount of time we are awake and alert, as well as the period of sleep.
- Establish a pre-sleep routine. What you do the hour or two before you go to sleep has major impact on the duration of sleep. Calming activities such as taking a bath, reading a book, watching television or doing relaxation exercises will promote quality sleep. Avoiding stressful, stimulating activities, or work-related activities before going to bed is helpful to your sleep.
- Make the sleep environment conducive to sleep. The room should be cool, dark and quiet. Sometimes white noise such as a fan can help reduce outside noise effects. And the bed should be comfortable. Pillows and mattress preferences should meet your individual needs. If you have children or pets, it is generally not helpful for your sleep quality to have them in bed with you.
- Go to bed when you’re sleepy. Get out of bed if you do not fall asleep in about 15 minutes. If you are not drowsy and do not fall asleep in this interval, it is best to get out of bed and do something relaxing until you become drowsy. “Pillow-pounding” will not help your sleep. Each time you go back to bed, follow the same rule of getting up, if not sleepy, in about 15 minutes.
- Avoid nicotine, caffeine, or alcohol before sleep. The stimulating effects of nicotine or caffeine will impair your ability to fall asleep. In general, do not consume these products for at least three hours before going to bed. And, although alcohol does have a sedation effect, it has a secondary effect after falling asleep that will cause you to awaken early from a deep sleep. Also, all beverages consumed late at night will result in waking up for trips to the bathroom.
- Limit daytime naps. Napping during the day can adversely affect your duration of sleep at night. Limit daytime naps to no more than 10 to 30 minutes when needed. The best time for this is in the early afternoon.
- Have a regular physical activity program. Exercise is a great facilitator of sleep duration. It will help you feel more naturally sleepy at night, help you fall asleep more quickly, and help you stay asleep longer. Be careful not t to exercise too late in the day because the stimulating effects of exercise could make it difficult to go to sleep. Generally, exercise at anytime up to about 6 p.m., will contribute to your feeling sleepy at bedtime.
- Maximize daytime light exposure. Getting exposure to daylight during the daytime has effects on sleep similar to the effects of exercise. Especially if your workplace has limited natural light, it is important to take breaks and be outside in the sunlight. Sunlight has direct effects on the part of our brain that controls the circadian rhythm. This has beneficial effects on alertness during the day as well as on sleep at night.
- Dietary factors effect on sleep. Especially the habit of a heavy meal in the late evening will adversely affect sleep. Generally speaking, it is wise to have dinner at night no later than 6 p.m., to have the least negative effect on sleep. Late meals also contribute to indigestion when you go to bed and can also cause reflux issues.
- Waking up in the middle of the night. This is called “mid-cycle awakening.” If this occurs, the preferred remedy is to get out of bed and stay out of bed until sleepy. You will then have a better chance of getting back to a deeper stage of sleep. If you do not get sleepy again until the early morning, the best way to improve the next night’s sleep is to stay up and start your daytime activities. This obviously requires considerable discipline but will usually result in much deeper sleep the next evening.
- Waking up in the early a.m. This is called “early morning awakening.” If this occurs, the best practice is to get out of bed and start your daytime routine. With this happening, sleep experts do not recommend a nap during the day. If you stay active during the day and do not nap, the likelihood is that the next sleep cycle will improve.
- Use of sleeping pills. With persistent sleep problems, sleeping pills are often prescribed. They are effective in improving the quality of sleep but are best used for short durations. Chronic use of sleeping medicines, especially in the benzodiazepine class (such as Valium, Xanax, Ativan, and Restoril), can result in dependence and actually decrease the quality of your sleep over the long term.
When to Seek Medical Attention for Insomnia
As we have all experienced, the occasional sleepless night is common. As a general rule, if you confront more chronic nightly problems with falling asleep, staying asleep or waking up early, interventions would be appropriate. A pattern of this occurring more than three nights per week for more than two weeks in a row probably warrants evaluation by a medical professional. And, treatment options that have the best outcome include a combination of behavioral interventions such as cognitive behavioral therapy and medication management. Remember that most common insomnia has psychological factors which have solutions and that medication interventions should be short-duration remedies.
If you live in N.C. and are experiencing problems getting a good night’s rest, contact us to set up an appointment!