Common Sleep Issues

Insomnia

Insomnia, which is Latin for “no sleep”, is the inability to fall asleep or remain asleep. Insomnia is also used to  describe the condition of waking up not feeling restored or refreshed. Insomnia is the most common sleep complaint among North Americans. It can be either acute, lasting one to several nights, or chronic, even lasting months to years. When insomnia persists for longer than a month, it is considered chronic. According to the National Center for Sleep Disorders Research at the National Institute of Health, about 30-40% of adults say they have some symptoms of insomnia within a given year, and about 10-15% of adults say they have chronic insomnia. People who have trouble sleeping every night without exception for months or years are fairly rare. More often, people experience chronic-intermittent insomnia, which means difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returns.

Insomnia can be a disorder in its own right, but often it is a symptom of some other disease or condition. Half of all those who have experienced insomnia blame the problem on stress (e.g. exams and paper deadlines) and worry. In the case of stress-induced insomnia, the degree to which sleep is disturbed depends on the severity and duration of the stressful situation. Sometimes this may be a disturbing occurrence like a loss of a loved one, loss of a job, bad mark on an exam, marital relationship issue, or a tragic occurrence. Anticipation of such things as weddings, vacations, or holidays can also disturb sleep and make it difficult to fall asleep or remain asleep. Insomnia can also occur with jet lag, shift work, and other major schedule changes.

If your sleep trouble is confined to difficulty falling asleep, the time you are choosing to go to sleep may not be synchronized with your biological clock. The biological processes that initiate and maintain sleep in humans are active throughout the night. Opposing this sleep tendency, however, is the alerting action of the biological clock that is active throughout the day. When the biological clock is active at your scheduled bedtime, you will have sleep-onset insomnia.

Symptoms

Symptoms of insomnia include:

    • difficulty falling asleep
    • waking up frequently during the night
    • difficulty returning to sleep
    • waking up too early in the morning
    • unrefreshing sleep
    • daytime sleepiness
    • difficulty concentrating
    • irritability

 

Treatment

Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression. Sleep deprivation is not insomnia. It is not actually clear that insomniacs “lose sleep”, particularly when it is primary. Many do not exhibit daytime distress or symptoms.

If you are experiencing difficulty sleeping, consider whether an event or particular stress could be the cause. If so, the problem may resolve in time. If not, and the problem persists for a few weeks or more, or if you experience distress and discomfort as a result of the insomnia, talk to your doctor about your symptoms. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having.

There are a number of approaches to treating insomnia. A health care professional will ask about your sleep experience, your sleep schedule, and your daily routine. A thorough medical history and physical examination may be called for.

Because of the close connection between behaviour and insomnia, behavioural therapy is often part of any treatment for insomnia. This is because people with insomnia may begin to associate certain sleep-related stimuli with being awake. For example, bedtime routines or the bedroom itself may become linked with anxiety for a person who is experiencing insomnia because they dread the thought of another sleepless night.

Relaxation techniques such as yoga, meditation, and guided imagery may be especially helpful in preparing the body to sleep. Exercise done early in the day can also be helpful in reducing stress and promoting deeper sleep.

Coping

Regardless of what’s causing your sleep problems, it is important to establish and maintain healthy sleep habits. Here are some tips that will help you sleep well.

At night:

    • Use the bed and bedroom for sleep and sex only
    • Establish a regular bedtime routine and a regular sleep-wake schedule
    • Do not eat or drink too much close to bedtime
    • Create a sleep-promoting environment that is dark, cool, and comfortable
    • Avoid disturbing noises – consider a bedside fan or white-noise machine to block out any disturbing sounds

During the day:

    • Consume less or no caffeine, particularly late in the day
    • Avoid alcohol and nicotine, especially close to bedtime
    • Exercise, but not within three hours before bedtime
    • Avoid naps, particularly in the late afternoon or evening
    • Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor

 

Snoring

Snoring is noisy breathing during sleep and is a common problem among all ages and genders. Snoring may occur nightly or intermittently, and is usually caused by an obstruction in the nose or throat. There are several factors which facilitate snoring. First, the normal aging process leads to the relaxation of the throat muscles, thus resulting in snoring. Abnormalities of the nose and throat, such as enlarged tonsils or adenoids, nasal polyps, or deviated nasal septum cause exaggerated narrowing of the throat during sleep and thus leading to snoring. Functional abnormalities (e.g. inflammation of the nose and/or throat as may occur during respiratory infection or during allergy season) will result in snoring. Sleep position, such as sleeping on your back, may lead to snoring in come people. Alcohol is a potent muscle relaxant, and its ingestion in the evening will cause snoring. Muscle relaxants taken in the evening may lead to or worsen snoring in some individuals. One of the most important risk factors is obesity, and in particular, having a lot of fatty tissue around the neck.

Symptoms

People who snore make a vibrating, rattling, noisy sound while breathing during sleep. It may be a symptom of sleep apnea. Consult your doctor if you snore and have any of the following symptoms or signs:

    • Excessive daytime sleepiness
    • Morning headaches
    • Recent weight gain
    • Awakening in the morning not feeling rested
    • Awaking at night feeling confused
    • Change in your level of attention, concentration, or memory
    • Observed pauses in breathing during sleep

 

Coping

People who supper mild or occasional snoring ,who wake up feeling refreshed, and function well during the day may first try the following behavioural remedies, before consulting their doctor:

    • Lose weight
    • Avoid tranquilizers, sleeping pills, and antihistamines before bedtime
    • Avoid alcohol for at least four hours, and heavy meals or snacks for three hours before retiring
    • Establish regular sleeping patterns
    • Sleep on your side rather than your back

 

Treatment

Snorers are generally unaware of their snoring, and must rely on the observations of their bed-partners. Some snorers may wake up at night choking and gasping for breath, but this occurs relatively infrequently. If the coping strategies mentioned above did not help you manage your snoring, you may want to consider other treatment options, which include:

    1. Lifestyle modification (i.e. avoidance of risk factors mentioned above, sleep position training if applicable, treatment of allergies if applicable, etc.)
    2. Surgery (generally on the back of the throat and roof of the mouth, or the nose if applicable, using a variety of instruments including scalpel, laser, or microwaves)
    3. Appliances (mainly oral appliances constructed by a dentist experienced in treatment of snoring and sleep apnea, but also other appliances such as nasal dilators)
    4. Sometimes CPAP (a continuous positive airway pressure appliance which blows room air into the back of the throat, thus preventing it from collapse)