By Dr. David B. Rawlings, PhD –
In my clinical psychology practice, I routinely interview patients to review their medical, cognitive, and personality functioning. One aspect of a person’s life that we always discuss, and which is frequently a barometer of their overall health, is the quality of their sleep and sleep behavior.
In most cases, people in good health tend to sleep well, whereas those suffering from repeated sleeping problems may have an underlying mental health or medical complication. In fact, it’s been said that Americans are notoriously sleep deprived, however, those with psychiatric conditions are even more likely to be yawning or groggy during the day. Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared to 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).
Sleeping well is essential to one’s physical health and emotional well-being. Unfortunately, minimal sleep disturbances can take a toll on one’s mood, energy, and ability to handle stress. Ignoring sleep problems and disorders can lead to poor health, impaired job performance, accidents, and relationship stresses. In order to feel your best, stay healthy, and perform up to one’s potential, sleep is a necessity.
Everyone experiences sleep problems from time to time due to various issues such as job stress, illnesses, final exams, financial concerns, etc. but when do sleeping problems become a serious issue that would suggest an underlying medical condition or true sleep deprivation? You may be dealing with a bona fide sleep disorder if you begin to experience some of the following symptoms on a regular basis:
a) you may feel irritable, grumpy, or sleepy during the day;
b) you may have difficulty staying awake watching television, reading, or sitting still;
c) you may have difficulty concentrating;
d) you may fall asleep or feel very tired while driving;
e) others may tell you that you looked fatigued or tired;
f) your reaction times may have slowed significantly;
g) you may have trouble controlling your emotions;
h) you may feel like you have to take a nap every day;
i) you may require more than your usual amount of caffeine to keep yourself going.
There are many types of sleep disorders including Restless Leg Syndrome (RLS), Narcolepsy, and Circadian Rhythm Sleep Disorders (such as jet lag, shift work, delayed and sleep phase disorder), but I’d like to focus on the two most common sleep disorders; Insomnia and Sleep Apnea; the latter of which can be the most disadvantageous to one’s health and memory.
In Insomnia, there is an inability on the individual’s part to wake up feeling rested and refreshed. Insomnia is often a symptom of either an underlying health problem, or situational difficulties such as stress, anxiety, and depression. It can also be caused by lifestyle choices including the medications one takes, a lack of exercise, or even the amount of coffee and nicotine one consumes. Insomnia tends to deplete your energy, mood, and ability to function throughout the day. Common signs and symptoms of insomnia include:
a) difficulty initiating or falling asleep at night, or getting back to sleep after waking up during the night;
b) waking up frequently during the night;
c) sleep feels light, fragmented, or exhausting;
d) you don’t feel rested upon awakening; and the
e) the sleep disturbance or associated daytime fatigue causes significant distress or impairment in social, occupational, or other important areas of functioning;
Typically most cases of insomnia can be treated with lifestyle changes that you can make on your own (see below) without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.
Sleep Apnea is a common sleep disorder in which a person’s breathing temporarily stops during sleep due to the blockage of the upper airways. These pauses in breathing interrupt your sleep, leading to many awakenings each hour. While most people with sleep apnea don’t remember these awakenings, they may feel exhausted during the day, irritable and depressed, or see a decrease in productivity. There are three types of sleep apnea: obstructive, central, and mixed. Obstructive Sleep Apnea, often called OSA, is the most common.
Sleep apnea is seen more frequently among men than among women; particularly, Afro-American and Hispanic men. Obstructive sleep apnea is caused by a blockage of the airway; usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed sleep apnea, as the name implies, is a combination of the two. With each apnea event, the brain rouses the sleeper, usually only partially, to signal breathing to resume. As a result, the patient’s sleep is extremely fragmented and of poor quality.
Sleep apnea is very common, as common as type II diabetes. It affects more than 18 million Americans. Untreated, sleep apnea can have serious and life-shortening consequences including: high blood pressure, heart disease, weight gain, impotence, headaches, stroke, depression, diabetes, and motor vehicle crashes caused by falling asleep at the wheel.
Symptoms of sleep apnea typically include some of the following:
a) loud, or chronic snoring;
b) frequent pauses in breathing during sleep;
c) gasping, snorting, or choking during sleep;
d) feeling exhausted after waking and sleeping during the day, no matter how much time one spends in bed;
e) waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat
Ironically, I find that many of my patients have these symptoms, yet they have not been questioned about their symptoms by their primary care doctor (PCP). If not treated, sleep apnea can also have an adverse effect on intellectual or neurocognitive functioning as well. Several studies have shown that OSA impairs inductive and deductive reasoning, attention, vigilance, learning, and memory. In children, OSA can cause attention deficit hyperactivity disorder (ADHD) in addition to behavioral problems and learning disabilities.
At a cellular level, OSA likely causes cognitive impairment through intermittent hypoxia (loss of oxygen), hormonal imbalances, and/or systemic inflammation. A common finding in several studies has also shown decreased hippocampal volume as well as focal reductions in the gray matter of both the frontal and parietal lobes of the brain.
Fortunately, sleep apnea can be treated, and several treatment options exist including CPAP, surgery (uvulectomy), as well as an Oral Appliance that can be fitted and provided to you by your dentist. Certainly, if you feel you or a loved one has symptoms of sleep apnea you should go to your PCP as soon as possible and have this potential condition further evaluated and treated if possible.
If you’re suffering from insomnia, there is self-help for sleeping problems without necessarily requiring a visit to the doctor or sleeping pills. Use of a Sleep Diary is an extremely useful tool for identifying sleep disorders and sleeping problems as well as pinpointing both day and nighttime habits that may be contributing to your difficulties. Keeping a record of your sleep patterns or problems will also prove helpful if you eventually find it necessary to see a sleep doctor. Your sleep diary should include the following:
a) what time you went to bed and woke up;
b) what number of hours you slept and the quality of your sleep
c) a record of time you spent awake and what you did during that time
d) types and amount of food, liquids, caffeine, or alcohol you consumed before bed and the times of consumption;
e) your feelings or moods before bed;
f) and any drugs or medications taken, including dose and times of consumption;
These details can reveal how certain behaviors or antecedents can be ruining your chance for a good night’s sleep. For example, you may notice that the night you could NOT sleep you drank far more caffeinated beverages than usual (including coffee and Mountain Dew) earlier in the day.
More importantly, you should always practice good sleep hygiene. Sleep Hygiene is a term used to describe good sleep habits; that is, things you can do to give yourself the best chance of acquiring a good, refreshing sleep. Most of these things are common sense, but in the hustle and bustle of modern life, these are often neglected. Below are some, “Do’s” and “Don’ts” from Sleep Disorders Australia, 2006.
Do -go to bed at the same each day. The body has a natural clock which will make you sleepy when you’re ready for bed. Try not to ignore this.
Do – get up from bed at the same time each day. Getting up at the same time helps to keep your body clock synchronized with what is going on outside. If you can stick to a fairly regular waking and sleeping time, your body will become accustomed to it.
Do – get regular exercise each day. There is good evidence that regular exercise improves restful sleep.
Do – try to spend some day time outdoors or in natural light. Light is important for the body to produce melatonin which is a sleep promoting substance.
Do – make the bedroom as restful as possible. This means keeping the temperature cool, keeping noises and outside light to a minimum, and leaving distracting things such as beeping watches or clocks outside.
Do – use your bed only for sleep and sex; the 2 S’s !! Some people use the bed as a lounge room, by knitting, studying, watching TV, telephoning. You need to try and avoid this.
Do – take medications as directed. Prescription medications may cause you to be alert or sleepy and the instructions that come with them should be followed to the letter.
Do – be comfortable and relaxed. If you are cold in bed, warm the room or wear warm pajamas. Warm hands and feet are particularly important. If you have uncomfortable pillows, mattress or bedclothes, get them fixed.
Do – understand your sleep need. Most people need between seven and nine hours of sleep each day but this includes naps and time spent dozing in front of the TV.
Don’t – exercise just before going to bed. Exercising immediately before bed stimulates the body and may make it difficult to fall asleep.
Don’t – engage in stimulating activity just before bed. Playing a competitive game, watching an exciting program on TV, or having an important family discussion stimulates your mind, and thoughts will overflow to the bedroom.
Don’t – drink caffeine containing drinks in the evening. Coffee and tea are the obvious caffeine containing drinks but things such as colas and many other soft drinks also contain caffeine such as Mountain Dew. Chocolate also contains caffeine. A glass of warm milk is an old-fashioned recipe that may work well.
Don’t – go to bed too hungry or too full.
Don’t – nap in the evening before you go to bed.
Don’t – stay in bed if you are awake. You can’t force yourself to sleep. If you do not fall asleep in a reasonable about of time, perhaps 20 to 30 min., then get up and do something boring but do this in another room. Try and keep the lighting fairly dim. When you’re tired, go back to bed.
Don’t – share your bed with children or pets.
Don’t -look at the clock all the time. Clocks with bright numbers are a distraction and obsessing over them will just make it more difficult to sleep.
Don’t – smoke. The stimulant effect of nicotine contributes to sleep loss.
Don’t – use alcohol to help you sleep. Alcohol may help you get to sleep, but it has a number of bad effects. It causes you to need more trips to the toilet, it causes you to wake up early, it causes fragmented sleep, it worsens snoring and sleep apnea, and it is a central nervous system depressant.
Don’t – rely on sleeping tablets to help you to sleep. Sleeping tablets have a role where there is some event or other circumstance that may temporarily cause you to have trouble falling asleep but they are a temporary fix only.
Our office is happy to help you with further education and treatment of these issues regarding sleep as well as the evaluation of the effects of sleep deprivation and sleep apnea on memory and cognitive issues across the adult age range.
Dr. David B. Rawlings, PhD
720 Goodlette Road N. | Suite 201 | Naples FL 34102
239-430-2303 | www.drrawlings.com