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May 13, 2005

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Publication Date: Friday, May 13, 2005

Not such a good night's sleep Not such a good night's sleep (May 13, 2005)

By Vivian C. Abad, M.D.

My husband snores so badly, I have to sleep in the guest room. Is there anything else I can do?

Nearly eight in 10 married people surveyed said their partner has a sleep problem, usually snoring. Urge your spouse to consult his physician. Snoring is caused by vibration of the soft tissues in the throat.

It may represent partial blockage of the airway during sleep (i.e., sleep apnea), particularly if present most nights, and if associated with gasping, choking, or body twitching. Even snoring without sleep apnea has health consequences, including increased incidence of heart disease. Snoring and sleep apnea are treatable.

What are the risks of sleep apnea?

Obstructive sleep apnea occurs when the throat collapses during sleep, thereby preventing the flow of air to your lungs. You actually stop breathing or have a shallow breath lasting more than 10 seconds. This cessation of breath is associated with an "arousal message" to your brain that triggers release of chemicals that raise your blood pressure, speed up your heart rate, and shift you from a deep stage of sleep to a lighter stage of sleep.

These arousals during the night impair the quality of your sleep and make you feel tired when you awaken. The apnea may also be associated with lowering of the oxygen level in your blood, leading to damage to your vital organs -- heart, brain, and kidneys.

Untreated sleep apnea can lead to high blood pressure, increased risk of strokes or heart attack, irregularities in heart rhythm, short-term memory problems, problems with focusing on tasks, mood disorders (irritability, anxiety, depression, irritability), increased heart burn symptoms, and sexual dysfunction.

In children, sleep apnea can lead to attention-deficit disorder symptoms and impaired school performance.

More than 20 million Americans -- 24 percent of adult men and 9 percent of adult women -- are estimated to have some degree of obstructive sleep apnea. Many remain unaware of their condition and are undiagnosed.

I've just come out of a very stressful series of life events, but I'm still not sleeping well. Any suggestions?

When the stresses of daily life intrude on a good night's sleep, it's time to build some new sleep habits. If you have trouble falling asleep, start by creating a soothing transition to sleep. Avoid discussing emotional issues with your partner in bed. You can't turn off your mind like a TV.

As little as 10 minutes of "down time" spent in the bathtub or listening to calming music can prime you for deep sleep. Light exposure to your eyes awakens you; avoid watching TV or working on the computer within 30 minutes of your bedtime.

Prevent dysfunctional sleep associations, which interfere with your ability to sleep -- reserve the bed and bedroom for sleep and sex only. Minimize noise, light, and temperature extremes during sleep. Go to bed only when you are sleepy. Avoid watching the clock to check the time, because it will make it harder to fall asleep.

Change your day habits, too. Standardize your sleep-wake schedule. Do your exercises earlier during the day, not within three hours of your bedtime. Vigorous exercise delays your ability to fall asleep. Do not nap during the day unless it is a safety issue.

Notice what is missing from the list. Many people "relax" with an alcoholic beverage. While alcohol may initially put you to sleep, as it is metabolized during sleep, it will produce frequent awakenings in the second half of your sleep cycle. Also avoid excess caffeine intake.

Since you have been through a stressful time, try to engage in relaxation techniques, breathing exercises, or meditation. If you are unable to fall asleep within 20 minutes, leave the bedroom, and go to a different room to read (with the light source behind you) or listen to soft music. Return to bed only when you are sleepy.

Does smoking cigarettes affect sleep?

Yes. If people need one more compelling reason to stop smoking, here it is. Nicotine stays in your system for as long as 14 hours and, even at low doses, nicotine can cause you to wake at night, reducing the amount of refreshing sleep you get. Like alcohol, nicotine first acts as a sedative but changes to a stimulant later. Smoking while drinking caffeine or alcohol can interact to dramatically disturb your sleep, and leave you feeling weary.

Why do I always seem to have insomnia during pollen season?

During the pollen season, nasal allergies may be making your nose stuffier, increasing the resistance to airflow. This will exacerbate any underlying predisposition to sleep apnea.

Additionally, some medications that are taken for nasal congestion, including over the counter "allergy medicines" can contribute to insomnia. Talk to your physician, since there are medications that may help relieve your nasal congestion.

Vivien C. Abad, M.D. MBA, is a board-certified sleep specialist and the director of the Sleep Center for Camino Medical Group.
@email:E-mail Camino Medical Group representative Cynthia Greaves at greavec@caminomedical.org.


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