From the library of

Frank Barnhill M.D.
 

There’s an old wives tale that claims, as we get older, we don’t need as much sleep. Nothing could be further from the truth, as studies have shown we all function better with a seven or eight hour sleep night.

There are many causes of insomnia or disorder of sleep. Among the most common are those we cause ourselves. Contrary to popular belief, alcohol actually interferes with a good nights sleep by interrupting your body’s normal sleep rhythm. Caffeine, nicotine, and other stimulants have similar effects. Vigorous exercise within four hours of bedtime can cause a very restless night due to high adrenaline levels.

One easily overlooked cause of insomnia is over the counter and prescription medications. Drugs such as prednisone, decongestants, cough syrups, blood pressure pills, stimulating anxiety medications and antidepressants, asthma pills, and thyroid medications can cause mild to severe sleep problems.

Natural changes of aging can lead to other medical problems, which interfere with a good nights sleep. For example, sleep apnea affects 10% of adults ages 30 to 60 and 60% of those over age 65. Affected persons may snore loudly and then abruptly stop breathing for 10 to 30 seconds. It’s possible for a person to experience apnea hundreds of times a night and never reach a state of complete sleep relaxation. The next day, that person will be very tired and may fall asleep without warning.

Another common cause of a restless night is acid reflux or GERD (gastroesophageal reflux disease). Reflux of acid into the esophagus and throat causes partial arousal (near awaken state) and interferes with sleep since you never reach the deepest sleep levels. Reflux can also cause a chronic cough, lead to ulceration and cause cancer in the lower esophagus. Like sleep apnea, reflux or GERD is worsened by being over weight and often improves with weight loss. It can be treated with antacids and drugs, which reduce acid output such as Prilosec, Nexium, Axid, Zantac, and Pepcid.

Almost everyone over the age of thirty has jumped out of bed in the middle of the night grabbing a calf to massage terrible cramps. These cramps may be from Restless legs syndrome (RLS) or periodic limb movement syndrome (PLMS). Both disorders can cause jerking sensations of the legs and sometimes calf pain, which reduce the amount of time spent in deep sleep by awakening you or causing near arousal. Unfortunately, the cause of RLS and PLMS is not known, but drugs such as Sinequan, Sinemet, and Neurontin can be used to suppress these abnormal leg movements and help you get a good night’s sleep.

Advance sleep cycle dysfunctions can also cause restless nights and usually involve disturbances in our circadian (bio) rhythm. Normally, our core body temperature drops a little and we get sleepy around 10 or 11 pm and remain sleepy for 7 or 8 hours, such that we awaken between 7 and 8 am. As we get older, our body temperature falls at an earlier time, say 8 or 9 pm and we get sleepy and go to bed. When core body temperature rises 7 or 8 hours later, we awaken at 4 or 5 am unable to return to sleep. This essentially happens when we travel east to west and cross three or more time zones in a 12-hour period (jet lag). Wearing sunglasses in late afternoon in your new time zone can delay this effect if you wish to maintain your “normal sleep times” while traveling. Likewise, it is possible to delay onset of your normal sleep cycle by prolonged exposure to bright light similar to natural sunlight.

I know most of us have well meaning friends and families who blame a “bad case of nerves” for our sleepless nights. It’s true that untreated depression can cause sleep problems, but equally important, untreated insomnia can lead to depression. Diagnosis of sleep disorders can be quite complicated and requires identification of the underlying problem by a thorough medical exam. Blood testing and possibly x-rays or special diagnostic testing such as sleep studies may help your doctor make an accurate assessment. Once diagnosed, a modification in your lifestyle, such as weight loss, or getting rid of alcohol and tobacco, or a change in your current or addition of new medications may be needed.

For Further information on sleep apnea, depression, seasonal affective disorder, esophageal reflux and nocturnal leg cramps, please access the archives at drhuggiebear.com.

Have a great night’s sleep!
Dr. Frank