Northwest Health Magazine Spring 2013 IssueNorthwest Health Spring 2013

Want to Sleep Better?

Group Health experts can help you understand what's behind your restless nights, and how to improve your sleep.

Go to: Northwest Health Index

You probably know that without a good night's sleep, you'll feel tired, distracted, and foggy-headed the next day. But did you know that sleepiness can result in unhealthy eating? That's because sleep deprivation leads to an increase in ghrelin, a hormone that stimulates appetite, especially for salty, sweet, and starchy foods.

The link between sleep and food cravings is just one of many discoveries researchers are making about the effects of insufficient sleep, and one of many reasons doctors urge patients to make the effort to get adequate rest. "People who are sleep deprived can have myriad health issues," says Group Health pulmonologist and sleep medicine doctor Peter Chuang, MD. Sleep deprivation can make chronic pain feel worse. Anyone at risk for a seizure is more likely to have one if they don't get enough sleep. And too little sleep — less than six hours per night on a regular basis — is bad for your blood pressure.

Sleepiness is also a safety risk: Motor vehicle accidents, medical errors, and other mishaps are often caused by excessive sleepiness. Sleep deprivation can even be associated with decreased longevity. "We don't know how chronic sleep deprivation does this," says Dr. Chuang, "but good sleep is very important."

The effects of sleep deprivation are cumulative, so if a person misses a few hours of sleep for several days in a row, it can feel like the equivalent of skipping one night completely.

Causes of Sleep Problems

There are many reasons you may have trouble sleeping. But sleep problems fall into a few categories:

Insomnia. This inability to sleep can strike at any time. Short-term reasons can include indulging in a cup of coffee or a chocolate bar too late in the day, worry over an exam, excitement about an upcoming event, or jet lag. Other times, "insomnia can be a product of unhealthy habits," says psychologist and sleep specialist Ben Balderson, PhD, with Group Health Behavioral Health Services. For instance, taking daytime naps or not exercising enough can keep a person awake at night. He points to a study that found that 30 minutes of exercise a day for 16 weeks decreased the time needed to fall asleep by 50 percent and increased sleep time by 60 minutes. People also commonly experience sleep issues if they have ongoing stress, anxiety, or depression.

Fragmented sleep. Sleep that is interrupted by periods of wakefulness is particularly common as we age. Our bodies may give us more reasons to wake up — we need to use the bathroom more often, or experience aches and pains.

Sleep disorders.
One of the more common disorders is sleep apnea, a condition in which a person experiences pauses in breathing or very shallow breathing during sleep. During those times, the sleeper develops mini-awakenings they may not even be aware of that disrupt normal sleep. If this occurs frequently it can lead to daytime sleepiness and other sleep deprivation issues. Another common sleep disorder is restless leg syndrome. People with this issue have an uncontrollable urge to move their legs in the evening when going to sleep. It can keep them awake during the night.

Diagnosis and Treatment

Good sleep hygiene is one way to improve sleep. "Sleep hygiene is the pre-bedtime ritual," says Dr. Balderson. Just as children have rituals such as bath time and story time, adults sleep better when they give their bodies time to unwind.

For many, one particular ritual, or a combination of treatments, works best. Lisa Zobrist, a Group Health member with lifelong sleep issues, had suffered with poor sleep since childhood. Her sleep pattern, triggered by anxiety and depression, may sound familiar. "I would fall asleep OK, but then I would wake up in the middle of the night and worry about anything and everything, which would then prevent me from falling back to sleep." She got about four hours of sleep a night, even after practicing good sleep hygiene.

That changed when she met with Barb Morrow, RN, a nurse with Group Health Behavioral Health Services. Morrow suggested that Zobrist write in a journal before bedtime. She first wrote down what she was thankful for from her day. "That turned my mind to positive things," she says. Then she jotted down everything she was worried about, and told herself that she didn't need to worry about those things during the night. Within just a few days, she noticed a distinct difference in her sleep. With nightly journaling, the change has lasted for several months. Zobrist now sleeps six or seven consecutive hours each night. "I have more energy. I have more interest in doing things. I'm more pleasant to be around," she says.

If there is one thing Zobrist would tell fellow insomnia sufferers, it's that there's hope. "Sometimes, it's a combination of things that can be really successful — sleep hygiene, journaling, medication, if necessary. Keep working and don't give up."

Family physician Leslie Becker, MD, also says that patients need to continue good sleep habits once they're established. "They can't just treat their sleep problem and then forget about it."

A family physician can help with many sleep issues. If you have good bedtime habits and are still tossing and turning, your doctor can look for possible secondary causes of insomnia, such as prescription drugs, or conditions such as sleep apnea and restless leg syndrome. They can also evaluate a patient for chronic anxiety or depression, which can be treated with counseling or with a combination of counseling and medication. Restless leg syndrome, which can be triggered by low iron stores in the body or by some medications, is also usually treatable by a family physician.

A family physician will listen for sleep apnea clues when taking a patient history. One of the most common signs is loud snoring. Another is difficulty staying awake during the day, says Dr. Becker.

"They're not necessarily napping — they're dozing off at meetings, or having to pull over their car to get fresh air to keep awake." People with certain body types can be at a higher risk for this condition, such as those with a large neck or recessed jaw, and people who are overweight. Women are somewhat protected from the condition until menopause, after which they are as at-risk for sleep apnea as men are. Both adults and children can have sleep apnea.

Group Health member Glenn Dodson was recently diagnosed with the condition after years of drinking a pot of coffee a day to keep himself going. "When I felt run down, I'd just grab some coffee and then feel refreshed again," he says. Dodson, who is in his 60s and has had heart bypass surgery, eats healthy foods and walks four miles a day. He didn't suspect he had sleep issues until his wife was diagnosed with sleep apnea this year. "I thought I was waking up during the night because of her snoring," he says. Because of his previous health issues, and the connection between sleep apnea and heart disease, he decided to get checked for sleep apnea just to be sure.

Dodson consulted a sleep specialist, who ordered a home sleep test. This involves bringing home a machine that uses sensors to continuously detect snoring and airflow rates, heart rate and oxygen levels, sleep positions, and how often a patient's chest moves while sleeping. Patients can often self-administer the test. Those who can't test at home, or who have other sleep conditions, may need inpatient testing at the Group Health or other sleep lab.

Dodson soon learned that he had sleep apnea — he had stopped breathing 26 times in one hour. The primary treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) device, which is worn to bed each night to ensure proper airflow. While some patients may balk at wearing the device, which includes a face mask, Dodson and his wife each use one, and he says the change is "like night and day." They feel more awake during the day, and aren't bothered by nighttime wakeups. "Also," he says, "I'm not drinking nearly as much coffee!"

Guidelines for Better Sleep

  • Exercise daily, not too close to bedtime.
  • Avoid taking naps.
  • Reserve your bed for sleep and intimacy.
  • Keep your sleep area quiet and dark, and without stimulating input such as electronic devices.
  • If you haven't fallen asleep after 30 minutes of trying, get up, go to another room or a chair, and read, meditate, or do something else nonactive.
  • Write down your worries if they keep you awake, and solve them tomorrow.
  • If you're a clock watcher, put your clock where you can't see it.
  • When falling asleep, or if you wake during the night, listen to a meditation tape, a CD with soothing sounds, or soft classical music if it calms you.
Other sites: Providers | Producers | Employers