Sleep and Health

Sleeping Well to Live Well

Sleeping well is the first step to living well. Eliminating or reducing sleep problems will improve both your health and well-being. There are many factors that can affect your sleep. These include such things as:

• Medical illness
• Stress
• Other psychological problems

The quality of your sleep may even be affected by your surroundings. A barking dog, a lumpy mattress, or a snoring spouse can all keep you from sleeping well. An erratic work schedule or frequent travel may also disturb your normal sleep pattern.

A sleep disorder may also prevent you from getting the sleep that you need to feel alert and well rested. Do you need an alarm clock to wake up in the morning? Do you find it hard to get out of bed? Do you wake up feeling irritable or stressed? Do you often feel tired during the day? Having trouble sleeping or feeling tired much of the time are signs that you may have a sleep disorder.

Common and effective treatments are available for most sleep problems. But the first step is to realize that a problem exists. The second step is to discover the cause of the problem. Then the cause can be treated.

There are common factors that play a role in most sleep disturbances. Understanding these factors can help you overcome a sleep problem. This will lead to better sleep and a healthier life.

Lifestyle Factors

What are your lifestyle and exercise habits?

Many people know that regular exercise can improve sleep. But did you know that you should avoid exercise within two hours of going to bed? Exercising close to bedtime can boost your level of alertness. This will have a negative effect on your sleep. Studies show that exercising four to six hours before going to bed is best for your sleep. This will help you fall asleep and stay asleep.

What are your eating and drinking habits?

1. Drinking alcohol may help you fall asleep at first. But in the end it will disrupt your sleep. It causes you to wake up more often during the night.

2. Having caffeine too close to your bedtime may also disrupt your sleep. About half of the caffeine you consume at 7 pm is still in your body at 11 pm. Keep in mind that caffeine is found in many foods, drinks, and medications. Avoid all caffeine within four to six hours of your bedtime.

3. The use of tobacco before going to bed can affect your sleep. The nicotine in tobacco is a stimulant and can keep you awake. Avoid all of the following before bedtime:

• Cigarettes, cigars, and pipes
• Chewing tobacco
• Smokeless tobacco

4. Eating heavy or spicy foods before bed can cause heartburn and disturb your sleep.

5. Hunger from an empty stomach may keep you from falling asleep. It may also wake you later in the night. Have a light, healthy snack before going to bed. A good choice would be milk, yogurt, crackers, or cereal.

6. Some people find that foods with tryptophan help them feel sleepy. Tryptophan is a natural amino acid. The brain converts it to serotonin. Serotonin is a chemical that promotes sleep. Foods containing tryptophan include the following:

• Dairy products
• Bananas
• Turkey
• Yogurt
• Whole-grain crackers
• Peanut butter

7. The need to urinate may wake you up in the middle of the night. It takes about 90 minutes for the body to process liquids that you drink. This means that you should limit your intake of fluids for at least 90 minutes before going to bed.

Environmental Factors

Have there been any recent changes in your sleep environment?

Changes in your living situation or bedroom environment can lead to sleep problems. This should be considered when trying to find the cause of your sleep trouble. For example, did you just move into a new home? Are you sleeping in a new room? Are you sleeping on a new pillow or mattress? Has your bed partner changed? Is your bed partner snoring more? Has he or she been coughing, kicking, or more restless? Is your bedroom too cold, too hot, or too humid?

Common environmental problems are easy to resolve once they are found. If noise is a problem, then there are many types of earplugs that should help. They can be made of foam rubber, wax, or molded putty. White noise machines produce a steady sound of rushing air. They can be used to help mask disturbing noises with a more relaxing sound. Your schedule may require you to sleep during the day. Daylight coming into your room can prevent you from sleeping well. You can use blackout curtains to help block the unwanted sunlight.

Children and pets can also affect your sleep. Is your child crawling into your bed in the middle of the night or early in the morning? Do you have pets that like to climb into your bed, bark, or make other noises while you sleep? In both cases, it may be hard for you to go back to sleep once you are awakened. Steps should be taken to help limit the occurrence of these disruptions.

Shift Work and Jet Lag

Working a night shift or rotating shift can cause ongoing sleep problems. It requires you to sleep when your body clock signals you to be up and about. These signals are called circadian rhythms. It is especially hard for people who must rotate shifts on a regular basis. This may include the following professions: [t1]

• Doctors
• Firefighters
• Flight attendants
• Nurses
• Policemen

Jet lag occurs when a flight quickly takes you across many time zones. Like shift work, it causes your body to have problems sleeping. Your body clock is not set to the time of day in the new time zone. The following factors may worsen jet lag:

• Fatigue from sleep deprivation during or before the flight
• Broken sleep after arriving in the new time zone
• Dehydration from a lack of fluids during a long flight

Common Medications that May Disturb Sleep

Many medications can disturb your sleep in a mild or severe manner. These are often used to treat common medical problems. They may affect you by doing any of the following:

• Keeping you from falling asleep
• Waking you up during the night
• Causing you to sleep for a shorter length of time

Inhaled and oral drugs are used to treat common breathing disorders. These breathing problems include the following:

• Asthma
• Chronic bronchitis
• Emphysema

These drugs may contain steroids and a compound called "theophylline." They act as stimulants and can keep you awake at night. Some heart medications can produce insomnia and nightmares. Arthritis medications may contain either aspirin or a similar agent. They can irritate the stomach and cause abdominal pain at night. They can also cause heartburn. This is likely to result in broken sleep. Some antidepressants can lead to insomnia. Others may produce daytime sleepiness.

Many "over-the-counter" drugs can be purchased without a prescription. They are found on the shelves of your local drugstore. People are often unaware of the side effects that these drugs can cause. Many of them have adverse effects on your sleep and daytime alertness. Examples of common medications that can disturb your sleep include the following:

• Nasal decongestants
• Aspirin-containing preparations
• Pain relievers with caffeine
• Cold and allergy medications containing an antihistamine

You may suspect that a medication you are taking is affecting your sleep. But you should never stop taking a prescription drug without first talking to your doctor. He or she can decide how to help you sleep better. Changing your dose or your medication may be a proper solution. But you should not try to solve this problem on your own.

Sleep Problems Due to Common Psychiatric Disorders

Insomnia is a common sleep problem for people who suffer from depression. They often wake up early in the morning. Then they are unable to go back to sleep. They may also find it hard to fall asleep or stay asleep. Depression can also cause you to feel very sleepy during the day. It may produce an overall sense of fatigue.

Anxiety may also cause insomnia. It can range from mild to severe. Unlike depression, it does not affect sleep in a uniform way. A sleep problem will tend to occur whenever the feelings of anxiety increase. The nature of the specific cause does not matter. Many people who suffer from anxiety disorders are unable to sleep well when away from home. This can make it very hard to travel.

Stress is one of the most common causes of short-term sleep disturbances. The sleep problem tends to go away as soon as the stressful situation is resolved. Common sources of stress include all of the following:

• School
• Work
• Family or marital problems
• Illness
• The loss of a loved one

Medical Problems that May Interfere with Sleep

Many chronic medical conditions have symptoms that occur or worsen during sleep. They can wake you up many times during the night. This will cause you to be sleepy during the day. Safe and effective treatments exist to help control medical problems that disturb sleep. These conditions can lead to serious health problems if they are not treated. Treating them also tends to ease the related sleep disturbances. In some cases, you may need to be referred to a sleep specialist. He or she can detect the source of your sleep problem and determine the best treatment option. The following medical conditions are likely to disturb your sleep: [t2]

Benign prostatic hypertrophy (BPH) is very common in older men. This is when they have an enlarged prostate gland. It makes it hard for them to empty their bladders. The result is a frequent need to urinate. This causes men to wake up often during the night. They will then be very tired the next day.

Breathing disorders may also disrupt your sleep. Asthma sometimes flares up as you sleep. Chronic obstructive lung disease can also wake you up during the night. This includes chronic bronchitis and emphysema. They involve coughing and shortness of breath. Mild cases of these breathing disorders may only affect the quality of your sleep. They will not fully wake you up. But severe cases can wake you from your sleep struggling for breath.

Chronic Fatigue Syndrome (CFS) is a disease that causes severe daytime fatigue. It does not improve with rest. Sleep problems are common in people with CFS. There is still no cure for this chronic and disabling disease. Studies have shown that practicing the habits of good sleep hygiene can help. A regular exercise program may also ease the symptoms.

Fibromyalgia, also called fibrositis, involves pain in the muscles and tendons. This can keep you from falling asleep or staying asleep.

Gastroesophageal (acid) reflux is also known as "heartburn." Common signs include coughing or burning pains in the lower chest. It can also disturb your sleep by waking you up during the night.

Heart muscle weakness can cause a shortness of breath that develops suddenly during sleep. You will be able to breathe normally when you go to bed at night. But after an hour or more, you will wake up with a severe shortness of breath. This condition tends to be a result of having either a heart attack or ongoing high blood pressure.

Pain can also disrupt sleep. Pain may be sudden or ongoing. Any of the following painful conditions can disturb your sleep:

• Arthritis
• Back pain
• Carpal tunnel syndrome
• Headaches (especially migraines or cluster headaches)
• Tempero-mandibular-joint disorder (TMJ)

Snoring and obstructive sleep apnea (OSA) can have a severe impact on how well you sleep. The long-term effects of OSA can also be dangerous. Loud and frequent snoring is a primary warning sign of OSA. The actual sound of snoring is more likely to disturb the sleep of a bed partner. He or she may choose to wear ear plugs or sleep in a separate room. A person who snores may be unaware of having a sleep problem. But snoring is very serious when it is a sign of OSA.

OSA occurs when your throat muscles relax as you sleep. This leads to a narrowing and closure of the airway. Air is unable to pass into and out of the lungs. These pauses in breathing may last for periods of 10 to 20 seconds or more. Then you briefly wake up with a loud choking or snorting sound. You are able to breathe normally until your muscles relax again. This process may occur hundreds of times in a night. OSA lowers the level of oxygen in your blood. It also raises your risk of heart attack, high blood pressure, and stroke. Most people with OSA remain undiagnosed. They don't realize how many times they stop breathing and wake up during the night. They tend to rise in the morning feeling unrefreshed even after a full night of sleep. They may also be very sleepy during the day. Be sure to talk to your doctor is you have any of the signs of OSA.

Hormonal Factors

Hormonal changes are likely to affect a woman's sleep as she ages. Estimates show that at least 40% of women have trouble sleeping at some point in their lives. This is true of only 30% of men. A woman's sleep can be mildly or severely disrupted by the natural processes of her body. This includes the following causes:

• Menstrual cycle - cramps, headache, etc.
• Pregnancy - especially in the third trimester
• Menopause - hot flashes/flushes, excessive sweating

The effects of these changes in the body may be made worse by the increasing demands faced by women today. These demands make it harder for women to give their bodies the care, and sleep, that they need. Pressure can arise in all of the following situations:

• Being a single parent
• Balancing a career with a family
• Caring for aging parents

Women are less likely to develop obstructive sleep apnea (OSA) prior to menopause. This is most likely a positive effect of estrogen. After menopause, the rate of OSA in women increases sharply.

Melatonin

Melatonin is a natural hormone that is produced by your body. It plays a role in telling the body and brain when it is time to sleep. Some older people with insomnia may have lower levels of melatonin. Melatonin supplements may be useful for treating some sleep problems. But the effects of using melatonin have not been well studied. There are known risks involved in using it. It can worsen some common medical conditions. Melatonin should not be seen as a cure for insomnia. Be sure to consult your doctor before using melatonin.

The Sleep Quiz

Read the statements below. True or False.

1. I feel sleepy during the day, even when I get a good night's sleep.  True  False
2. I get very irritable when I can't sleep. True  False
3. I often wake up at night and have trouble falling back to sleep. True  False
4. It usually takes me a long time to fall asleep. True  False
5. I often wake up very early and can't go back to sleep. True  False
6. I feel an uncomfortable/restless sensation in my legs at night. [t3]  True  False
7. My legs often move or jerk during the night. True  False
8. I sometimes wake up gasping for breath. True  False
9. My bed partner says my snoring keeps her/him from sleeping. True  False
10. I've fallen asleep while driving. True  False 

If you circled "True" more than twice, then you may want to discuss your sleep problem with your doctor.

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[t1]This list of professions was placed in alphabetical order.

[t2]The list of medical conditions in this section were re-arranged so as to be in alphabetical order.

[t3]Questions #6 and #7 were changed in this manner by a member of the AASM Board in Spring 2005 when the Sleep Quiz was evaluated before being placed on the website.