PAT McBRIDE TALKS ABOUT INSOMNIA

Pat McBride spoke to the last AWAKE meeting on Oct17th. She reviewed many of the issues surrounding insomnia. As a specialist in the dental treatment of sleep apnea, a board member of the Physicological Dentistry and Medicine Association, and Dental Sleep Medicine Consulting and Practice Management, she noted that Insomina is the most common complaint encountered in the field of sleep medicine. In any one year 1/3 of the adult population reports difficulty in sleeping and about 4% take some sort of sleep medication. Some individuals become distraught from unrealistic expectations as to how much sleep they should achieve. The patterns vary; 1) Prolonged time to fall asleep, 2)Awakening the middle of the night, and 3) early morning awakening.

There are two types of insomnia; primary and secondary.

Primary insomnia means a person is having problems that are not directly associated with any other health condition or issue.

Secondary Insomnia does have multiple causes and can be categorized as:

1. Medical conditions – pulmonary, cardiac, arthritis, gastrointestinal, nervous system
2. Psychiatric – dementia, depression, anxiety, stress
3. Sleep disorders – sleep apnea, sleep disordered breathing, periodic leg movements
4. Psychosocial – retirement, isolation, loneliness, bereavement, lack of physical activity
5. Circadian Rhythm Shifts – age related changes, shift work
6. Can result from other medications, foods, beverages
7. Environmental factors – temperature, noise, light
8. Poor sleep hygiene

Underling conditions must first be treated and stabilized, and if insomnia persists then sleep hygiene, behavioral therapy, counseling, or medications can be used. If no underling cause is identified then insomnia is described as Primary Insomnia. Insomnia is usually intermittent and unpredictable on any given night. It can be transient lasting only a few weeks or it can be chronic and go on for years.

There are daytime consequences of insomnia, such as, excessive drowsiness, impaired job performance, difficulties with concentration, memory, attention, problem solving, vitality, emotional stability, and increased reaction times, depression, absenteeism, auto accidents.

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

*Causes of acute insomnia can include: Significant life stress, job loss or change, death of a loved one, divorce, moving) Illness, Emotional or physical discomfort, Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep. Some medications, Interferences in normal sleep schedule (jet lag or switching from a day to night shift,)

*Causes of chronic insomnia include:
• Depression and/or anxiety
• Chronic stress
• Pain or discomfort at night

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting drugs can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia, because they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful. Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep and beat insomnia.

Here are some tips:
– Try to go to sleep at the same time each night and get up at the same time each morning.
– Try not to take naps during the day, because naps may make you less sleepy at night.
-Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants from falling asleep.
– Alcohol can cause waking in the night and interferes with sleep quality.
– Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.
– Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
-Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
– Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
– Avoid using your bed for anything other than sleep or sex.
– If you can’t fall asleep and don’t feel that is not overly stimulating until you feel sleepy.
– If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.

CPAP CAN IMPROVE YOUR LOOKS

(WebMD News, Sept. 13, 2013)

Treatment for sleep apnea may do more than improve your sleep and health: It could help you look better, according to a new study.

The study included 20 middle-aged sleep apnea patients whose facial appearance was rated before and after they started using a treatment called continuous positive airway pressure (CPAP), which helps keep the airway open by providing a stream of air through a mask that is worn during sleep.

Improvements in the patients’ faces were noted just a few months after they started using CPAP, according to the study published in the Journal of Clinical Sleep Medicine.

These changes included: looking more alert, more youthful, more attractive, having less-puffy foreheads and less-red faces.

The findings need to be confirmed in larger studies, the researchers said. They decided to conduct their study because sleep center staff often noted improvements in patients’ faces after they began using CPAP.

What Are Naps?

By Brandon Peters, M.D.

(Dr. Peters is a neurology-trained sleep medicine specialist who currently practices in Novato, CA and serves as adjunct clinical faculty at Stanford University.)

A nap is a short period of sleep that typically occurs during the day. Children may take frequent naps as their nighttime sleep is less consolidated. As we get older, we do most of our sleeping at night. Nevertheless, we typically have a strong desire to take a nap in the early afternoon.

Reasons to Nap

There are plenty of reasons to get a little extra sleep in the form of a nap. The most obvious reason for a nap is that you simply are not getting enough sleep at night. This may be a temporary inadequacy or a chronic issue. It may be helpful to determine how much sleep you need to see if this is a likely contributor.

There may be other reasons that you have excessive daytime sleepiness and need a little extra sleep in the form of a nap. This could be due to any of the sleep disorders that can cause sleepiness, including sleep apnea, narcolepsy, and insomnia.

Napping Options and Benefits

People will commonly say that they “power nap.” The implication is that a short amount of time spent sleeping (15 to 20 minutes) can revitalize and recharge. Assuming that you are able to fall asleep fairly quickly, you may be expected to enter into the lighter stages of sleep (either stage 1 or stage 2). This can be refreshing, but it may not give you the brain boost you desire.

More prolonged naps seem to have favorable consequences, improving memory and creativity. When naps last 30 to 60 minutes, you are more likely to enter into deep or slow-wave sleep. It is thought that even longer naps (up to 90 minutes or more) can enhance creative problem solving. Studies have consistently shown that naps can improve alertness and motor performance. Naps can furthermore reduce stress and even decrease your risk of heart disease.