Sunday, February 06, 2005

It's essential to fight long-term insomnia and get the rest you need

Good Nights Sleep

Source: Heath Beat By Jillian O'Connor

It's 4 a.m., and the numbers on the clock cast their menacing crimson light from across the room. Your eyes start to burn, but you just can't seem to shut them and get back to sleep. As you begin to wonder if you'll ever doze off again, rest assured that you're not alone.
In the United States, more than half of the adults polled by the National Sleep Foundation said they experienced short-term insomnia a few times a week, while the National Institutes of Health estimates that 10 to 15 percent of grown-ups may be affected by its long-term cousin, chronic insomnia.

Insomnia refers to the inability to fall asleep and to stay asleep. It is unlike sleep apnea, a disorder characterized by brief interruptions of breathing during sleep that may have played a role in the recent death of football legend Reggie White.

One local long-term sufferer of insomnia is Saralane Tennin-Allen. While she uses old tricks such as counting sheep under a perfect, cloudless sky to get back to dreamland, she often finds herself wide-eyed after bedtime - usually about four times in a night.

"I fall asleep right away, but then about an hour later I wake up," she said. "Partially because my husband snores and because my dogs move around, and they're on either side of me. So that's part of it," she said with a laugh.

"But I've always been a poor sleeper. I wake up at the drop of a hat."

Beverly Heap, 75, has also experienced problems staying asleep and used to find herself kept awake by the relentless whooshing noise of traffic from the nearby Hollywood Freeway. But in a moment of inspiration, the Los Angeles County resident devised a clever way to find solace in the hum - and to get some shut-eye at last.

"I close my eyes and pretend I am sleeping in the sand, and the freeway noise becomes the roaring of the ocean," she explained. "The slapping of the waves lulls me right back to sleep."

Though struggling to fall asleep or doze off again can be frustratingly difficult, physicians point out that it's not really a problem if it lasts for less than two weeks. Acute insomnia, which tends to be tied to stressful events in a person's life, such as an upcoming exam or evaluation for a promotion, usually runs its course quickly and goes away once the stressor has been removed.

When the problem persists for about a month, though, it may be time to check in with a physician and review possible causes.

"Somewhere between two and four weeks, that's when you should consider making a doctor's appointment," said Dr. David Brandes, director of the Sleep Evaluation Center at Northridge Hospital Medical Center and assistant clinical professor of neurology at UCLA's David Geffen School of Medicine.

The dangers of forgoing the recommended seven to eight hours of sleep, said Brandes, are not as dire as one might expect, but the lack of rest may cause people to fall short of their best.

"The main thing comes from activities during the daytime where you need to be alert," he said. "And driving is one of the most common. Daytime activity that requires alertness could be dangerous or difficult."

People may find their impaired alertness could hurt them in doing their best even at desk jobs, though there are no compelling direct risks to health from losing hours of rest.

Good sleeping habits, referred to as sleep hygiene, are usually the first area doctors address when trying to pinpoint the root of an insomnia case. Not keeping a regular schedule of bedtimes and waking times is often a problem for insomniacs, as is napping during the day, considered a no-no since the habit can set off a vicious circle.

"Some patients will not get a good night's sleep because they'll nap in the daytime," said Brandes, "and then when they go to bed at night, they're not sleepy yet."

Another non-sleeper is Mike Kirwan, who said he feels he can't sleep at various times during the year, but he's never quite sure if it's true sleeplessness.

"I'm not sure if I've slept or not, because I'm dreaming I can't sleep," said Kirwan.

He has found, though, that he rests quite normally most of the time, as he keeps regular sleep and wake times, one of the top recommendations for maintaining good sleep habits.

Other doctor recommendations include avoiding caffeine within six hours of bedtime; some people even need to rule out caffeine altogether to get a restful night.

Apart from poor sleep habits, Brandes noted, major causes of insomnia seem to be psychological distress, such as that seen with anxiety and depression. Patients are often unaware of the potential stresses in their lives, and a doctor's perspective can help identify the trigger of the insomnia.

And men who suffer insomnia due to depression often aren't aware of the psychological cause because they experience depression so differently from women, said Brandes.

"Men get kind of irritable and withdrawn, but they don't cry very much, and they don't really feel depression like women do."

Medical conditions, especially those causing pain, like arthritis, or lack of mobility, such as Parkinson's disease, may also contribute to the problem. Neurologist Dr. David Thompson, the medical director of the Sleep Disorders Center at Glendale Adventist Medical Center, finds that the use of alcohol or medication can also be disruptive to maintaining sleep.

Alcoholic beverages may help people fall asleep at first, but a few hours later, plummeting alcohol levels can actually rouse the person.

"Many people use alcohol recreationally, and the intake is going to be excessive, and they may be able to fall asleep relatively easily with alcohol in their system, but one, two, or three hours later, the alcohol wears out, and they literally are then awake for much of the night," Thompson said.

Certain prescription medications, on the other hand, can cause problems, including hallucinations or dreams that jolt people awake, he said.

Insomnia may be a bit more prevalent among older adults, from middle age up.

"It increases a little bit more in the retired group, where their sleep schedules are more erratic," said Thompson. "For those of us who continue to work, most of us have to be up at a specific time in the morning. In the retired age group, the individuals may feel freer to get up anytime they want to."

That can cause problems, he explained, when there is napping and a somewhat early bedtime despite a late waking hour.

Other causes of insomnia that involve frequent waking (sleep-maintenance insomnia) include obstructive sleep apnea, which can suddenly rouse a sufferer when the upper airway constricts and the sleeper can't breathe for a period of time, often awaking with a snort.

In the relatively common condition restless legs syndrome, the sufferers' legs can feel extremely uncomfortable, though they don't quite hurt.

"They get a creepy-crawly feeling, and they can't get to sleep until their legs kind of settle down," said Brandes, who mentioned that treatment is available for the common but seldom-diagnosed affliction.

Periodic leg movements in sleep (PLMS), a condition that causes sudden movements that sometimes arouse sleepers, has also taken the blame as a frequent cause of poor sleep maintenance.

All three of the conditions often go undetected until a patient seeks the help of a sleep laboratory in pinpointing the cause of insomnia, usually after all other possible explanations for the problem have been fully explored.

At Northridge Hospital's sleep center, for instance, patients come in for a night of sleep in the evening, then are connected to electrodes, which help the sleep experts detect irregularities as the subject gets a night's rest.

"It may not be the best night's sleep ever, but with five or six hours, we're able to make a diagnosis in 95-plus-percent of cases," said Brandes.

Short-term solutions for insomnia often include the over-the-counter drug diphenhydramine hydrochloride, found in Benadryl and Tylenol PM, though Brandes warned that the medication can cause a hangover effect the next day and should not be used for more than short bouts of insomnia, as the body will build a tolerance to the substance.

Prescription medications used currently to treat insomnia in the short term include the newer drugs Ambien and Sonata, which Brandes said do not produce the hangover effect of some older sleep aids and do not affect takers' daytime performance.

But for Rose Sarkissian Knapp, 82, saying the Lord's Prayer alternately in English and Armenian helps her ward off insomnia when she has rough nights.

"I say it once, and if I don't get the feeling that sleep is coming, I just keep saying it slowly, slowly, slowly," she said. "And in a way you say, 'I'm with God, right,' instead of taking a sleeping pill.

"Then I fall asleep."

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