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Online Chat - Getting Better Sleep

Online Chat - Getting Better Sleep

Tuesday, March 8, 2011

Dr. Coles:
Hello everyone. I am Dr. Jason Coles, a sleep medicine physician with the Spectrum Health Medical Group. Today our topic is improving your sleep. We can talk about common sleep disorders and treatments. I would be happy to answer your questions.

Comment From Erin Gawne:
I have difficulty getting to sleep what can I do?

Dr. Coles:
Scheduling time for sleep and keep regular sleep schedule are important. That means going to bed and getting up at the same time each day, even on days off and weekends. This helps to regulate your 24-hour body clock. It also helps to start getting ready for bed about an hour before your bedtime. Doing something relaxing, like reading, will help prepare you for sleep. Working, studying or watching TV right before bedtime can make it hard to fall asleep.

Spectrum Health:
FACT: An estimated 40 million Americans have a sleep disorder. (National Sleep Foundation)

Comment From Pat:
I get to sleep without any problem but have trouble waking at 2:00-3:00am. What can I do to break this cycle?

Dr. Coles:
Good question Pat. A few others here have similar difficulties. Waking up at night is normal. Usually people fall back to sleep quickly. Sometimes it can be difficult to go back to sleep. It’s important not to do anything active when you wake up like studying or working around the house. It’s important to not lie in bed and get frustrated about not being able to fall back to sleep. Try something relaxing like reading. If necessary, you can lie down in another room in the house and read until you feel drowsy. Then return to your bed. If the problem persists that would be a good time to talk with your doctor or see a sleep specialist for further evaluation and treatment.

Comment From Basil:
Is sleep deficiency a genetic condition?

Dr. Coles:
Sleep difficulties including insomnia do tend to run in families. Sleep disorders like sleep apnea also have a large genetic component.

Comment From Larry:
I have constant head pain that often prevents sound sleep. Does disturbed sleep contribute to head pain?

Dr. Coles:
Good question. Headaches are a very common symptom of poor sleep and sleep disorders generally. Sleep disorders are also common in chronic pain conditions such as fibromyalgia.

Comment From Erin Gawne:
There are times that I don't go to bed until 2-4 am just because I can't sleep even though I might be tired . Or sometimes I will stay up all-night.

Dr. Coles:
It sounds like your sleep pattern is very irregular because of your insomnia. Keeping to a regular schedule is very important, with the most important intervention being getting up at the same time each morning. Further evaluation with your doctor or a sleep specialist might be helpful.

Here are a few other suggestions:

Avoid caffeine within four to six hours of bedtime

Avoid the use of nicotine close to bedtime or during the night

Do not drink alcoholic beverages within four to six hours of bedtime

While a light snack before bedtime can help promote sound sleep, avoid large meals

Avoid strenuous activity within six hours of bedtime

Minimize light, noise and temperature extremes in your bedroom

Try to sleep only when you are drowsy

Avoid napping during the day

Spectrum Health:
FACT: 74 percent of American adults are experiencing a sleeping problem a few nights a week or more. (National Sleep Foundation)

Comment From Jeremy:
Do SSRI affect sleep?

Dr. Coles:
SSRIs and other antidepressants often can contribute to insomnia. Of course, the conditions they treat like depression and anxiety, are also major factors that can disrupt sleep.

Comment From Erika:
My husband has a cpap machine and he did not wake up during his sleep study however now he is waking up 2 or 3 times a night. Per his last download his sleep apnea is under control with the cpap machine

Comment From Frank :
I have sleep apnea, have tried using the C-pap but had difficulties and gave up. I have just heard that there is another alternative a B-pap, what is the difference?

Dr. Coles:
Several questions about CPAP (continuous positive airway pressure) and sleep apnea treatment. Usually when people are having trouble with CPAP that means that something is going wrong. We follow patients closely in clinic to try to figure out why they are having problems with their sleep apnea treatment, and make interventions to help. If all else fails, there are several alternatives to CPAP, including BiPAP (which varies the pressures for comfort), dental appliances, and surgery.

Comment From Guest:
What are the common causes of sleeplessness?

Dr. Coles:
Sleepiness is usually caused by inadequate total sleep. Americans don't on average get enough sleep at night, usually because of our busy lifestyles. If you are getting enough sleep, excessive sleepiness can be caused by a sleep disorder which interferes with your quality of sleep. There are also conditions that cause the brain to be primarily sleepy, such as narcolepsy.

Spectrum Health:
FACT: More than one in three Americans (37%) are so sleepy during the day that it interferes with daily activities. (National Sleep Foundation)

Dr. Coles:
I noticed in the poll results that many of you aren't getting enough sleep at night. On average, adults need 8 hours of sleep per night. However, kids and teens need more sleep. Teenagers need about 8 – 9 hours of sleep per night. And elementary and junior high kids need 9 – 12 hours of sleep per night. The key is that people should be able to maintain their alertness throughout the day.

Comment From Judy:
Is there any risk with taking over the counter sleep aids - example: Tylenol PM?

Comment From Paula :
Are there simple, effective remedies for snoring? Does over-the-counter options work, or how about the mouth bites that can be obtained from a dentist?

Dr. Coles:
Over the counter sleep aids are usually antihistamines, which are pretty safe generally. These medications can be helpful for many people, especially in the short run. They are rarely effective for chronic insomnia. The biggest worry with these medications is that they can cause a lot of sedation that lasts into the next day.

Dr. Coles:
Regarding Paula's question about snoring, dentists can make appliances that position your jaw slightly forward during sleep. This is effective for many people, and can actually treat sleep apnea as well. The over-the-counter mouth guards do the same thing (move the jaw forward) but are not tested to treat sleep apnea, and don't hold up as well. There is little downside to trying one however.

Comment From Lori:
I have trouble falling asleep at night due to restless leg syndrome. I am physically exhausted but still unable to sleep because of this sensation in my legs. Then, during the day I am fighting to stay awake. This happens 3-4 nights a week. Is there anything I can do to get relief?

Dr. Coles:
Restless legs syndrome is a common problem. For some people it is mild but for others it can severely affect sleep. There are very good treatments for RLS, but need a prescription. I'd recommend speaking with your primary doctor about this. Also please know that some medications and health conditions (like low iron) can contribute to this as well. Some simple blood work may be helpful.

Comment From Larry:
What can be done?

Dr. Coles:
In response to Larry's follow up about head pain affecting his sleep... This is a hard problem to answer in this format, and would require further evaluation. I'd recommend speaking with your primary physician about this. We'd also be happy to see you in the sleep clinic for a full consultation.

Comment From Jeremy:
Any long term affects of sleeping medication such as Ambien... I take Ambien every night to sleep. Any particular ways to ween off?

Dr. Coles:
Thanks for your question Jeremy. There have been a lot of questions about sleep aids generally. There are many people who do use chronic sleeping pills, and do well with them. It is always about trying to balance the risk and benefits. The problem is that they often stop working, and the dose needs to be increased or they need to switch to another medication. Dependence can also develop, and it can be hard to get off these medications. There are ways of addressing insomnia without medications, through behavioral changes. A full consultation would be needed to make a plan for an individual patient.

Spectrum Health:
FACT: 39 percent of American adults get less than seven hours of sleep each weeknight. (National Sleep Foundation)

Comment From Erin Gawne:
Also I have Epilepsy can that affect me and having insomnia?

Comment From Erin Gawne:
Dr. Cole I get migraines a lot can this is because of lack of sleep?

Dr. Coles:
Erin asked about epilepsy and migraine headaches. Epilepsy can rarely affect sleep by causing seizures at night. This can be seen on a sleep study. Migraine headaches can certainly be made more common by the presence of inadequate sleep or a sleep disorder disrupting sleep.

Comment From Michelle:
Any words of advice to encourage a spouse to come in for a Sleep test?

Dr. Coles:
Great question Michelle. Spouses are often affected by their partner's sleep disorder (like sleep apnea). If you think it is a problem, I'd encourage you to bring this up as a concern. We see people for a consultation before considering sleep studies. This is a good opportunity to discuss reasons to get sleep looked into further, and can help your spouse to make a good decision for him and your relationship.

Comment From Guest:
I have problems falling asleep and staying asleep. I literally cannot stop my mind from thinking. I also do overnight call at least once a week where I do not usually get to sleep. I did see a sleep specialist who I did not find very helpful. Wonder if I should have a sleep study

Dr. Coles:
Insomnia can be a very complex issue, and unfortunately the process of getting it addressed can be frustrating. Sorry your initial experience didn't help. I'd recommend a second opinion with a sleep specialist. A sleep study may be needed, depending on your specific complaints. Shift work is a really common issue that makes addressing insomnia complicated.

Comment From mka:
I dream sometimes and other times I don't remember dreams, what sleep pattern am I in when I dream. Is it better sleep when I don't remember my dreams.

Dr. Coles:
Most people go into REM ("dream stage sleep") several times during the night. The interesting thing is that we have amnesia for our dreams, unless we actually wake up during them or immediately after them. Remembering your dreams or not doesn't necessary give us an idea of your sleep stages or sleep quality.

Spectrum Health:
FACT: Over 80 percent of American adults believe that not getting enough sleep leads to poor performance at work, risk for injury and poor health, and difficulty getting along with others (National Sleep Foundation)

Comment From Erin Gawne:
How can one improve their sleep insomnia if they have had it for 20yrs now and are tired of the whole staying up late cycle . I need of help!!

Dr. Coles:
The process starts with an initial meeting with a sleep physician. For many patients, diagnosis and treatment includes an overnight sleep study. Based on the results, treatment may include medication, continuous positive airway pressure (CPAP) machines, surgery, or behavioral therapy.

Comment From Guest:
I am on a cpap machine and sleep 7-8 hours a night and feel that it is good sleep, however I am still very tired during the day and have fallen asleep while reading during the day. I have a Nap test scheduled next week.. what might that show that the overnight sleep study did not?

Dr. Coles:
Nap tests (called Multiple Sleep Latency Testing or MSLT) evaluate your degree of sleepiness during the day, and are the tests for narcolepsy and other forms of primary sleepiness.

Spectrum Health:
FACT: Sleep deprivation leads to approximately 100,000 sleep-related vehicle crashes each year and results in 1,500 deaths. (National Sleep Foundation)

Comment From Basil:
I've heard stories about individuals getting by on short "cat" naps throughout the night and day. What are the medical effects of this behavior?

Dr. Coles:
There is no medical downside of cat napping. For the chronically sleep deprived this might be necessary to catch sleep when you can. But, I would say that any sleep you get during the day is definitely going to affect your sleep at night. If you do take a nap during the day, try to limit it to just a few minutes.

Comment From Sid:
How will the upcoming time change affect my sleep?

Dr. Coles:
The time change (and loss of an hour of sleep) will usually cause people to be tired for up to a few days afterward and the body's internal clock adjusts. Bright light in the morning when you first wake up will help your body to adjust quicker.

Spectrum Health:
FACT: Sleep loss costs U.S. employers an estimated $18 billion in lost productivity (National Sleep Foundation)

Comment From Ron:
I think I need a sleep study...how do I get scheduled? Does my family doctor need to refer me?

Dr. Coles:
Talk with your physician at your next appointment. Your doctor can help to determine whether you can improve your sleep on your own or whether an appointment with a sleep physician is necessary. If you believe you suffer from a sleep disorder, call the Spectrum Health Sleep Disorders Centers directly at 1.888.SLEEP.LAB or 616.391.3759.

Comment From John:
I sleep a full night (7.5 hours), and rarely wake up during the night. However, I often don't feel refreshed the next day. I do snore, and have been told I have a deviated septum. Are these signs of apnea?

Dr. Coles:
Yes. I think this definitely should be looked into further.

Comment From Erin Gawne:
I just want to say thank you Dr. Cole for you help today

Dr. Coles:
Thank you for participating in the online chat today. I hope that I have been able to answer your questions. If you think you need to see a sleep specialist, talk to your doctor or call the Spectrum Health Sleep Disorders Centers at 888.SLEEP.LAB or 616.391.3759.

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