Ask the Doctor – The Rest of the Story – In Many Ways, Sleep Is Important to Your Overall Health

Q. After reading and hearing so much in the news lately about sleep, I’ve become concerned regarding the sleep patterns of my own family. Why does there seem to be an increased interest in sleep, and why is so important to our health?
A. This interest reflects the abundance of research studies linking sleep disorders with an increased number of significant diseases, among them hypertension, acid reflux, attention disorders, depression, diabetes, heart disease, stroke, and memory disorders. Most recently, the relationship between sleep apnea and dementia has received national attention in studies, demonstrating that effective treatment of sleep apnea alleviated the loss of cognitive function.
Q. My mother was an insomniac for many years before she sought help from a doctor. Could this symptom signify other health issues?
A. Insomnia may be the result of other medical conditions, such as anxiety, depression, chronic lung disease, heart failure, degenerative arthritis, and acid reflux. Also, in women more than in men, insomnia may be a sign of sleep apnea. Some prescription medications may also cause sleep disruption. Restless legs syndrome, which occurs during the evening, may continue into the night as excessive leg movements disrupting sleep.
Q. While I don’t consider myself an insomniac, I have had some problems falling asleep recently and turned to over-the-counter medications for help. What is known about over-the-counter, as well as prescription, sleep medications?
A. The use of over-the-counter (OTC) sleep aids may help you for a few nights, but the benefits are often short-lived, and there is a great potential for troubling side effects. These OTC sleep aids frequently have sedating antihistamines as their main ingredient, which may cause morning sleepiness. They may be especially hazardous in the elderly, because they may provoke confusion, falls, and heart irregularities.
The herbal remedies valerian and chamomile are generally safe and may help, but are of unproven benefit in studies. Melatonin is frequently used, but there is also minimal evidence in studies that it helps with insomnia. Melatonin, however, has been shown to be very effective for jet lag, delayed sleep phase disorder (quite common in teens), and other sleep disorders.
Prescription medications, such as Ambien and Lunesta, may have short-term benefit, but carry a significant risk of parasomnias (defined as undesirable behavioral events that accompany sleep), such as sleepwalking. The effectiveness  of prescription sleeping pills has been shown to be far less enduring than a form of counseling known as cognitive behavioral therapy for insomnia (CBT-I).
Establishing sound ‘sleep hygiene’ is essential. This includes considering the adverse effects of smoking, alcohol, caffeine, poor sleep environment, excessive light, or mental stimulation before bedtime, and exercising too closely to sleep time.
Q. Almost every day I read or hear commercials for mattresses and how this one or that one is the best for a good night’s sleep. How important is our mattress, and is there really a best kind to purchase?
A. This is a highly individualized and subjective issue. Consumer Reports recently undertook a review of mattresses that merits reading.
Q. My mom lives with us, and now that she is older, she gets up at 5 a.m., sometimes even earlier. We have two teenagers and a younger child. Our teenagers tend to go to sleep later and often sleep until 10 a.m. or later on the weekends. Are these sleep habits unusual?  
A. Teens are somewhat programmed to have what we call a delayed sleep phase, meaning they go to bed later and get up later. Many school districts are responding to this by starting the school day later. On the other hand, as people like your mother age, the opposite may occur, and they develop an advanced sleep phase characterized by going to bed earlier and waking earlier.
Treatment is available if either the delayed or advanced sleep phases become disruptive in one’s life. This includes manipulation of the timing of light exposure and the use of evening melatonin as a ‘phase shifter’ for teens with delayed sleep phase. Both options are best coordinated by a sleep specialist because the potential for complications exists in both of these groups. Moreover, underlying medical, mental-health, or sleep disorders need to be considered first, as well as reviewing sleep hygiene.
Q. What is the current state of knowledge regarding the ideal amount of sleep?
A. For the longest time, it has been suggested that adults require eight hours of sleep a night. Recent data suggest that a slightly lower amount of seven to seven and a half hours is also conducive to good health for some people. Teens need nine hours of sleep on average, but often achieve much less for a variety of reasons. Many adults are chronically sleep-deprived as a consequence of work, societal, and family responsibilities, with a resulting proven risk of accidents, as well as hypertension, diabetes, and obesity.
Q. I’ve heard many tales about how to get a good night’s sleep, such as drinking a warm glass of milk before bed. Are there ways to help ensure a good night’s sleep?
A. Sound sleep hygiene and consistent sleep habits are crucial. Developing a consistent routine of retiring for sleep and arising at the same times every day is a good start. Make sure that your bedroom environment is conducive to sleep — it should be cool, dark, and quiet with no light or sound disrupters. Television viewing should ideally be excluded from the bedroom. On the food front, you should avoid heavy meals before bedtime, as well as caffeine, alcohol, or nicotine — yet another good reason to quit smoking.
The timing of vigorous exercise is also important, as it may increase the body temperature if undertaken within four hours of bedtime. This may negatively impact one’s normal ability to fall asleep. On the other hand, exercise before that window of time will help to promote sleep. A warm, but not too hot, shower one hour or so before bedtime will help promote temperature changes conducive to sleep onset and maintenance.
Q. My spouse’s snoring sometimes wakes me up.  I’ve heard snoring may signify health problems. Is this true?  Is testing required?
A. Your husband’s snoring may be a sign of sleep apnea. In sleep apnea, airflow is repeatedly interrupted. If your sleep partner has gaps in their breathing or crescendos of snoring culminating in a choking or gasping noise, they may have sleep apnea. This disorder impacts the quantity and quality of one’s sleep and has been shown to lead to a wide variety of serious health issues, such as hypertension, diabetes, heart disease, and stroke. A more immediate issue is the hazard of excessive daytime sleepiness, with risk of accidents on the road and in the workplace. Snoring itself, without sleep apnea, has been determined to be associated with increased hypertension and stroke risk.
In individuals without more complex chronic diseases, the diagnosis of sleep apnea is made with a home sleep study, which is a portable kit that is returned for analysis the next day.
For patients who have diseases such as congestive heart failure, COPD, stroke, or neuromuscular diseases, other sleep-related breathing disorders need to be considered, such as hypoventilation with sleep and central sleep apnea. The effective treatment of these may require more elaborate therapy than that for sleep apnea.
A diagnostic sleep study, conducted in a hospital sleep department, is indicated in these diseases and allows for more elaborate and safer monitoring of a wide range of parameters, such as carbon-dioxide levels. Similarly, sleep studies of children are conducted in the monitored setting of a sleep department.
If you suspect that you may have a sleep disorder, consultation is available in Springfield, Northampton, Greenfield, Palmer, and Ware through the Baystate Regional Sleep Program, which is fully accredited by the American Academy of Sleep Medicine. For more information about these services, call (413) 794-5600.