Most people have trouble sleeping from time to time, but it can cause serious health problems when it happens almost every night.
According to the Centers for Disease Control & Prevention (CDC), adults need at least seven hours of sleep per night, and anything less is considered “short sleep duration.” Alabama is one of 10 U.S. states with the highest rates of short sleep duration; between 38% and 44% of its adult population aren’t getting the recommended seven-plus hours of slumber.
“The health consequences of chronic sleep deprivation are severe,” says Patricia Patterson, MD, medical director of the UAB Medicine Sleep/Wake Disorders Center. “There is an increased risk of diabetes, obesity, depression, and anxiety, as well as the possibility of worsened memory and decreased immune function.”
March 8-14 is National Sleep Awareness Week, so it’s the perfect time to shine a light on our nocturnal routines and consider ways to improve nighttime slumber and daytime peppiness.
Signs of Poor Sleep
Dr. Patterson points to seven signs that you may not be getting enough sleep or that you may have a sleep disorder:
- Daytime sleepiness, which can be caused by a sleep disorder or nighttime behaviors that reduce your sleep duration
- General fatigue, which may occur for months or years but doesn’t include daytime sleepiness
- Increased appetite, which may be caused by hormone imbalances that can lead you to feel hungrier than usual and then less satisfied when you do eat
- Inability to fall asleep, which in many cases is caused by digital devices. Melatonin is a hormone crucial to the sleep-wake cycle, and the blue light from smartphones and tablets reduces melatonin production.
- Frequent trips to the bathroom during the night, a condition known as nocturia, may be caused by sleep apnea, certain medications, or caffeine.
- Nighttime awakenings, which are a common result of alcohol. Although alcohol may help you get to sleep, your body’s overnight processing of the alcohol sugars can lead to waking up, increased snoring, sleep apnea, and nocturia.
- Waking up gasping or choking, which may be symptom of sleep apnea, a condition in which the airway becomes blocked during sleep
Better Sleep Behaviors
When a patient is first seen at the Sleep/Wake Disorders Center, Dr. Patterson and her colleagues ask a series of questions and take an inventory of the person’s bedtime habits. The first line of treatment is encouraging patients to adopt sleep-promoting behaviors such as:
- No electronics 1-3 hours before bedtime. “Electronics interrupt physiological sleep mechanisms and stimulate the brain,” Dr. Patterson says. “If you have to be on your computer or phone at night, wear glasses that block blue light.”
- A more sleep-friendly environment that may include dimmer lights, a cooler temperature, and no television. “It’s best to have a comfortable mattress and pillow, with no dogs, cats, or children in the bed,” she says.
- Avoid heavy meals late in the evening. “Indigestion and heartburn can keep you up,” Dr. Patterson warns.
- Avoid caffeine 3-4 hours before turning out the lights, and no alcohol, nicotine, or marijuana 1-3 hours before sleep. “Insomnia is a primary sleep disorder in the U.S., and these stimulants can prevent people from falling asleep,” she says.
- Daytime exercise. “Even a small amount of daily aerobic exercise can improve sleep quality,” Dr. Patterson says.
- A consistent bedtime: “Shift workers have an especially hard time with this, but those on routine nights do better than those who do rotating shifts,” she says.
According to Dr. Patterson, cognitive behavioral therapy can be an effective treatment for insomnia. “Our sleep lab has one of only two sleep psychologists in Alabama,” she says. While not a substitute for a sleep psychologist, there are mobile apps that offer cognitive behavioral therapy for insomnia (CBTI) and work for some people.
Sleep Disorders
While adopting sleep-promoting behaviors can help many who suffer from periodic daytime sleepiness and fatigue, the CDC estimates that 50-70 million Americans live with a chronic sleep or wakefulness disorder. That’s where the UAB Sleep/Wake Disorders Center steps in to help. Sleep apnea is the most common disorder it treats.
“Patients often come to us because their significant other complains about their snoring or notices that their breathing pauses during sleep,” Dr. Patterson says. “Based on their symptoms and our examination, we may recommend a sleep study.”
A sleep study monitors several physiologic parameters, including respiratory effort, airflow, and blood oxygen levels. It may be done in the center’s sleep lab or at the patient’s home. The number of pauses in breathing or episodes of shallow breathing per hour is evaluated, and if sleep apnea is diagnosed, then the patient is prescribed treatment.
“The gold standard of treatment is CPAP,” Dr. Patterson says. A CPAP, or continuous positive airway pressure device, consists of a mask connected by a tube to a small machine that increases air pressure to help ensure that the airway doesn’t collapse when the sleeper inhales. “Other options include positional therapy, which prevents patients from rolling on their back during sleep, and an oral appliance that resembles a mouth guard.”
The Sleep/Wake Disorders Center also treats patients with other sleep disorders, such as:
- Restless legs syndrome (RLS), which is an uncontrollable impulse to move your legs: “We first check on the patient’s iron levels and replace iron if they need it,” Dr. Patterson says. “Prescription medications – especially antidepressants – can also play a contributing role, so we review those.” Proper hydration, regular exercise, and sleep-promoting behaviors are emphasized to fight RLS, and medication is available as a last resort.
- Narcolepsy, a condition marked by excessive daytime sleepiness: “This is typically a genetic disorder, though rarely it can be caused by a head injury,” she says. If the patient’s nighttime sleep study shows no problems, a daytime sleep study often is the next step.
- Idiopathic hypersomnia, which has symptoms similar to narcolepsy: “We treat both narcolepsy and hypersomnia with stimulant medications and therapeutic naps,” she says.
Getting to the bottom of poor sleep – whether caused by routinely binge-watching Netflix or a sleep disorder – is critical.
“Sleep affects everything we do – our family responsibilities, our ability to socialize, our work, and our medical conditions,” Dr. Patterson says. “Good quality sleep is the key to being fully present in our lives.”
Click here to learn more about UAB Medicine’s Sleep/Wake Disorders Center.