Who Needs Sleep?
Kathleen Harder-Brouwer, MD
Ravalli Family Medicine
411 West Main Street
Hamilton, MT 59840
Who Needs Sleep?
Canadian pop group Barenaked Ladies once sang about the problem of insomnia,
lamenting "my mind is racing filled with lists, of things to do and
things I've done, another sleepless nights begun". While a catchy
tune, it is truthful that many people suffer from chronic insomnia. According
to the Centers for Disease Control, one in three adults does not get the
seven hours of sleep recommended each night.
Trouble sleeping is a frequent complaint seen in medical offices, in persons
of all ages. The idea of having to work to sleep may seem unusual, but
once you have experienced this issue, you know that work is sometimes
needed to break the cycle of sleeplessness.
Insomnia can present in variable ways. Certain patients have trouble falling
asleep; others may fall asleep easily but wake a few hours later only
to toss and turn in the early hours of the day. Insomnia can also be the
result of medical problems. Congestive heart failure, uncontrolled gastroesophageal
reflux (heartburn) and arthritic pain are a few of the conditions that
may need attention before quality sleep can be achieved. There is also
a host of sleep related issues, such as sleepwalking, restless leg syndrome
and sleep apnea that may result in poor sleep and chronic fatigue. This
article will focus on insomnia without such causes and the type that is
most amenable to lifestyle interventions.
The environment in which one tries to sleep is very important. Even with
your eyes closed, ambient light can be detected and affect sleep. Temperature
may be even more important. The ideal temperature for sleep is between
60 and 67 degrees. A quality mattress and pillow, both of which support
your preferred sleep position, should be a priority investment. If you
spend the equivalent of 8000 of your days on earth sleeping, your bed
is a priority investment.
Behaviors either before bed or when retiring for the night can also impact
your chances of having, or avoiding, insomnia. Eating a heavy meal before
bed decreases sleep quality. Drinking alcohol, while initially sedating,
will always affect the ability to get a full night's sleep. Watching
TV in bed can retrain the brain to stay awake in bed and should be avoided
if you struggle with quality sleep. Reading may be a good way to help
one fall asleep, but those who struggle with insomnia may be again teaching
the body to stay awake. We really are creatures of habit and also sleep
best when we keep a consistent schedule with regards to times we get up
in the mornings and sleep in the evenings. If you are a person who does
best with some element of noise in the bedroom, it should be what is classified
as "white noise", such as a fan or a machine with sounds of
nature, such as waves or wind. Music and television can stimulate the
brain to wakefulness even once you have fallen asleep.
If you have tried all these lifestyle interventions without benefit, it
could be time to discuss sleep aids with your health care provider. There
are a host of medications available, both by prescription and over-the-counter.
Regardless of the type you and your provider agree upon, they all carry
similar risks. Daily use can lead to dependency; in this situation you
cannot fall asleep without the drug in your system. This is true of even
over-the- counter medications. Anything that helps you sleep is, by nature,
sedating and can increase the risks of falls if you need to get up in
the middle of the night to use the bathroom.
Sleepwalking can be seen with many of the agents and can include such
behaviors as cooking and eating without being aware of the actions. If
the benefits of getting a good night's sleep outweigh these risks,
the lowest dose of medication should be used for the shortest time possible.
Even if you have never suffered from insomnia, paying attention to these
tips is good practice for everyone and will help you avoid singing along
with the Barenaked Ladies and "Who Needs Sleep?".
The community health column is brought to you this month by a partnership
between Marcus Daly Memorial Hospital and Ravalli Family Medicine. For
questions and or comments regarding this week's health column or request
for a health column on a specific health topic, please contact Kathleen
Harder-Brouwer, MD, c/o Ravalli Family Medicine, 411 West Main Street,
Hamilton, MT 59840.