by Daniel Cosgrove, MD
Sleep, or lying in bed trying to sleep, is an investment of your time, and you should get a good return on that investment.
Quality sleep is restorative, and makes all the other hours in the day more pleasant and effective. Without quality sleep, your personality changes. You become less focused as concentration decreases. Many people become short-tempered and irritable. You simply do not perform as well.
If you’re sleepy or tired all the time do not dismiss this as proof that you’re working hard and have to push through it. If it is due to non-restorative sleep, you’re fighting a losing battle. More caffeine is not the answer.
INSOMNIA: WHAT IS IT AND DO YOU HAVE IT?
Trouble relaxing and getting to sleep, waking up after a few hours and staying awake, and waking up too early and be unable to get back to sleep – are the three major types of insomnia. They are associated with different causes and may require different treatments.
If you have a quiet dark safe place, and make time for adequate sleep, yet still suffer from chronic insomnia, you must deal with it. Sometimes insomnia is the result of an underlying condition that requires treatment.
Insomnia can be treated, and it often does not require medication. Since insomnia is often due to stress, targeting stress and allowing or teaching one’s body to relax is often effective. Medispas that have sleep centers (see below) can be a wonderful place to get treated. Spa therapies, water treatments or massage, can be very relaxing and promote the right state of mind to get to sleep easily.
Some people are determined to work harder to sleep and avoid any medication or natural remedies in a pill. But an effective pill – one that preserves sleep quality and does not leave you sedated in the morning – is a huge improvement over lying awake for half the night. And to make the point again, insomnia is not just a restless or unpleasant night, it diminishes overall health and daytime energy.
Alcohol is well known to worsen insomnia. It may help you fall asleep initially but alcohol has been associated with waking after about three hours with inability to get right back to sleep. The initial treatment for insomnia is Sleep Hygiene
REM, NON-REM AND RESTORATIVE SLEEP
Sleep scientists now describe ‘sleep architecture’ in which there is REM and non-REM sleep, and non REM has four stages of sleep. REM refers to ‘rapid eye movement’ and it happens while dreaming. In stages 3 and 4 of non-REM, there is no dreaming, and the EEG, the tracing of electrical activity of the brainwaves, displays a slow sine wave. The neurons of the cortex are turning off and just briefly relight to keep going but there is minimal electrical activity. It is during the slow wave non-REM sleep that your brain secretes human growth hormone (HGH) and serious neurophysiologic recharging activities are going on.
The non-REM recharges the body. Dreaming (REM sleep) recharges the mind. Every day thousands of bits of new information are sent to the brain. These have to be processed and prioritized. Some of the older medications used to improve sleep may decrease REM sleep, and so they might not be as helpful as they seem.
Restorative sleep contains both REM and this important slow-wave non-REM sleep. Some people are not getting it because of loud noises, a snoring partner, anxiety and insomnia, or sleep apnea. With most of these causes, the people know that their sleep is poor. If you might be one of those people, the first step toward improving your health is to recognize that restorative sleep empowers you, and the lack of it drains your energy and can change your personality. Poor sleep affects your waking hours; it affects your whole life. You can now get motivated to get to bed earlier, or create a dark and quiet environment, or find ways to diminish anxiety so you don’t carry it to bed with you.
OBSTRUCTIVE SLEEP APNEA (OSA)
You might imagine that if a person is not sleeping well, he or she would be the first to know it. Yet most people who have obstructive sleep apnea (OSA) don’t even know they have a problem, except they might have daytime sleepiness. OSA is an important disease that affects more than energy. Those with OSA have a much higher incidence of strokes and heart attacks.
Sleep apnea is a syndrome in which one literally pauses in breathing due to a temporary collapse of the trachea. In sleep apnea, the person starts to get into deeper sleep, and this very relaxation permits the collapse of the airway. Arousal signals are sent to the brain: ‘wake up, you are suffocating!’ and the person arouses into a lighter sleep, takes a couple of deep breaths, and then drifts into deeper sleep only to have the pattern repeat. These people are sleep deprived, yet they will tell you they have no insomnia at all: they usually fall asleep very quickly, and they don’t remember anything until morning. Most (but not all) sleep apnea victims snore so others will testify that they sawed logs all night. Yet they lack restorative sleep.
The typical person that suffers from OSA is an obese man or a man with a big neck (over 17 inches). His wife complains about snoring, but upon questioning, she admits that he seems to pause in breathing, which can be disconcerting, if not downright scary. OSA can occur in skinny people and women can have it too.
Losing weight and sleeping on one’s side may help in some mild cases of OSA. Severe sleep apnea requires medical treatment. Continuous positive airway pressure (CPAP) is the most common way to treat OSA in adults. CPAP provides a gentle and steady flow of air through a mask that is worn over the nose. This keeps the airway open and prevents pauses in breathing as you sleep.
Tell your doctor if you snore loudly and are often tired during the day. He may refer you to a sleep specialist to find out if you have sleep apnea. Often these doctors order a ‘sleep study.’
Medical spas that offer a comprehensive ‘sleep study’ called polysomnography may provide the most pleasant way to get a complete sleep assessment. Several leaders in medical spa healthcare, including Canyon Ranch (Tucson, AZ and Lenox, MA), Pritikin Longevity Center and Spa (FL), and our own WellMax Center for Preventive Medicine at the La Quinta Resort and Club™ offer complete sleep studies. At WellMax, for example, a physician would meet with you and discuss your sleep issues in detail. Then you could spend the night in a comfortable room, but 17 leads monitor breathing patterns, brain waves, leg movements, and how much oxygen is in your blood, all without needles or invasive methods. The results allow the physician to identify and specifically address any issues that affect sleep. Sleep apnea is just one of many.
Restless Leg Syndrome is another under diagnosed problem. Patients often simply describe trouble getting to sleep. They interpret the fact that it is hard to lie still as ‘tossing and turning’ when in fact it is a treatable neurological condition. It is very often due to iron deficiency. For patients that have trouble getting to sleep, especially if they suspect they might be iron deficient (as many menstruating women are), replenishing the body’s iron stores leads to more energy and better sleep…which leads to even more energy and health!
HOW TRAVEL DISRUPTS SLEEP AND WHAT YOU CAN DO ABOUT IT
Even after you decide to give sleep time its due, if you travel, time zone changes can take their toll on restorative sleep. Have you ever flown to Europe, where it is, for example, eight hours later than California (PST)? After an exhausting day of travel, you arrive at what should be 11pm at night, so you can soon sleep, but instead everyone is chipper, the sun is bright: ‘Good morning!’ If you try to sleep then, many hotels and inns are bustling during the day and sleeping well is not easy.
Even if you never use sleeping pills at home, travel across several time zones may be one time that it is really justified. In the example above, I would take Provigil about the time I arrived in Europe in their morning. Provigil is a prescription medication for ‘awakeness’ that has a much safer profile than amphetamines. I would enjoy the day there, then go to bed early, about 9 pm, take Ambien or Lunesta, then wake up in the morning there rested and on their schedule. On that next night, I would probably take nothing (after a busy day in Europe!) but I could just take melatonin, to help convince my brain it is time to sleep. Melatonin, which can be purchased over-the-counter, is found naturally in our brains and helps regulate circadian sleep cycles. It is safe, and for many people it is effective for inducing sleep, especially when the brain’s circadian cycle needs adjustment.
Natural sleeping aids
Another ‘natural’ sleeping pill is 5HT or 5-hydroxytryptophan. It is a precursor to tryptophan, an amino acid that sedates. It has not been ‘proven’ effective, but it is safe and many people claim it works for them. You may have heard that Kava Kava is good for sleep. It can be toxic and it should be avoided.
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Dr. Cosgrove is the Medical Director at WellMax Sleep Center in Palm Springs, California