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.
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