Everything You Wanted to Know About Sleep but were Too Tired to Ask

© 2014 Dr. Sharon Norling

If you are lying awake at night watching the ceiling while everyone else is in la-la-land you are not alone. Insomnia occurs in all age groups. Sleep is the most basic biological activity. Its purpose is protective and restorative. At age 70 the average person has spent cumulatively 20-25 years asleep!

Problems with falling asleep or daytime sleepiness affect approximately 35 to 40% of the U.S. adult population annually and are a significant cause of morbidity and mortality. It is 1.5 more common in women. The International Classification of Sleep Disorders distinguishes more than 80 different disorders, which can be effectively treated.  One adult out of four complains of insomnia; however only one insomniac out of four has ever complained about it to their practitioner during a visit made for another problem and only one out of twenty has come to discuss specifically the problem of his or her insomnia. Insomnia may be considered an ordinary complaint (after one poor night) or as a chronic disease. Only a few patients with insomnia take a treatment for it and many times they self medicate by taking over the counter products. This leads to an under appreciation and under treatment of sleep disorders, making this group of illnesses a serious health concern.

One aspect concerns the impact of insomnia on daytime alertness and performance. Patients usually complain of an impaired daytime functioning with a feeling of fatigue, sleepiness, irritability, risk of mistakes, difficulty focusing and short term memory loss. Good health and happiness are impossible when we are robbed of sleep for very long.  “Compared to good sleepers, severe insomniacs reported more medical problems, had more physician-office visits, were hospitalized twice as often, and used more medication. The 1999 “Sleep in America” survey, sponsored by the National Sleep Foundation (NSF), found that 40 percent of adults are so sleepy during the day that they have difficulty carrying out their responsibilities. Severe insomniacs had a higher rate of absenteeism, missing work twice as often as did good sleepers. They also had more problems at work (including decreased concentration, difficulty performing duties, and more work-related accidents).” Sleep. 2002 Sep 15; 25.

Drowsy driving is an underestimated risk factor in official statistics, and as many as 15-30 percent of today’s traffic accidents are related to drowsiness; thus it is an even greater risk factor than alcohol. Drowsy drivers suffer from inattention, impaired concentration and may even fall asleep at the wheel. Accidents during dozing result in three times as many fatalities as other accidents. There are about 100,000 police-reported accidents due to fatigue and 1,550 people die each year reports NSF. According to a study in the Journal of Sleep research of the association between sleep and fatal occupational accidents concluded that “self-reported disturbed sleep is a predictor of accidental death at work.” Accidental death was nearly twice as likely in subjects who reported difficulty sleeping in the previous two weeks. Additionally, lack of sleep slows your problem-solving skills and may make you take unnecessary risks.

Associated Causes of Poor Sleep

  • Neurotransmitter imbalance; low Serotonin, high Nor-Epinephrine, low GABA
  • Restless Leg Syndrome; related to high Dopamine
  • Adrenal fatigue
  • Anxiety
  • Depression
  • Blood Sugar swings
  • Stress. Concerns about work, school, health or family can keep your mind too active, making you unable to relax.
  • Societal and family demands
  • Stimulants. Prescription drugs, including some antidepressants, high blood pressure and corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.
  • Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body’s circadian rhythms.  Research has shown there is a higher incidence of cancer in individuals who work the night shift.
  • Long-term use of sleep medications. If you need sleep medications for longer than several weeks, talk with your doctor, preferably one who specializes in sleep medicine.
  • Medical conditions that cause pain such as arthritis, fibromyalgia and neuropathies.
  • Eating too much too late in the evening. Having a light protein snack before bedtime may help you sleep better. Some people wake up at night because of low blood sugar.
  • Physical disorders such as kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease and hyperthyroidism.
  • Quality of sleep can also be impacted by environmental conditions, such as noise levels, extremes in temperature and changes in sleeping locations and time zones.

Associated Health Risks with Sleep Disturbances

Insomnia can affect not only your energy level and mood, but also your health as well.  The impact can be cumulative. People with chronic insomnia are more likely than others to develop psychiatric problems, such as depression or anxiety.

The lack of sleep has been shown in research to increase gastrointestinal symptoms. People with Irritable Bowel Disease have sleep disturbances even when they do not have symptoms. This is due to inflammation. Increased inflammation cause difficulty sleeping and increases high sensitivity C-Reactive Protein. Sleep Medicine Review 2005.  Sleep is also critical for immune function. Short sleep causes high blood pressure. Hypertension 2000.  Individuals who have less than 5 hours of sleep significantly increase their risk of coronary heart disease (CHD). The sympathetic nervous system is stimulated with poor sleep.

Trying to lose weight? Sleep better.  A recent study documented impaired glucose control, increase cortisol, increase insulin resistance, and increased diabetes. In the study decreased sleep increased hunger 24% and increased appetite 23% resulting in an increase intake of carbs 33-45% as compared to those sleeping well. Lack of sleep also raises body mass index (BMI).

Healthy Sleep Tips

  • Minimizing consumption of caffeine, alcohol and nicotine. This includes coffee, colas and chocolate. It is advised to restrict consumption after 3pm.
  • Establish a consistent positive routine. Stick to a schedule. Go to bed at the same time and get up at the same time.
  • Take time for yourself and keep your schedule reasonable. Your life depends on it.
  • Bedroom should be dark, quiet relaxing and climate controlled.
  • Use bedrooms only for sleep. Watching TV contributes to insomnia.
  • Use an eye mask or ear plugs as needed.
  • Sleep without animals if they disturb your sleep
  • Relax to prepare for sleep; calming music, meditate, guided Imagery CDs
  • Exercise 20-30 minutes a day preferable 4-5 hours before sleep
  • Gentle supplements promote restful sleep, calm the mind and relax the muscles. Speak to knowledgeable professional before using herbal products, supplements or over the counter preparations to help you sleep.

Written by: Dr. Sharon Norling, MBA