Tag: sleep

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There are Many Reasons for Insomnia

A woman suffering from insomnia. (iStockphoto/Thinkstock)
A woman suffering from insomnia. (iStockphoto/Thinkstock)

Insomnia is defined as chronic inability to fall asleep or remain asleep for an adequate length of time. It is estimated 10 to 40 per cent of people suffer from some sort of insomnia. This is only an estimate as nobody has yet defined what constitutes normal sleep.

Most adults sleep seven to eight hours a night. Newborns and children may sleep up to 16 hours a day. Older people may sleep only six hours a night. There is no magic number. If you are tired the next day or are yawning all the time then you need more sleep.

The quality of sleep you get is also important. The quality and quantity of sleep depend on many factors like your health, your lifestyle and your environment.

In a survey done in the United States, it was found that many patients with insomnia have other medical problems. Thirty per cent of the patients have depression, 20 per cent have other mental disorders, and 19 per cent have other illnesses. But 31 per cent of the patients have primary insomnia – no medical condition contributing to insomnia. Sometimes insomnia may be the first symptom of depression.

“The prevalence of insomnia has also been reported to be higher in women, women in minority groups, people who are unemployed or separated, lower socioeconomic groups and in those with medical or psychiatric – particularly substance abuse – disorders,” says an article in the Canadian Medical Association Journal.

It is very important you consult your doctor if you have trouble falling asleep or cannot remain asleep for an adequate length of time. The cause of your insomnia could be stress, depression, anxiety, panic attacks, spastic bladder, arthritis, hyperthyroidism, congestive heart failure, obstructive sleep apnea, or lung disease. You may be overindulging in caffeine or alcohol. Or there may some other cause.

Your physician can help you sort some of these problems by recommending regular daytime exercise, avoiding large meals at night, avoiding caffeine, tobacco and alcohol; reducing evening fluid intake; maintaining a consistent wake-up time; avoiding or limiting daytime napping and avoiding bright lights – including television, noise and temperature extremes. In some circumstances he may recommend medications.

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I am no fan of Daylight Saving Time

A man with sleep apnea using a CPAP machine. (iStockphoto)
A man with sleep apnea using a CPAP machine. (iStockphoto)

As a person who believes in getting enough sleep each night, I find Daylight Saving Time (DST) a nuisance. This disturbs my sleep rhythm for the next several months. Then I have to change the clocks again.

If I don’t like this then I can move to Saskatchewan or Hawaii, American Samoa, Guam, Puerto Rico, the Virgin Islands or Arizona where there is no such thing as DST. People are happy there. Having no DST has not ruined their economy.

The question is: Would you like one extra hour of sleep or sunlight?

The idea of DST is to have people up and about during the longer daylight hours, to save energy and increase productivity. In 2005, U.S. Congress and subsequently other countries expanded daylight savings time, by shifting its start to the second Sunday in March and its end to the first Sunday in November.

Has DST increased productivity? Has it improved people’s health and wealth? Have we saved any energy? Are we doing better than people in Saskatchewan or other places where there is no DST?

The DST began in Europe to conserve fuel during World War I. Since then it has gone through several changes. U.S. Congress passed the Uniform Time Act of 1966, which declared that DST be observed from the last Sunday in April to the last Sunday in October. Some exemptions were allowed. This has now changed to March and November.

In recent years several studies have suggested that daylight saving time doesn’t actually save energy – and might even result in a net loss. Studies have found that the practice of DST reduced lighting and electricity consumption in the evening but increased energy use in the dark mornings. So there is no gain as such.

As you may expect there are other studies which do show energy gains. The U.S. Department of Energy asserts that springing forward does save energy. Extended DST saved 1.3 terawatt hours of electricity. That figure suggests that DST reduces annual U.S. electricity consumption by 0.03 per cent and overall energy consumption by 0.02 per cent. While those percentages seem small, they could represent significant savings because of the enormous total energy use.

Does DST affect your health?

DST is supposed to boost your health by encouraging active lifestyles. Advocates of DST say that television watching is substantially reduced and outdoor behaviours like jogging, walking, or going to the park are substantially increased.

But others warn of ill effects. Some studies show that our circadian body clocks – set by light and darkness – never adjust to gaining an “extra” hour of sunlight to the end of the day during DST. This results in drastically decreased productivity, decreased quality of life, and increasing susceptibility to illness. People are generally more tired during the months of DST.

One expert says that one of the reasons why so many people in the developed world are chronically overtired is that they suffer from “social jet lag.” In other words, their optimal circadian sleep periods are out of whack with their actual sleep schedules. Shifting daylight from morning to evening only increases this lag.

A 2008 study in the New England Journal of Medicine concluded that, at least in Sweden, heart attack risks go up in the days just after the spring time change. The most likely explanation to the findings are disturbed sleep and disruption of biological rhythms.

DST clock shifts present other challenges. They complicate timekeeping, and can disrupt meetings, travel, billing, record keeping, medical devices, heavy equipment, etc. Software can often adjust computer clocks automatically, but this can be limited and error-prone, particularly when DST protocols are changed.

I am not sure what the majority of the people think about DST, but I find changing my circadian cycle and my clocks twice a year is annoying, to put it mildly. Anyway, the sun is shining and we have an extra hour to enjoy the evenings. So, lets get out and have fun.

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There Isn’t One Best Treatment for Sleep Apnea

A man with sleep apnea using a CPAP machine. (iStockphoto)
A man with sleep apnea using a CPAP machine. (iStockphoto)

Noorali demonstrating CPAP

There are two main goals to be achieved when it comes to treating sleep apnea. First, to establish adequate ventilation. When you stop breathing your ventilation system stops. Second, to make sure your body gets enough oxygen.

There are three ways to treat the problem. Each treatment method has advantages and disadvantages. The treatment involves behaviour modification, medical treatment and sometimes surgical treatment.

For mild cases of sleep apnea, the treatment often starts with behavioural therapy. Counselling for behavioural changes includes losing weight and avoidance of alcohol, sleeping pills and sedatives. These pills relax throat muscles, contributing to the collapse of the airway at night.

Most patients snore sleeping on their back. These patients should be asked to train themselves to sleep exclusively on their side. One way to do this is by sewing three or four tennis balls at the back of an old shirt. Wear the shirt when you go to bed and you will never sleep again on your back. It will be painful. It works and it is cheap. This can prevent the tongue and palate from falling backwards in the throat and blocking the airway.

The medical management of sleep apnea uses continuous positive airway pressure (CPAP) or dental appliance.

For moderate to severe sleep apnea, the most common treatment is the use of a CPAP. CPAP is delivered through a mask to be worn when a sleep.

CPAP keeps the patient’s airway open during sleep by means of a flow of pressurized air into the throat. The patient wears a plastic facial mask (see picture), which is connected by a flexible tube to a small bedside machine. The CPAP machine generates the required air pressure to keep the patient’s airways open during sleep. The machine can humidify the air and keep it warm.

CPAP therapy is extremely effective in reducing the episodes of apnea. But some patients find it uncomfortable. The mask is not easy to fit your face and it is not easy to sleep with. One study demonstrated 46 per cent of patients used CPAP for more than four hours per night for more than 70 per cent of the observed nights. Others have adapted to CPAP quite nicely. Some studies have shown improved survival in patients who use CPAP.

Oral dental appliance has been promoted as a useful alternative to CPAP. It is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. There are a variety of appliances. The appliances are worn only during sleep and are generally well tolerated. Not all patients have clinically proven response. It is considered as a second line of treatment compared to CPAP.

Surgical treatment for snoring and obstructive sleep apnea has become quite popular. Probably due to the inconvenience of CPAP and oral appliance. Surgery is considered if only other methods fail. Several surgical procedures are available, each one with advantages and disadvantages. These procedures are done by Otolaryngologists (specialists in ear, nose and throat surgeries).

There isn’t one solution to the problem of snoring and obstructive sleep apnea. Weigh your options carefully. Have yourself checked out at a sleep clinic and talk to a specialist in sleep disorders. Until then happy snoring.

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

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Sleep Apnea Disturbs a Good Night’s Sleep

A tired man who did not wake up when someone drew a mustache on his face! (Ulrik Tofte)
A tired man who did not wake up when someone drew a mustache on his face! (Ulrik Tofte)

Now that you are back from your Family Day long weekend, it is time to catch up with your sleep. But if you suffer from sleep apnea then you will never feel rested.

Normally, breathing is regular. Apnea means cessation of breathing. Sleep apnea is a condition that interrupts breathing during sleep.

Sleep apnea may be central – that is due to instability of the feedback system that regulates breathing. Or sleep apnea may be obstructive – due to recurrent obstruction of the upper airway. Or it can be mixed – central followed by obstructive.

Today, we will confine our discussion to obstructive sleep apnea.

A typical individual with obstructive sleep apnea starts snoring shortly after going to sleep. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period during which no breathing is taking place (apnea). The apnea is then interrupted by a loud snort and gasp and the snoring returns to its regular pace. This behaviour may recur repetitively and frequently throughout the night.

Obstructive sleep apnea causes frequent night awakening, feeling of tiredness in the morning, abnormal daytime sleepiness, headaches, memory loss, poor judgement, personality changes and lethargy. It may also raise the blood pressure.

Who suffers from obstructive sleep apnea?

Obstructive sleep apnea affects two percent of women and four percent of men. It is a condition of middle-aged adults.

Contributing factors may include obesity, use of alcohol or sedatives before sleep, anatomically narrowed airways, and massively enlarged tonsils and adenoids. Genetic and environmental factors may also adversely affect airway size. The condition may run in some families.

Diagnosis of sleep apnea is made by sleep study.

Is sleep apnea hazardous to your health?

During periodic breathing, there is a change in the amount of carbon dioxide and oxygen in the blood and this results in irregular heart rhythm, change in the blood pressure and in the autonomic nervous system. Heart failure, heart attack and stroke are likely complications.

Chronic sleep deprivation caused by sleep apnea increases risk for motor vehicle accidents. The accident rate for such patients has been reported to be seven times that of the general driving population.

In 1997, a review article in the British Medical Journal evaluated all studies published between 1966 and 1995 on the association between obstructive sleep apnoea and mortality and morbidity. The authors concluded that there was limited evidence of increased mortality or morbidity in patients with obstructive sleep apnea.

A report published recently in the American Journal of Respiratory and Critical Care Medicine found middle-aged and older men with untreated obstructive sleep apnea have more than double the risk of experiencing a stroke when compared with their counterparts who don’t have obstructive sleep apnea. Among women, an increased stroke risk was observed only among those with severe obstructive sleep apnea.

The paper concludes by saying that it is not known if treating obstructive sleep apnea reduces stroke risk but treatment offers a number of benefits, including greater alertness and less sleepiness in the day and improved concentration and memory.

Next week we will discuss treatment of sleep apnea. Until then sleep well.

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