Dr. Kevin Most: Sleep Awareness

Doc Most readies the meds.

Well it is not by mistake that last week was Sleep Awareness week, with the change to daylight savings time the impact of sleep on our health should be understood. The importance of sleep impacts not only our mood but also our immune system, our heart health and many other areas of our health. The study of Sleep medicine has been around for many years but really became popular in the 80”s as more studies came out about the effects of sleep on out health. Before this was studied we thought of sleep only in the terms of insomnia and what can we do about it. Now Sleep and Sleep medicine is a multi-billion dollar industry as we understand more about what we can do to improve our sleep and our health.

Sleep health- Burning the candle from both ends may not be a good idea- late to bed and early to work is not healthy.

Studies over the past 10-15 years have shown us the importance of sleep. We all know how after a bad night’s sleep we feel groggy in the morning and struggle thru the day with our attitude and productivity. The bad night’s sleep actually has a bigger impact than just our attitude.

Studies have shown that poor sleeping patterns can impact your health as much as a good diet and exercise can, yet we do not normally give it the attention it needs.

Health impact of poor sleeping patterns, include
1. Obesity- several studies have shown the link between insufficient sleep and obesity. The tipping point appears to be 6 hours, as those who sleep 6 hours or less are much more likely to be obese than those who average 8 hours of sleep a day. This actually is even noted in babies. Babies who are “short sleepers” are much more likely to develop obesity later in childhood
2. Diabetes- individuals who again have sleep patterns of less than 5-6 hours a night have a greatly increased risk of developing Type 2 diabetes. Improved sleep patterns can actually decrease your risk of diabetes.
3. Heart disease- sleeping less than 6 hours is also associated with a greatly increased risk of coronary artery disease, which is associated as a future predictor of heart attacks
4. Hypertension and stroke also show an increase in individuals with poor sleeping patterns, these are often associated with obstructive sleep apnea.
5. Immune function- sleep deprivation has been shown to decrease the ability to resist infection and thus help fight viral infections ( Steve’s cold that would never go away?) this study showed that individuals who got less than 7 hours of sleep a day were 3 times more likely to develop a cold when compared to others who got 8 hours of sleep and were exposed to the exact same virus.
6. Add all of these up and data has shown that the individuals with poor sleeping patterns and times, will spend on healthcare, have lower productivity, lower day to day wellbeing and ultimately affect life expectancy.

Sleep is important to provide cells and tissues the opportunity to recover from the wear and tear of daily life. Sleep allows us to help repair tissue damage, muscle growth and joint inflammation. To put it simply there is plenty of data to show that having a good sleep pattern and history will not only make you feel better, it will make you more productive, keep you healthier, save money and will increase your life expectancy.

Sleep Apnea-
You probably have all heard of sleep apnea. Would you believe that it is estimated that close to 25 million Americans have sleep apnea and 80% of those cases are undiagnosed. This is a serious medical condition. Let’s take a minute to discuss it and understand what to look for and what to do. Sleep apnea is a sleeping disorder where the patient actually stops breathing while sleeping for 10 seconds or longer. This can occur from 5 to 100 times an hour. The most common type is obstructive sleep apnea, this occurs when the throat muscles relax and actually block the airway. The brain eventually realizes that it needs oxygen and will force the breathing to occur, essentially showing as a gasp for air or loud snoring. This can be a very serious problem and needs to be evaluated.

Symptoms to look for
1. Loud snoring
2. Episodes where you stop breathing
3. Gasping for air during sleep
4. Awakening with a dry mouth
5. Headache in the morning
6. Difficulty staying asleep
7. Excessive daytime sleepiness- this symptom has a threefold greater likelihood of ending up with heart failure
8. Irritability

This condition can lead to heart problems, high blood pressure, diabetes, daytime fatigue and should be evaluated. Studies have shown that individuals can actually die from sleep apnea and the condition may cause individuals to have a life threatening heart rhythm. Discuss with your doctor and perhaps a sleep study will be ordered where your sleep pattern is monitored thru the night. Sleep studies used to be done in a hospital setting, now technology has allowed the initial screening sleep study to be done in the comfort of your home, this test may lead to a more exact test in a hospital setting.

Risk factors for sleep apnea include
1. Obesity
2. Neck circumference- over 17 inches has a high risk
3. Narrow airway, this may be caused by enlarged tonsils
4. Male – men have this 2-3 times more often than females
5. Family history
6. Smoking history
7. Alcohol or sedatives- these relax the muscles and may worsen sleep apnea
8. Nasal congestion

The significant other may identify the symptoms and when coupled with the risk factors, a push for a recommendation to have the individual evaluated should occur. This is one where we need the help of others to push for the diagnosis.

Treatment for Sleep Apnea is often with a machine called CPAP, Continuous Positive Airway Pressure. The machine does exactly as described, it maintains a pressure in your throat so that your airway does not collapse. This machine is used each night while you sleep. CPAP machines used to be loud and bulky. They are now much more quiet, and smaller so use when traveling is easier. The masks are also getting smaller and less bulky. The combo of smaller quieter machines and masks has shown to increase compliance in OSA and will make a health impact in those that use them

Restless leg syndrome-

Although Restless Leg syndrome is not actually a sleep medicine, the symptoms certainly impact many individuals sleep patterns. RLS is a condition that causes an urge to move your legs because of an unpleasant sensation in the legs. This often begins after a resting period is started, often when lying down. The symptoms may resolve or lessens with movement or stretching. The symptoms can happen at any time but occur more at work. This is highly associated with a condition periodic limb movement of sleep, this is a condition which causes your legs to twitch and kick thru the night.

No known cause for Restless Leg Syndrome, which frustrates patients and their significant other as it often will impact their sleep as well. It has been associated with difficulty falling asleep or staying asleep. Physicians have noted in some individuals that Iron deficiency may lead to this, so correcting that may resolve the problem. Other treatments include some of the medications for Parkinson’s, muscle relaxants and some pain medications.

This is a very frustrating disease for many people as we have close to 5 million cases in the US alone.

Better Sleep-

We should discuss the simple things one can do to have a better sleep and sleep pattern. First is the pre sleep routine or what you do before you sleep. That bowl of ice cream, bowl of popcorn or bag of chips may fill a craving but are not a good idea before sleeping. Coffee and other caffeinated drinks should be avoided for many hours prior to sleep. The full stomach can cause problems with reflux and actually may keep you in a more awake state as the body digests the food. The nightcap or drinking alcohol before going to sleep may help you fall asleep but after the alcohol wears off you may be wide awake. Staying away from email and social media before going to bed has been found to be helpful in falling asleep as well, as these will often not be relaxing and may keep you awake. Even TV before bed has been shown to be disruptive, especially TV Binge watching

What can you do in your environment to help you fall asleep, set a routine so your body knows when it is time to sleep,
1.) Keep the bedroom temperature cool, ideal temperatures are between 60-67 degrees.
2.) Consider a warm bath or shower before bed as it will relax you.
3.) Make sure your bedding is comfortable for you. Pillows should be replaced each year and make sure your mattress is of the firmness and consistency that you enjoy.
4.) Although antihistamines may help you fall asleep faster they may negatively impact your sleep pattern
5.) Refrain from caffeinated drinks and minimize alcohol.
6.) No TV immediately at bedtime, or cell phone text or email, etc.
7.) Exercise but well before sleeping, 2-3 hours before.

So what do you do when you can’t sleep and you walk thru Walgreens and see all the bright colored boxes of sleep aids? Well before buying any take the time to discuss it with your doctor, although that quick fix on the shelf may seem appealing discussing your sleep issues with your doctor should always be the first step for your safety and health. Individuals who need these medications may have more serious underlying health conditions that should be discussed with your physician. Individuals who take these medications should make sure they will not interact with any other prescribed medications

These simple things can help you fall asleep and hopefully get a good rest.

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