November is National Sleep Comfort Month, and sleep comfort has become more important than ever as many people today struggle with sleep related issues.

But how can you get a more restful sleep or recognize the signs of a sleep problem? We talked with SIMED Neurology and Sleep Center Dr. Kraiyuth Vongxaiburana (Vong) to find out everything you need to know to get a better night’s sleep!

How to Recognize if You Have a Sleeping Problem

A common symptom of most sleeping problem is waking up and not feeling refreshed or feeling tired. If you feel tired, something might have gone amiss while you slept. Not sleeping well could mean you have insomnia or other issues like sleep apnea.

Another indicator is if you have trouble falling asleep or wake up in the middle of the night and can’t get back to sleep. Sometimes, people might wake up often to use the restroom and think they have a urinary problem, but they really have sleep apnea. Snoring also might indicate that you have sleep apnea.

What is Sleep Apnea?

Sleep apnea is very common. More than 18 million people in the United States have sleep apnea. 

If you wake up and feel tired, if you snore loudly, or if your partner notices that you stop breathing at night or snore very loudly, you could have sleep apnea. Overweight people are more likely to have sleep apnea because when you’re overweight, your airway can relax and close, obstructing your breathing. The obstruction can cause you to snore loudly and stop breathing or not get a full breath of air.

When you have sleep apnea, your oxygen levels drop and you can wake up for short periods during the night without realizing. Waking up from sleep apnea can leave you unrefreshed in the morning and make your sleep fragmented. Even when you do get sleep, you might still feel lousy and like you haven’t slept. You can have trouble getting out of bed.

How Do You Diagnose and Treat Sleep Apnea?

You can participate in an overnight sleep study to find out if you have sleep apnea. SIMED performs overnight sleep studies which allow physicians to monitor your sleep patterns and determine your problem.

If you were diagnosed with sleep apnea, you might be prescribed a breathing machine called a CPAP. CPAPs have a mask that goes over your face and blows continuous air pressure into your airway to keep it open for more oxygen. Using a CPAP generally leads to decreased arousal, and people with sleep apnea feel more refreshed.

Why Should You Get Treated for Sleep Apnea?

Feeling more awake in the morning isn’t the only reason you should get treated. If left untreated, sleep apnea can lead to increased risk of high blood pressure, stroke, heart attack, and cardiac arrhythmias. Waking up throughout the night ramps up adrenaline and increases risk of many dangerous medical problems. It can even cause insomnia.

What is Insomnia?

Insomnia is another very common problem. About 30 to 40% of people have insomnia, and women tend to be more affected than men. Insomnia is when people have difficulty falling asleep or staying asleep.

People can have insomnia due to many different reasons. They might be uncomfortable or anxious and unable to sleep. Their circadian or sleep rhythm might be off. Patients might also have psychophysiological insomnia, meaning they are anxious about getting to sleep so they worry about sleeping and stare at the clock which makes sleeping even more difficult and creates a cycle where they’re more and more anxious and have increased difficulty sleeping. Breaking the cycle can be difficult, but working on good sleep hygiene can help.

10 Ways to Get a Better Night’s Sleep

If you have insomnia or trouble falling asleep, here are 10 tips for improving your sleep comfort.

1. If you have anxiety, write down everything that worries you. You don’t need to write everything down right before bedtime, but if you make a list a few hours earlier, you can get your worries out of your mind and into a journal.

2. Avoid stimulants like caffeine too close to bedtime. Don’t drink coffee or other caffeinated drinks past midafternoon.

3. Don’t constantly check the time. If you don’t fall asleep or have trouble falling asleep, after 30 minutes of trying, don’t stare at the clock. Instead, get up and do something calming for 10 minutes. For example, you could drink a glass of milk or read a book. Then try to go back to bed.

4. When in bed, try not to do other activities than sleep. If you’re working in bed or watching TV in bed, you train your mind to do other things than sleep in bed which can lead to your brain being more active at bed time.

5. With smartphones, avoid screen time. You can easily answer your phone or check emails at night, but when you do, you train your mind to do other things at night besides sleeping and can end up resetting your sleep clock. The bright light can reset your circadian rhythm and make getting to sleep more difficult.

6. Avoid sunlight in the evenings. Especially in the summertime, try to get bright sunlight in the morning instead of the evening because it will make you feel more awake.

7. Exercise. Exercise in general has been shown to help people get to sleep and stay asleep. Some people find that exercising before bedtime can make sleeping more difficult, so exercise earlier in the day or whenever works best for you.

8. Set a good sleep schedule. Go to sleep at the same time every night and wake up at the same time every day. You should get 7 to 8 hours of sleep, and some people may even need 9 hours of sleep. Try not to take naps during the day to avoid throwing off your schedule. Create a good bedtime routine (like you might for your children) that includes turning off the TV, dimming the lights, and avoiding stimulation a couple of hours before bedtime. Some people might even take a warm bath.

9. In the bedroom, keep everything cool and comfortable. Keep the room as dark as possible, and keep noise to the minimum.

10. Use a mattress that works for you. Some people like more firm mattresses, and some people prefer softer mattresses. Experiment to find what works for you, and if you have sleep apnea, elevating the front of your bed can help because gravity won’t be working as much against you. If someone is sleeping flat, their airway can close. Sleeping on your side or elevating your bed can help open it. You can get a wedge to put under your mattress or get a mattress that elevates the head.

What about Sleep Aid Medications? Are They More Harmful or Helpful?

Over-the-Counter Medications

It’s okay to use sleep medications once in a while. A lot of over-the-counter antihistamines can help people get to sleep and feel better in the morning, but some can end up blocking acetylcholine which can affect memory. Older people should try to avoid antihistamine sleep medications and instead try medications containing melatonin. While some people can get addicted to sleep medications like Benadryl, most people won’t be addicted to over-the-counter medications.

Prescription Medications

Try to avoid prescription medications, specifically the addictive ones like ambien and restoril. For some, they are needed, but for others, the medication can work for a while, but when people get used to it, they build up a tolerance. Non-addictive medications like trazodone should be tried first to help with sleep before something with more potential tolerance for addiction.

Alternatives

If you use sleep aids, you can also practice good sleep hygiene and try out cognitive behavioral therapy with a therapist or psychologist. We can have difficulty sleeping because we’re anxious and set up a cycle where we worry about things which can make it more difficult to sleep. A psychologist would help tease out abnormal thoughts

Also, a psychologist could help people in a cycle of bad sleep realize getting a bad night’s sleep would not be the worst thing in the world. Those people might not worry so much about it and get a better night’s sleep.

If you have trouble sleeping, talk to your doctor about getting a sleep study done or contact SIMED’s sleep center at 352-224-2338. To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.

Here are Dr. Lim’s tips to help you sleep:

1. Keep the same bedtime and wake-up time every day.

Going to bed at the same time every night and waking up at the same time every day will stabilize your circadian rhythm so you naturally become tired at the same time every night.

2. Try to sleep for at least 7 to 8 hours every night.

3. Sleep in a dark, quiet and cool room. Avoid stimuli such as light, TV and music.

4. Avoid caffeine after lunchtime.

5. Turn off electrical devices at least 30 minutes before bedtime.

Ask yourself the following questions:

• Are you tired during the day, dozing off during a meeting, church or movie, while reading or watching TV, or when driving? 
• Have you been told that you snore or have stopped breathing in your sleep?
• Do you wake gasping or choking during sleep?
• Do you have trouble staying asleep?
• Do you wake up unrefreshed as opposed to wakening wide-eyed and bushy-tailed? 
• Do you wake with a dry mouth, throat irritation or morning headache? 
• Are you increasingly irritable, forgetful, depressed or anxious?
• Have you been diagnosed with a hypertension, diabetes, thyroid disease, fibromyalgia, cardiac rhythm problem/atrial fibrillation, congestive heart failure, heart attack, stroke or early dementia?

If you answered yes to any of these questions, you may have obstructive sleep apnea.

What is sleep apnea?

Sleep apnea is a condition where your airway is blocked or partially blocked, causing interruptions in sleep, decreased oxygen to the heart and brain, and may contribute to the development of amyloid plaques in the brain. Amyloid plaques have been found in brains of individuals with Alzheimer-type dementia as well as other neurodegenerative disorders.  Left untreated, obstructive sleep apnea may lead to poor quality of life, contribute to diseases and even have dire consequences for your health, including hastening death. 

Individuals with chronic pain are often are treated with opiates (e.g., tramadol, hydrocodone, oxycodone or morphine); individuals with anxiety are often treated with benzodiazepines (e.g., alprazolam or clonazepam). These medications decrease the breathing drive and may lead to central sleep apnea.

Some individuals may have a combination of obstructive and central sleep apnea, called complex sleep apnea.  Other individuals, especially those who have heart failure, may have cycles of slowing down followed by speeding up in their breathing, which is known as periodic breathing.

How is sleep apnea diagnosed?

Sleep apnea is diagnosed with an overnight sleep study.  These can be done at home or in a sleep center. A center study is preferred because the monitoring can differentiate between the different types of sleep disorders.

A center sleep study consists of:

• Electodes that are placed around the head to determine stages of sleep and around your eyes, nose and mouth (not to worry, no needles!) to measure breathing, mouth movements, and dream status
• EKG (heart) monitor placed on your chest to monitor for abnormal heart rhythms,
• Pulse oximetry to check for drops your oxygen levels,
• Elastic bands around the chest and abdomen to determine when you are breathing, and finally
• Electodes on the legs to monitor for leg movements

All of these connected wires which are bunched into a single connector that may be easily disconnected should you need to use the bathroom during the night.  Home studies are an option, but due to the fewer things being monitored are unable to tell the difference between obstructive, central or complex sleep apnea.  Home studies are also unable to identify other sleep disorders, such as periodic limb movements of sleep, nighttime teeth grinding (bruxism) or parasomnias (sleep talking, sleep walking, confusional arousals or REM sleep behavior disorder).

How is sleep apnea treated?

Fortunately, sleep apnea can be easily treated.  The most effective and most preferred method of treatment is positive airway pressure (CPAP or bilevel PAP) therapy.  This therapy consists of a mask that comfortably fits around the individual’s nose and/or mouth, providing the minimum air pressure necessary to keep the airway open, allowing air to reach the lungs and ultimately provide oxygen to the heart and brain.  For those who do not tolerate positive airway pressure therapy, there are alternatives, such has oral appliances that keeps the tongue and jaw forward; or surgical procedures, such implants to support the palate, uvulopalatopharygoplasty (UPPP) or electrical stimulators to keep the tongue from falling back and blocking the back of the throat. 

How can you get evaluated?

If you think that you, your spouse, family member or friend may have sleep apnea, talk to your primary care physician, who can refer you to SIMED Sleep Center for a formal sleep evaluation.  If your insurance does not require a referral and you would like to set up an appointment, you can call SIMED Sleep Center directly at (352) 224-2388 to set up your sleep evaluation.

According to the National Sleep Foundation over 18 million Americans suffer from some type of sleep disorder. SIMED Sleep Medicine’s Dr. Larissa Lim weighed in on how quality of sleep can have serious implications on your overall health.

Sleep and heart health are closely intertwined.  A study has shown that adults who slept less than six hours per night were twice as likely to have heart attacks or strokes as people who slept six to eight hours per night.  Patients with untreated obstructive sleep apnea are at higher risk of developing congestive heart failure.  Obstructive sleep apnea has also been linked to hypertension and cardiovascular disease.

Proper sleep hygiene is important. Many Americans suffer from chronic sleep deficit. Dr. Lim has some tips for proper sleep hygiene:

• Set a bedtime and wake-up time allowing at least 7-8 hours of sleep with 30 minutes set aside for falling asleep
• Avoid caffeine after lunch 
• Sleep in a dark, quiet, and cool room 
• Avoid alcohol at bedtime 
• Limit use of electronics at bedtime including computers, TV’s, smartphones, and tablets as they tend to delay bedtime

The warning signs of obstructive sleep apnea include loud snoring, daytime sleepiness, waking up gasping or choking, waking up with morning headaches or dry mouth, getting up to urinate, and frequent awakening.

If you have disturbed sleep, or are waking up tired after a night of sleep, a diagnostic polysomnogram, i.e. sleep study is the gold standard test to evaluate for a sleep disorder. There are a few different options for treatment of sleep apnea. Most patients find continuous positive airway pressure or CPAP provides the best method for returning to a long restful night of sleep.  

Sleep is important not only to your heart but your health in general.  Thankfully, achieving good sleep is something we all can do. Contact your SIMED physician to talk about your risk factors for sleep disorders. Set up an appointment at SIMED Sleep Medicine to discuss your questions and concerns with one of our board certified sleep medicine specialized physicians.

Author: Dr. Lim, ABIM Board Certified in Internal Medicine and Sleep Medicine