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Trouble sleeping can impact your health
Mari Adachi, MD, who recently joined the Backus Hospital staff, is board certified in internal medicine/pulmonary disease and specializes in sleep disorders. She did her internship, residency and a fellowship at Beth Israel Medical Center in New York and attended Kanazawa University School of Medicine in Japan. HealthE*Connections interviewed Dr. Adachi about sleep issues and how they can affect overall health.
Question: What types of health issues can be caused by or exacerbated by sleep problems?
Answer: When you don’t get enough sleep, you feel tired, fatigued and more emotionally unstable. In the long run, it can cause problems with blood pressure and diabetes control. The health concerns depend on the reasons why you are not getting enough sleep. For example, if you have obstructive sleep apnea, that can certainly cause blood pressure problems, even stroke and heart attacks. If you are not getting a good night’s sleep, feel tired, or sleep excessively, you should ask your general practitioner about it. Keep a sleep log to determine what your sleep patterns are and bring it in to your doctor. Your doctor will be able to determine whether you need further evaluation with a sleep study or if you require a referral to a sleep specialist.
Q: What happens at the Backus Sleep Center?
A: Patients are monitored in the sleep lab overnight; we monitor brain waves, heart rate, oxygenation, lower extremity muscle activity and respiratory patterns to see if they have sleep-related breathing disorder or periodic limb movements. Insomnia patients usually do not require this sleep study, however if another sleep disorder is suspected, the patient may need one (According to the National Center for Sleep Disorders Research at the National Institutes of Health, about 30-40 percent of adults say they have some symptoms of insomnia within a given year, and about 10-15 percent of adults say they have chronic insomnia.). This test is indicated for certain patients with excessive daytime sleepiness to assess objective sleepiness and exclude narcolepsy (Narcolepsy is a neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. The main features of narcolepsy are excessive daytime sleepiness and cataplexy, when muscular weakness occurs in a type of seizure, according to the National Sleep Foundation.).
Q: More than 18 million American adults suffer from sleep apnea, according to the National Sleep Foundation. Obstructive sleep apnea is when breathing is briefly and repeatedly interrupted during sleep, because the muscles in the back of the throat are not able to keep the throat open. This can cause fragmented sleep and lowered levels of oxygen in the blood, which can cause hypertension, heart disease and mood and memory problems. What are some of the signs of sleep apnea?
A: Loud snoring is one indicator you may have sleep apnea. Also, if your sleeping partner witnesses irregular breathing or if you wake up choking or out of breath, you should talk with your doctor about further evaluation. Obesity and large neck size (more than 17 ½ inches) are the risk factors for sleep apnea. Other indicators include:
- Daytime sleepiness.
- Sore throat or dry mouth on waking.
- Headache on waking.
Q: More and more people work odd shifts, including police, doctors, nurses, hospital staff, casino workers and others. What do you recommend for them to make sure they are getting enough sleep?
A: Try to keep the same sleep schedule seven days a week. I know it can be tough to do if you have children or social obligations, but it is better not to alter your schedule too much. If your shift switches a lot, it can be hard to cope with the changes, but try to get some extra sleep when you are changing shifts, and keep 48 to 72 hours between switching from a late shift to an early shift to adjust.
Q: What do you recommend for people who have trouble sleeping?
A: It is important to practice good sleep hygiene. If you have trouble falling asleep, there are some steps you can take to improve your sleep habits.
- Keep your room dark and minimize noise (i.e. turn off the television).
- Keep the temperature cooler – it is better to sleep in a cool room than one that is too warm.
- Avoid big meals close to bedtime.
- Avoid alcohol close to bedtime; it may cause you to wake up in the middle of the night.
- Avoid caffeine close to bedtime.
- Avoid smoking near bedtime.
- Don’t exercise too close to bedtime. Exercising in the morning or at least six hours before sleeping is important, it will help you sleep deeper and better. However, exercising too close to bedtime can keep you awake.
Q: After trying these techniques, if you are still having trouble sleeping, what types of medications are available and are they addictive?
A: There are newer prescription sleep aids, such as zolpidem (Ambien) and eszopiclone (Lunesta), that have less sedative effects, respiratory effects or next-day drowsiness. There is also less concern with dependence with these newer agents. However, these medications do potentially cause side effects, and therefore if a patient is able to minimize their use, that would be optimal.
For more information about sleep issues, go to www.sleepfoundation.org
