Is coronasomnia wrecking your sleep?

Columbia Icefields (Dr. Noorali Bharwani)
Columbia Icefields (Dr. Noorali Bharwani)

Some sleep experts have coined a word “coronasomnia” to describe sleep problems related to stress caused by the COVID-19 pandemic. Coronasomnia is real and widespread. More people than ever are fighting a serious loss of sleep. It is affecting all age groups.

Sleep researchers are normally focused on primary sleep disorders such as sleep apnea, narcolepsy, or periodic limb movement disorder. But stresses of daily life can affect even healthy sleep.

Over the years scientists have known that psychological stress can have strong effect on normal sleep pattern. But it is not easy to define stress.

Stress can encompass all kinds of stimuli of varying amounts and duration. It can be physical stress or psychological stress or social stress. It can be acute or chronic, and high intensity versus low intensity stress. It is possible that different types of stressors may bring with them different impacts on sleep.

Sleep problems and ADHD (attention deficit hyperactivity disorder) are tightly interwoven. Plus, comorbid psychiatric disorders like anxiety and depression can cause or aggravate sleep problems. ADHD medications can cause insomnia. ADHD symptoms and the first-line interventions to treat those symptoms both elevate an individual’s risk for poor sleep.

Ask yourself what has produced unprecedented changes in your life to keep you awake at night. For many people, COVID-19 has generated significant stress, anxiety, depression and worries about health, social isolation, employment, finances as well as the challenge of combining work and family obligations and uncertainty about the future.

Are you putting on weight? Poor sleep can lead to weight gain, which causes problems like reflux that keep you awake. Lack of sleep can lead to depression, high blood pressure to higher risks for heart attack or stroke. Stress can make us more vulnerable to COVID-19, and knowing that creates more worries and more insomnia and more binge eating.

Whatever may be the cause of your sleep problem there are things you can do to help you get a good night’s sleep. Here are some examples.

  1. Try cognitive behavioral therapy for insomnia. A sleep therapist can help you replace thoughts and behaviors that hurt your sleep with new behaviors and thinking that will help you sleep well.
  2. Have an exercise schedule during the day that will help you relax. Include yoga and meditation in your schedule. Have a physical trainer show you the right technique and encourage you to keep you going.
  3. Do not watch TV in the bedroom. Do not bring your laptop to bed. Life will go on without these distractions.
  4. Find time to spend outdoors in the sun. It helps to keep our circadian rhythms in pattern so we produce melatonin at night, not during the day.
  5. Don’t go to bed hungry. Don’t eat late in the night. You want your body to shut down all metabolic activity and digest your food before going to bed. Avoid nicotine, caffeine and alcohol in the evenings.
  6. Daytime naps can be good if they are limited to 30-minutes or less. Longer naps will keep you awake at night.
  7. If your partner is a snorer then he or she has to get some expert advice. This can be investigated and managed.
  8. Taking sleeping pills can be useful for short term use but it has risks involved for long term use. Different types of sleep medications affect the brain and the body in different ways. All sleep medications have side effects – most commonly causing people to feel drowsy, dizzy, mentally less sharp, or unsteady the next day. More rarely, people taking sleep medications have reported sleepwalking, hallucinations, memory lapses, and odd behavior, such as eating or driving while asleep. With most medications, long-term use can be habit-forming and stopping the drugs can lead to a rebound effect, where insomnia actually gets worse. Do not take sleeping pills without medical advice. Researchers have estimated people taking sleeping pills were as likely to be in a car crash as those driving with a blood alcohol level over the legal limit.

There is nothing new in this advice. It is not rocket science. What we need is discipline and perseverance. The end result can be a satisfactory night with good sleep. So, I wish you a good night’s sleep tonight and every night. Take care and be safe.

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Risks and benefits of using melatonin for a good night’s sleep.

Happy Halloween (Dr. Noorali Bharwani)
Happy Halloween (Dr. Noorali Bharwani)

Sleep is important for mind, body, and mood. We spend roughly a third of our lives sleeping.

A poll conducted by the University of Michigan in 2017 showed nearly half of the adults between ages 65 and 80 said they often have trouble sleeping. Many of these individuals regularly seek sleep aids.

Insufficient sleep (insomnia) has been linked to an increased risk of falls, collisions, cognitive decline, and dementia. It can increase your risk of cardiovascular problems, obesity, and even cancer. It can drain your energy and affect your work performance and quality of life.

How much sleep do you need? That varies from person to person, but most adults need seven to eight hours a night. Does melatonin help to have a good night’s sleep?

Melatonin is synthesized and secreted by the pineal gland in the brain. Melatonin levels are regulated by exposure to light. Levels peak around 2 a.m. at concentrations 10 to 100 times daytime levels.

Melatonin regulates the body’s sleep cycle. It plays an important role in initiating and maintaining sleep. Natural melatonin levels slowly drop with age. Some older adults make very small amounts of it or none at all.

Melatonin balance may be disrupted if you are in a different time zone or doing shift work. Clinical trials suggest melatonin can reduce the time it takes to fall asleep, increase total sleep time and improve quality of sleep.

One study found a relatively low dose of melatonin (0.3 mg) was enough to improve nighttime sleep in older adults without drowsiness the next day. Studies have shown melatonin increases sleep time by 12.8 minutes and increased sleep efficiency by about three per cent. Is this good enough? The clinical significance of this is unclear. There is no consensus among experts regarding the use and benefits of melatonin for insomnia.

In spite of that in the U.S., sales have increased by more than 500 per cent between 2003 and 2014, and where melatonin is the second most popular natural product used by children.

Very small amounts of it are found in foods such as meats, grains, fruits, and vegetables. You can also buy it as a supplement. Melatonin supplements generally have fewer side effects than do many prescription sleep drugs. They do not produce dependence or hangover effect.

Side effects of melatonin are few but may include daytime sleepiness and tiredness on waking. Headaches, nausea and dizziness also can occur. You should avoid activities that require alertness, such as driving, for five hours after taking melatonin. These pills can also undermine the effectiveness of blood pressure drugs and diabetes medication. Do not start taking melatonin without consulting your doctor. Do not use melatonin if you have an autoimmune disease.

If you do decide to take melatonin, choose commercial supplements produced in a lab. Melatonin supplements made from animal sources may contain contaminants. Melatonin should only be taken in its man-made form (myhealth.alberta.ca).

Know what you are buying. Make sure to look for the “USP verified” label. This means product is accurately labeled and free of harmful substances (Consumer Reports February 18, 2017).

People commonly use melatonin for sleep disorders, such as insomnia and jet lag. Evidence that melatonin supplements can treat sleep disorders is shaky, and over-the-counter melatonin has been banned for years in the United Kingdom, European Union, Japan, and Australia.

Melatonin is the only human hormone available in Canada without a prescription.

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Heavy Snoring Can Be A Danger Sign

Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)
Mount Kidd, Kananaskis Golf Course (Dr. Noorali Bharwani)

Do you have sleep problem that leaves you chronically fatigued, sleepy and irritable?

If yes then you may have disorders like narcolepsy, snoring or sleep apnea.

Narcolepsy is a neurological disorder that affects the control of sleep and wakefulness. People with narcolepsy experience excessive daytime sleepiness and intermittent, uncontrollable episodes of falling asleep during the daytime. These sudden sleep attacks may occur during any type of activity at any time of the day.

Snoring is rough rattling noise made on breathing in during sleep by vibration of the soft palate and the uvula.

Snoring is believed to occur in 30 per cent of women and over 40 per cent of men. It can be potentially serious health hazard. Many people may not think of snoring as a sign of something potentially serious, and not everyone who snores has obstructive sleep apnea.

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night’s sleep.

Obstructive sleep apnea is more common form that occurs when throat muscles relax and block your airway during sleep and cause snoring. The other two are central sleep apnea and complex sleep apnea syndrome.

Obstructive sleep apnea can seriously affect your health. High blood pressure, heart attack, heart failure and stroke top the list. It can affect your heart rhythms. It can lower your blood pressure, lower your oxygen level and lead to heart attack and death.

If you are a chronic snorer and your partner observes that you make a snorting, choking or gasping sound then you have a problem.

It is time to discuss your symptoms with your doctor and get a referral to a sleep specialist. You will undergo tests to confirm the diagnosis. The tests involve overnight monitoring of your breathing and other body functions during sleep. The test is called nocturnal polysomnography.

If you have obstructive sleep apnea, your doctor may refer you to an ear, nose and throat specialist to rule out any blockage in your nose or throat. An evaluation by a cardiologist may be necessary.

How to manage obstructive sleep apnea?

Guidelines (2014) from the American College of Physicians (ACP) emphasize lifestyle modifications – especially weight loss. Though the guidelines do not offer any radical treatment updates, they do reinforce the effectiveness of tried and true therapies.

Breathing devices are still best for treating obstructive sleep apnea. Continuous positive airway pressure (CPAP) works well. It is the first line of treatment. It has to be used during sleep. It relieves symptoms but does not cure the problem.

Oral appliances are useful. They are worn only during sleep. Research shows that oral appliance therapy is an effective treatment option. But does not cure the problem.

Surgery is the last option to be used if all else fails. There are many different types of surgery for sleep apnea and snoring. Surgery will not fix everything. You may need to continue using CPAP even when surgery successfully reduces the severity of sleep apnea.

Remember, surgery can have side effects and surgery alone will not fix all your problems. Discuss your options, long-term outcome and side effects of treatment with your specialist before going for surgery.

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A Dangerous Trio – Snoring, Sleep Apnoea and High Blood Pressure

Keep smiling, it makes people wonder what you are upto! (Dr. Noorali Bharwani)
Keep smiling, it makes people wonder what you are upto! (Dr. Noorali Bharwani)

Reports indicate nearly eight in 10 married couples say their partner has a sleep problem, like snoring, insomnia, or incessant tossing and turning. Sleep difficulties force their partners into separate sleeping quarters. More than 20 per cent say they are too sleepy for sex.

You can blame this on too much work, stress, caffeine, nicotine, alcohol, 24-hour cable TV, the Internet and email.

Lack of sleep has consequences like increased blood pressure that raises the risk of heart attacks and stroke. Diabetes and obesity have also been linked with chronic sleep loss. People who do not get enough sleep are more than twice as likely to die of heart disease.

To stay awake people tend to eat more and that means they put on weight. They smoke more and drink too much coffee and alcohol. That means they are prone to motor vehicle collisions. They hurt themselves and hurt others.

For optimal health it is important for adults to consistently sleep around seven hours each night. When we sleep, the body rests and restores its energy levels. A good night’s sleep will help us cope with stress, solve problems and help us recover from illness.

If you have sleep problem then seek help. There are many ways to help diagnose and treat sleep disorders including snoring. Your family doctor can refer you to a sleep clinic.

We know heart disease is the leading cause of death in advanced industrialized countries, and stroke is also a leading cause of death and disability.

American Heart Association wants you to know that the evidence is very strong for the relationship between sleep apnoea and hypertension and cardiovascular disease generally. If you are a snorer and have sleep apnoea then get proper treatment.

In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnoea, characterized by five to 15 episodes per hour; moderate sleep apnoea, defined by 15 to 30 per hour; or severe sleep apnoea, meaning more than 30 each hour.

A sleep clinic can get you started with investigations and treatment known as continuous positive airway pressure (CPAP). The CPAP device involves wearing a mask while sleeping. It keeps the breathing passages open and oxygen flowing. It can yield fast results. Blood pressure comes down quickly. This improves your prognosis.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!