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Losing More Than Sleep

Everybody suffers occasionally from not getting enough sleep. But a lack of sleep can do more than just make you feel tired the next day. Chronic sleep problems can be a contributing factor to more serious health problems.

According to the National Center for Chronic Disease Prevention and Heath Promotion, almost 30% of Missouri residents report getting insufficient rest or sleep. Insufficient sleep has been linked to diabetes, cardiovascular disease, obesity and depression1, 2, 3. Additionally, a 2006 report by Institute of Medicine estimates that almost 20% of all serious car crash injuries in the general population are associated with driver sleepiness.

“Calling it a national epidemic is not an overstatement,” sleep specialist, pulmonologist and critical care specialist Shiraz A Daud, MD, says. “Twenty years ago we didn’t know sleep deprivation was harmful.”

Our bodies go through several stages while we sleep, known as Stages 1-4 and Rapid Eye Movement (REM) Sleep. As we progress through the stages to REM, our brain activity, breathing, and muscle movements change.

According to the National Institutes of Health, researchers believe that our bodies use sleep to repair neurons used while we’re awake. Deep sleep (stages 3 and 4) coincides with the release of growth hormones in children and young adults. The body has increased production and reduced breakdown of proteins, the basic building blocks for cell growth and repair, during deep sleep. Learning and memory also seem to be affected by sleep.

Daud says that two of the most widespread causes of chronic sleep problems are sleep apnea and insomnia.

Sleep Apnea

Sleep apnea is a condition where a person’s airway closes during sleep. This causes the person’s brain to wake up for a moment to restart breathing. When this happens too frequently, a person is unable to get sufficient sleep.

The most common form of sleep apena, called obstructive sleep apnea, occurs when the muscles that hold the windpipe open during waking hours relax, allowing the soft tissue to close, obstructing the airflow. Other contributing factors may be hereditary,  advancing age, being overweight, being male and alcohol use.

Signs of sleep apnea are heavy snoring, excessive daytime sleepiness, morning headaches and witnessed apneas—when a bed partner or someone else observes apnea occurring.

Dr. Daud says researchers estimate that 90% of people who suffer from sleep apnea are unaware of the problem and only seek treatment after suffering for years.

“Most have had symptoms for five years before seeking treatment,” he says. “A third of referrals are initiated by a bed partner.”

Although previously thought to be a problem of older, overweight men, Daud says sleep apnea is diagnosed increasingly often in younger, thinner men and in women. And, as research continues, the full effects become better known.

In addition to troublesome daytime sleepiness, irritability and forgetfulness, the effects of sleep apnea can be serious.

“The brain has only one solution when it detects breathing has stopped,” Dr. Daud says. “It sends a rush of adrenaline to wake you up and restart breathing.”

This adrenaline rush tends to raise blood pressure and increases the risk of atrial fibrillation (a type of irregular heartbeat), stroke and heart attack.

The most widely used treatment for sleep apnea is the use of the Continuous Positive Air Pressure (CPAP) machine. This device is attached to a hose that connects to a mask worn during sleep. Air is continuously pumped through the device to inflate the windpipe and hold it open. Dr. Daud says many users experience immediate improvements with the use of the CPAP.

Although highly effective, some people cannot tolerate or do not wish to use a CPAP machine. For these people, sleep apnea can be treated with dental devices, weight loss, sleep position modification, and in extreme cases, surgery.

Insomnia

Insomnia is a condition in which a person has trouble falling asleep or remaining asleep or both. Insomnia can be caused by many factors such as stress, irregular sleep schedule, use of some medications and drugs, pain and depression.

For many people, the worry of not sleeping well exacerbates the problem, Dr. Daud says. “It can be a struggle to get insomnia under control.”

Developing good sleep hygiene, such as controlling noise levels, temperature and other environmental conditions, and behavior modification are two important steps to overcoming insomnia, Daud says.

 “The bedroom environment is often overlooked,” Daud says. “We fall asleep best when we’re in a comfortable, dark, quiet room.”

There are several steps a person struggling with insomnia should take to prepare for bed,

  • Use the bed for sleeping only. The brain must be trained to fall asleep when you are in bed. Distracting activities, such as watching television, doing bills or reading, signal the brain to remain active.
  • Keep a regular sleep schedule. For people with insomnia, a regular sleep schedule helps the brain know when to be asleep. “If you have insomnia, you don’t get the luxury of sleeping in on the weekends,” Daud says.
  • Exercise regularly. Dr. Daud says that exercise helps the body get tired and ready for sleep, but the exercise should be four to five hours before bedtime. If you exercise too close to bedtime your body is too stimulated to fall asleep.
  • Avoid caffeine after lunch. Alcohol and nicotine near bedtime also interfere with sleeping. Although alcohol is a depressant, it can affect the amount of REM sleep a person gets.

To help your brain associate the bed with sleep, Daud recommends that you give yourself 20 minutes to fall asleep. If you’re not asleep after 20 minutes, get up and do a relaxing activity in another room until you’re sleepy. Then try again. Repeat as necessary.

In some cases, doctors will recommend over-the-counter or prescription medications to help people sleep. However, Daud says, these should be used with caution because of side effects.

“Medicines have a role,” he says, “but they are the exception not the rule.”


1. Wheaton AG; Perry GS; Chapman DP; Croft JB. Sleep disordered breathing and depression among U.S. adults: National Health and Nutrition Examination Survey, 2005-2008. SLEEP 2012;35(4):461-467.

2. Fang J, Wheaton AG, Keenan N, Greenlund KJ, Perry GS, Croft JB. Association of sleep duration and hypertension among US adults varies by age and sex. Am J Hypertension 2012;25(3):335-341.

3. Strine TW, Chapman DP. Associations of frequent sleep insufficiency with health-related quality of life and health behaviors.  Sleep Med 2005;6:23–lol27.

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