The incidence of sleep disturbance in the United States is high. More and more people are reporting episodes of restlessness and non-restorative sleep. Besides feeling un-rested during the day, lack of sleep can also affect a number of medical conditions such as diabetes, hypertension, heart failure, depression, PTSD, abnormal heart rhythm, and stroke to name a few. Sleep deprivation can increase a person’s risk of cardiovascular events such as myocardial infarction (aka heart attack). We can also see the effects of sleep deprivation in the blood, because of increased blood markers of inflammation.

Insomnia, the subjective feeling of being unable to fall asleep or stay asleep, is the most common sleep disorder in the United States and it’s estimated that up to 15% of people suffer from chronic insomnia. Insomnia results in daytime functional impairment such as sleepiness when you should be awake, fatigue, difficulty concentrating, and difficulty remembering things. Insomnia is also associated with increased risk of heart disease, and is associated with depression, anxiety, and PTSD. It usually starts off acutely due to a triggering event, like stress or worry of an upcoming event or situation. This worry leads to poor sleep, and then we subconsciously begin to associate sleep, or sleep-related stimuli like our bedrooms, with that stress, which further causes insomnia, and the whole cycle feeds itself.

There are many non-pharmacologic as well as pharmacologic ways to manage insomnia. Stress management through yoga and mindfulness meditation is a great way to start. Decreasing intake of caffeine containing products early in the afternoon as well as cutting out all nicotine products will go a long way. Herbal supplements like valerian, passion flower, kava, and skullcap can help, but prior to starting any herbal supplement, it’s important to consult with your doctor so that review of your health as well as medications can be done to make sure there will be no interactions, as well as to discuss duration of use as some herbs cannot be taken for prolonged periods of time. Melatonin is a popular sleep hormone supplement with very limited side effects and can be used to help initiate sleep. Pharmacologically, hypnotics such as benzodiazepine receptor agonists (eg Lunesta and Ambien) are also options, but beware of complex sleep behaviors like sleep walking, sleep-eating, even sleep-driving. Finally, diphenhydramine, found in medicines like Tylenol PM, can be used if sleeplessness is associated with muscle aches and pain.

Another well known condition that leads to sleep deprivation is Obstructive Sleep Apnea (OSA). OSA is the repeated obstruction of the airway during sleep that leads to low oxygenation of our red blood cells, frequent wakings, and increase work to breathe. Risk factors include obesity, male gender, and retrognathia (a condition where the lower jaw is set farther back than the upper jaw, like an overbite). We release catecholamines, our fight-or-flight hormones, when we go through episodes of apnea (no breathing due to the obstruction), and repetition of this can strain the heart, which contributes to hypertension, abnormal heart rhythm, coronary heart disease, and heart failure. As sleep apnea worsens, so does a persons degree of hypertension. OSA also increases the risk of stroke. So, what can you do? First, ask yourself a few questions: am I frequently tired during the day? do I snore? am I overweight? If you answer yes to some of these questions, you should talk to your doctor in order to set up further evaluation. But as you know, risk reduction is key! If a person’s primary issue is obesity, then weight loss is required and mouth guards can be fitted for people with retrognathia. The usual treatment once OSA is diagnosed is usually a CPAP (positive airway pressure machine that keeps the airway open while a person sleeps), or surgery by an ENT or oromaxillofacial surgeon.

Children can also suffer from Sleep Apnea. If your child is of normal weight and has a diagnosis of ADHD, discuss evaluation for sleep apnea with their pediatrician as they may have enlarged tonsils. If your child is overweight or obese, they may suffer from the common adult form of sleep apnea, OSA, and treatment would be similar to that of the adult population.

There’s so much more when it comes to sleep and dream science so will stop here for now, but as I write more, I’ll use the tag Sleep so that the subject is easily found. Before starting or stopping any medication or supplement, ALWAYS consult with your doctor.

BONUS: there will be a follow up post on sleep hygiene but get a sneak peak by checking out my instagram page for a post from January 10th, 2020.

Sleep Disturbances