Sleep And Health
Sleeping well, living well, for good health

Do you need an alarm clock to wake up in the morning? Do you find it hard to get out of bed or wake up feeling irritable or stressed? Do you often feel tired during the day? If you are having trouble sleeping or are feeling tired and sleepy much of the time, you may have a sleep disorder.

Sleeping well is the first step to living well. That’s why eliminating or reducing sleep problems is so important to your health and well being. There are many factors that can cause sleep problems, such as medical illness, stress, and other psychological problems. The quality of your sleep may even be affected by something in your environment (surrounding) like noise, comfort of bedding, etc. An erratic work schedule or frequent travel may also affect your normal sleep pattern.

These days there are treatments for most sleep problems, but the first step is recognizing that a problem exists. The second step is determining what causes the problem, and the third step is treating the cause.

Lifestyle Factors
What are your personal lifestyle and exercise habits?

We know that regular exercise can improve sleep, but did you know that you should avoid exercise within two hours of going to bed? Exercising that close to bedtime can boost your alertness and have a negative effect on your sleep. Studies have found that exercising between four to six hours before going to bed has the most positive effect on falling, and staying, asleep.

What are your eating and drinking habits?

1) If you drink alcohol, you may not know that it may actually disrupt your sleep. Although alcohol may initially induce sleep, once it wears off, sleep tends to be fragmented.

2) Consuming caffeine four to six hours before your bedtime may also disrupt or fragment your sleep. Approximately half of the caffeine consumed at 7pm remains in the body at 11pm. Keep in mind that caffeine is found in many different foods beverages, and medications.

3) If you smoke (chew tobacco or use snuff) prior to bedtime, the nicotine may affect your sleep because it is a stimulant.

4) Eating heavy or spicy foods just prior to bed can interfere with your sleep by causing heartburn.

5) If the hunger associated with an empty stomach keeps you from sleeping, having a light snack such as milk, yogurt, crackers, or cereal may help.

6) Some people find that foods containing Tryptophan aids in sleep. Tryptophan is a naturally occurring substance, which the brain converts to serotonin (a sleep-inducing chemical). Foods containing Tryptophan include dairy products, bananas, turkey, yogurt, whole grain crackers, and peanut butter.

7) If the need to urinate wakes you up in the middle of the night, you may want to limit your intake of liquids for at least 90 minutes before your bedtime. It takes about 90 minutes for the body to process liquids.

Environmental Factors
Have you noticed any changes in your sleep environment from the point when your sleep problem(s) began?

Changes in your living situation or bedroom environment can lead to sleep problems and should be considered when trying to determine the cause of your sleep trouble. For instance, had you just moved into a new home? A new room? Purchased a new pillow? A new mattress? Has your bed partner changed? Is your bed partner snoring more? Coughing? Kicking? More restless? Is there a temperature-control problem in the bedroom (is it too cold, too hot, or too humid)?

Common environmental problems, once found, are easily resolved. If noise is a problem, there are many types of earplugs as well as white noise machines that may help decrease disturbing noises and provide a more restful sleep. If your sleep schedule has changed and light is affecting your sleep, blackout curtains may eliminate unnecessary sunlight.

Another factor that could affect your sleep is your children or pets. Is your child disrupting your sleep by crawling into your bed in the middle of the night or early in the morning, leaving you unable to fall back to sleep? Do you have pets that like to climb into your bed, bark or make other disturbing noises while you are sleeping? In each of these instances, the source of the problems needs to be discovered before you can make the necessary changes.

Shift Work and Jet Lag
Shift work requires you to sleep when your own biological clock (referred to as circadian rhythm) really wants you to be up and about. This is especially difficult for people who must rotate shifts on a regular basis (like firefighters, flight attendants, nurses, doctors, and police officers). Jet lag, from time zone changes like shift work, causes similar problems, with your biological rhythm getting "out of sync" with the new time. Other things that may worsen jet lag include fatigue (from sleep deprivation during the days before travel), broken sleep after arriving in the new time zone, and dehydration (from long flights and inadequate fluid consumption).

Common Medications that May Disturb Sleep
Many of the medications used to treat common medical problems can cause mild to serious sleep disturbances. Some delay sleep onset, disrupt the continuity of sleep, or decrease the length of a night’s sleep.

Medications used to treat common breathing disorders (like asthma, chronic bronchitis, or emphysema) include inhaled and oral drugs which may contain steroids and thophylline-drugs that can act as stimulants and make it difficult for you to fall and stay asleep. Some heart medications can produce insomnia and nightmares.

Arthritis medications containing aspirin and the similar agents may irritate the stomach and produce nighttime abdominal pain and/or heartburn that results in broken sleep. Some antidepressants can lead to insomnia and others may produce daytime sleepiness.

Many people falsely believe that over-the-counter (without prescription) medications are free of side effects. Nasal decongestants, aspirin-containing preparations, pain relievers with caffeine, and antihistamines are examples of commonly used over-the-counter medications that can have significant adverse effects on sleep and daytime alertness.

In addition to all these concerns about common medications, prescription medications used to treat medical problems should never be stopped suddenly without the advice of your healthcare professional. If you have difficulty sleeping and believe that a medication may be the cause, you should always consult you healthcare professional before stopping the medication.

Sleep Problems Due to Common Psychiatric Disorders
Insomnia and more frequently, early morning awakening, are a common occurrence if you suffer from depression. You may also find it hard to fall or stay asleep. If you have been diagnosed with depressions, or experience depression symptoms, you may sometimes feel excessive daytime sleepiness or an overall sense of fatigue.

Anxiety may also cause mild to sever insomnia. Unlike depression, it does not affect sleep in a common way. In general, an anxious person may have trouble sleeping whenever anxiety increases (regardless of the specific cause). Many people suffering from anxiety disorders have difficulty sleeping away from their homes making travel a great hardship.

Stress is often considered the most common cause of short-term sleep disturbances. The source of stress may include school or work-related pressure, family or marital problems, illness, or the loss of a loved one). Sleep problems caused by these events often disappear after the stressful situation has been resolved.

Medical Problems that May Interfere with Sleep
Many chronic medical conditions have symptoms that occur or worsen during sleep, causing frequent mid-sleep awakenings, eventually causing daytime fatigue. The chronic condition, benign prostatic hypertrophy (BPH), or "enlargement of the prostate," causes the need to urinate frequently, making men awaken often during the night and feel fatigued the following day.

Gastroesophageal (acid) reflux, or common "heartburn," may also cause frequent nighttime awakenings. Burning pains in the lower chest or coughing are heartburn symptoms that can disturb sleep. Following a heart attack or due to a longstanding high blood pressure problem, a person may suffer heart muscle weakness. The first symptom is usually shortness of breath that develops suddenly during sleep. Typically, people with early or mild heart failure will breathe without difficulty upon lying down for the night, only to wake up suddenly an hour or so later with terrible shortness of breath.

Pain can also disrupt sleep. Pain may be sudden or chronic. Any of the following conditions could contribute to poor sleep; back pain, arthritis, carpal tunnel syndrome, tempero-mandibular joint disorder (TMJ), and headaches (especially cluster migraine).

Snoring caused by obstructive sleep apnea (OSA) a medical disorder that occurs only while asleep-can significantly a person’s sleep and lead to long term consequences. People with OSA breathe abnormally during sleep because of how their throat muscles function. Throat muscle relaxation leads to a narrowing and closure that keeps air from passing in and out of the chest, eventually awakening the person, if only briefly. The absence of breathing (called apnea) may occur for periods of 10-20 seconds or more; in some people this occurs hundreds of times a night. Apnea is also accompanied by a fall in the level of oxygen in the blood.

A lowered oxygen supply contributes to the symptoms and long term consequences of OSA. OSA may affect bed partners because the person with OSA snores loudly, has episodes of silence, snorts, or gasps, and usually awakens. This is why bed partners of people with OSA often wear earplugs or sleep in a separate room. The majority of people with OSA are not aware of their breathing trouble or fragmented sleep. They usually just complain of sleep that is not refreshing or of sleepiness during the day.

Asthma may also disrupt sleep because asthma sometimes flares up during sleep. Chronic obstructive lung disease (chronic bronchitis and emphysema) also can fragment sleep because of coughing and trouble breathing (including shortness of breath). Breathing disorders, such as asthma, may be mild, affecting sleep quality but not causing a full arousal from sleep. If severe, however, they may result in a full-blown mid-sleep attack of shortness of breath.

Pain in the muscles and tendons, referred to as fibrositis or fibromyalgia, can also cause difficulty falling asleep. Chronic Fatigue Syndrome, a disease characterized by unrelenting daytime fatigue can interfere with sleep. As yet, there is no cure for this chronic disabling disease but studies have shown that good sleep hygiene combined with a regular exercise program may help some individuals.

Several safe and effective treatments exist for controlling medical problems that lead to sleep disruption. These conditions are common and if not treated can lead to serious health problems. When medical problems disrupt sleep, the disturbance can be effectively controlled by correction of the underlying medical problem. In some cases, referral to a sleep disorder specialist will be necessary in order to establish a diagnosis and guide treatment.

Hormonal Factors
Women are affected by hormonal fluctuations over their lifetime, more so then men. It is estimated that 40% or more women experience trouble sleeping at one point in their lifetime as compared to 30% of men. A woman’s sleep can be mildly or severely disrupted by any or all of the following natural biological processes: menstrual cycle (cramps, headache, etc.), pregnancy (especially third trimester), and menopause (hot flashes/flushes, excessive sweating). Biological changes may be further worsened by the increasing demands of women today single parenting, child-care, and care of aging parents). Women are actually somewhat protected from developing OSA prior to menopause, probably due to the effects of estrogen, but after menopause a sharp increase in the incidence of OSA in females has been reported.

Melatonin is a naturally occurring hormone that helps tell the brain when it is time to sleep. Some older people with insomnia may have lower than normal amounts of melatonin. Melatonin has many other functions and its use can worsen some common medical conditions. Since melatonin does not help all insomniacs and it can potentially produce harm, you should consult you healthcare professional before using melatonin.
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