Can't Sleep? Is Your House In Order?

By Louise Stroman, RPSGT

Ms. Stroman is Supervisor of The Sleep Disorder Laboratory at Lourdes Hospital in upstate NY since 1990. She is a sleep activist and a member of AASM, Narcolepsy Network, Restless Leg Foundation and a Board Member of the American Lung Association of Mid NY. She is also a Coordinator of A.W.A.K.E. and editor of the A.W.A.K.E. newsletter, with formation of Narcolepsy, Restless Legs, and Women's issues in Sleep Disorders groups in progress. Ms. Stroman is a lecturer and has appeared on numerous radio and television programs promoting sleep issues.

According to the finding of the National Commission Report on Sleep Disorders (reported to Congress in 1992) "40 million Americans are chronically ill with various sleep disorders." Along with that it was found that "insomnia affects 20-40% of the adult population. 9% or more claim to have severe, chronic insomnia, a condition often characterized by impaired functioning, frequent illness and sedative abuse."

With this said, let us remember this was in 1992. Since then, the population (both professional and the lay community) have been exposed to more and more information about sleep disorders and they continue to ask questions of their care givers. It is quite likely that this figure has been inflated since then.

Anyone who works in the field of Sleep Disorders Medicine will tell you that one of the most prevalent question they encounter has to do with "How can I improve my sleep? I am always tired." As most of you know, there are many things that can affect your sleep, or contribute to the lack of it. I would like to deal with 5 specific points.

• 5 Major points of Sleep Hygiene
• 5 Changes that affect Sleep Hygiene
• How do the seasons affect us?
• What can you do?
• Contact your Physician

There are many different things that can be done to improve the routine you have before going to bed and when you rise in the morning. However, for this purpose, we will use the 5 Points of Sleep Hygiene.

5 Points of Sleep Hygiene

• Rise and sleep times remain constant
• Quiet, darkened comfortable room and bedclothes
• No consumption of alcohol or caffeinated product (or at least reduced consumption)
• Leave day to day stressors outside the door
• There are 2 purposes for the bedroom - sleep and intimacy

5 Changes That Affect Sleep Hygiene Can Be:

Environment - such as a change of residence, a change of sleep arrangements to a different room (with or without a bed partner). The body becomes used to certain signals and will react to changes in these.

Disease states and/or pharmacological changes - Sometimes due to chronic or acute pain, therapies involved in disease state, and the effect and interaction of drugs, your sleep may be disturbed. Mental and emotional states brought on by crises in your life, or certain medications will also cause changes in sleep patterns.

Life changes - such as job related changes (positive or negative), shift work, work related travel (sometimes time zone changes), an addition to the family, or the death of a family member will always have some effect on how you sleep and when you are able to sleep.

Age/Gender - can be extremely varied as to whether you are an infant, child, adolescent, adult or older adult. You might ask yourself the question: Are these changes being addressed adequately by the medical community? Are disease states, pharmacological states and chronic pain for males vs. females addressed differently? For example, did you know it has been seen in studies that females maintain deep sleep longer into old age than do males? There are many differences between male and female anatomy and physiology, mental states, dealing with stress, etc. It is becoming increasingly apparent that these differences need to be addressed.

Emotional changes - have a great deal to do with how you sleep (or don't). I am sure that we have all experienced a family crisis, financial problems or other things of that nature. That type of thing usually resolves itself with time. But, sometimes there is an actual clinical depression that must be dealt with by a medical professional. One of the first things asked of an individual suffering from clinical depression is " are you sleeping?"

The seasons affect many of us in different ways. The most commonly known disorder is Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder is most prevalent in sun challenged areas (such as the northeast US). In Spring, the days begin to grow longer and we set our clocks ahead by one hour. Even though most of us enjoy that extra hour of sunshine, it quite often knocks out our internal clocks for a while. Along with that, we have Spring allergies, which will cause problems for some folks in relationship to their breathing, or the medications they take for relief.

During the Summer months the days are longer still, and the weather changes to a higher heat and humidity index. If you sleep with your windows open, quite often you are assaulted with environmental noise, pollen etc. Americans like to take vacations in warm weather. Quite often that change (for a week or two) will throw off our internal rhythms.

Fall and Winter comes along with all its accompanying allergies, cold dry weather (which sometimes causes irritation to respiratory membranes), illness and infections, less physical activity, holiday activity, energy level drops and increased consumption of comfort food.

So, you ask -

What can I do?

The following ten points will help you to put your house in order - so to speak!

Get Up the Same Time Everyday and Go to Sleep the Same Time Every Night

This will send a signal to your brain that it is time for rest or awakening. Even if you only get an hour of sleep that night, continue on the same schedule. You will find that your body will eventually pick up on this signal, and you will have established a routine that it can respond to.

Establish Specific Routines Before Going To Sleep

This is another way to "send a signal" that it is time to relax and sleep. An example of this might be a warm bath, light snack and setting your alarm clock before retiring. If done every night, in the same order, your body will become accustomed to this ritual and know it is time to sleep.

Hunger

Hunger may disturb sleep and a light snack may be helpful. Foods that have a high concentration of L-tryptophan, which is an amino acid that is conductive to sleep, would be good candidates for snacks. These foods include: milk, eggs, tuna fish, cottage cheese, soy beans, cashews, chicken and turkey (especially dark meat). Also, the last heavy meal of the day should be 2-4 hours before sleep.

Caffeine and Alcohol

Caffeine in the evening disturbs sleep, even in those who feel it does not. All coffee (even decaffeinated), most teas and cola drinks, Mountain Dew soda contain caffeine. Alcohol has long been the traditional "nightcap". However, even one drink can affect your sleep and fragment it due to the sedating effect of the drink wearing off in 2-3 hours (depending how quickly your body metabolizes it).

Sleeping Pills and Medications to Promote Sleep

An occasional sleeping pill may be of some benefit, but their chronic use is ineffective in most people affected with insomnia. Try to avoid sleeping pills, or use them conservatively. Most doctors avoid prescribing sleeping pills for periods longer than three weeks. Do not drink alcohol while taking sleeping pills.

Exercise

Regular exercise tends to be an effective aid for sleeping, partly due to the release of energy and partly due to the release of mental tensions. It can be something as simple as walking around the block everyday (or in the mall) and does not need to be rigorous. You should confine rigorous exercise to early hours, at least six hours before bedtime, and do mild exercise - such as simple stretching or walking - at least four hours before bedtime.

Slow Down

As the evening unfolds, you should unwind. Avoid exciting or stimulating activities, especially in the hours just before bedtime. Try to set aside worries or concerns over the upcoming day's events before you go into the bedroom. Remember that the bedroom is a place of rest and intimacy and everything else should be left outside the door. Keeping a regular schedule, such as chores, meals, medications and other activities will help keep your inner clock running smoothly.

Lights and Television

Try to avoid lights after you have gone to bed. There is some indication that the brain is very sensitive to light (and the strobe light type effect from TV) and that light tells the brain that it is time to wake up. Appropriate timing of exposure to light and dark may help you organize your sleep schedule by sending the right signals to your brain.

Falling Asleep

You've been lying in bed for 10-20 minutes and sleep is no where near. People who become tense and frustrated because they cannot sleep should not try harder to fall asleep. Don't stay there getting more and more frustrated, get up and do something in a dimly lit area that is either relaxing or boring. Don't watch the clock - turn it around so that you cannot see the face. Don't watch TV because of the stimulating effect on your brain.

The Need to Sleep

You should sleep as much as needed to feel refreshed and healthy, but no more. Going to bed because of boredom or to escape an unpleasant situation can sometimes lead to a situation where your circadian rhythms are disrupted and you find yourself experiencing difficulties at night.

In ongoing studies, it has been noted that children and adolescents have distinctly different patterns of sleep and circadian rhythm needs than adults do. Unlike adults, teenagers quite often need to "make up sleep" because of the demands of their schedule. Adolescents' bodies are constantly changing. Unfortunately, many of the school systems across the country have not caught up with the research that shows the differences in wake times and learning curves between children and teens.

Many teens hold down jobs that quite often exceed 20 hrs. /week, are involved in extra-curricular activities inside and outside of school, are carrying heavy academic leads and try to juggle social lives. Along with that is the inevitable change of sleep and wake times that occurs (due to hormonal changes) which finds most teenagers awake until much later than parents would like to see, or sometimes know about.

Contact Your Physician if You:

• Remain unable to fall asleep after a 3-week period of time. Quite often, attacks of Insomnia are temporary in nature and will be gone in a week to ten days.
• Fall asleep, but can't remain asleep for more than an hour at a time. Occasionally we wake up because there is a noise outside, or we need to use the bathroom - this is normal. But, when you are waking up chronically 3 or more times a night, you may want to discuss this with your Physician.
• Sleep at night but constantly feel sleepy during the daytime. Some people experience this and have one of a number of medical problems that may have to do with Sleep Disorders. Speak with your Physician if you are experiencing this.