Many sleep disorders are known but treatment is limited to a few of the most common. Treatments may be simple, with behavioral modifications only, or more complex and requiring medical supervision. The purpose of this article is to provide guidelines for treatment and to direct the more severely affected to the appropriate healthcare resource. Treatment of insomnia, the most frequent sleep disorder, and sleep apnea will be featured. The more serious disorders, including narcolepsy and restless leg syndrome, may require treatment with prescribed medication and are beyond the scope of this review.
Insomnia, the disorder of staying or falling asleep, responds well to behavioral changes. Knowing what to do for certain types of insomnia may be all that is needed to achieve restful sleep. We all will suffer from transient insomnia when traveling to a different time zone (jet lag) or whenever our normal routine is disrupted (hospitalization, for example). Nothing needs to be done for this brief condition since our natural sleep cycle is not reset and, once we return home, we quickly catch up on our sleep debt. For longer periods of insomnia, especially those that last more than a few weeks, we must consider changes in our normal routine. The following suggestions may help to eliminate activities known to interfere with sleep and add others that may promote a good night’s rest.
Establish a routine Set times for sleeping and awakening. Once you establish a schedule, stick with it. Resist the urge to retire early or sleep late. Once a sleep/wake cycle is established, changing it, even on weekends, may be enough to reset it. Avoid sleeping in, even on weekends.
Avoid exercise at night Exercising within three hours of retiring can actually interfere with sleep. By elevating our body temperature, exercise may act as a stimulant and energize us. Avoiding exercise prior to bedtime allows the body to slow down and prepare for sleep. Exercising earlier in the day promotes sleep.
Limit time in Bed Avoid watching TV, eating or reading in bed. Using the bed for sleeping only helps the body associate the bedroom with sleep. Removing the radio and other distractions (windup clock, for example) from the bedroom is recommended.
Avoid stimulants This is the most important change we can make. Avoiding caffeine, alcohol and nicotine is essential to help treat sleep disorders. Medications such as non-drowsy oral decongestants and blood pressure pills will interfere with sleep. Ask your health care provider or pharmacist about the medications you are taking to see if insomnia is a possible side effect.
Limit napping during the day It makes sense to avoid napping during the day if you do not sleep well at night. If you nap and still sleep well at night, do not change anything.
The use of some dietary supplements for sleep disorders may be helpful but, in general, these are not recommended. Melatonin, a natural chemical that promotes sleep, is available only in doses that are much higher than what occurs naturally. Tryptophan, an amino acid that the body uses to build serotonin, promotes sleep but was a possible cause of severe medical problems when sold as a dietary supplement. Milk, a safe source of tryptophan, acts as a sleep aid when taken before bedtime. Chamomile tea, Valerian and Saint-Johns Wort are promoted as sleep aids and may be helpful.
Sleep apnea, another treatable sleep disorder, occurs in any age or group or gender but is considered an obese, middle aged male problem. Apnea, the absence of breathing, may occur during sleep because of central (brain) conditions, airway obstructive problems or respiratory muscle weakness (polio or emphysema). Airway obstruction is the cause of snoring. When it completely blocks the exchange of air, the oxygen level in the blood falls and awakening occurs. This is associated with snorting and gasping for breath and increased risk of cardiovascular mortality. Sleep apnea is frequently unrecognized even though sleep is interrupted multiple times during the night. Usually it is noticed by the sleep partner first. Whenever it is suspected, a sleep center with trained medical personnel and specialized equipment is the best facility to confirm the diagnosis. Not only will this type of facility diagnosis sleep apnea but it will suggest the correct treatment options.
If sleep apnea is diagnosed and the patient is obese, a weight reduction program will be offered. The use of a nasal continuous positive airway pressure device (CPAP) may be indicated as well. This method of introducing air under pressure into the nasal passages helps to keep the airway open during sleep. Studies have confirmed that this treatment is successful in 3 out of 4 patients suffering from mild sleep apnea, with improvement in mood, fatigue levels and general health. CPAP needs to be prescribed by a professional. The mask must fit properly and the compressor’s settings adjusted to deliver the correct pressure. Retail prices range from $500 to over a $1000 depending on how sophisticated the device needs to be. Air pressure ranges from 3 to 20 cm of H20, humidification, mask removal indicator and quiet operation are features to look for. There are so many mask options that it would be hard to make a recommendation. Try on as many masks as possible. Consider the fact that this mask must be worn for an entire night and not slip off. Masks may cost up to one hundred dollars so picking the right one the first time is important. A health care practitioner’s prescription is necessary for the purchase of these products. Insurance coverage may be available if the sleep apnea effects are within the guidelines set by the carrier.
In certain situations, a dental appliance may be suggested. These devices are custom made and will help to maintain the airway by holding the lower jaw and preventing it from slipping backward during sleep. Getting use to them and keeping them clean may be an issue to consider. Surgical treatment, such as a tonsillectomy, may be helpful if the obstruction is amenable to surgical excision.
If a sleep disorder is suspected and behavioral changes do not help, seek the advice of a sleep specialist. Most larger hospitals and medical centers will have a sleep laboratory equipped with EEC sensors, oximetry and other sleep evaluation tools. The local medical society will have a list of qualified facilities. Call them for an evaluation. Not only will sleep be more restful but the days will improve as well.