Sleep Problems

A problem with your sleep can often have serious consequnces during the day as well as the night. If you do not get good sleep at night, you may find that you are tired and listless while awake, and may not be able to function at your best in work or school. You may also be less able to recover from illnesses, and may be more likely to suffer from concentration or mood problems.

Types of sleep probelms that are identified by their cause include:

• Primary Insomnia - A problem sleeping that lasts at least a month, leads to problems during the day, and is not caused by another medical, mental, or chemical problem.
• Breathing-related Sleep Disorder - A sleeping problem judged to be related to sleep-related breathing condition such as obstructive sleep apnea (a condition in which you stop breathing during the night and wake up choking), uncontrolled asthma, or central alveolar hypoventilation syndrome.
• Insomnia due to a general medical condition - This can include conditions such as severe pain, upset stomach, headaches, needing to go to the bathroom frequently to urinate, and poor sleep due to the effects of another physical illness such as a heart problem or hormone problem.
• Narcolepsy - Irresistable attacks of deep sleep that strike daily for at least 3 months.
• Insomnia related to another mental disorder - A sleep problem caused by depression, mania, stress, or anxiety
• Substance Induced Insomnia - Sleep problems that are caused by the use of caffeine, alcohol, stimulants, pain medications, herbal medications, over-the-counter medications, prescription medications, or some of the addictive drugs.

There are many patterns in which your sleep can be disturbed:

• Hypersomnia - Excessively long sleep episodes at night, or frequent daytime sleep episodes
• Initial Insomnia - Significant trouble falling asleep in the early part of the night
• Middle Insomnia - Waking up in the middle of the night and having a difficult time falling back asleep
• Terminal Insomnia- Waking up too early
• Circadian Rythym Sleep Disorder - A mismatch of your body's natural sleep pattern and the normal schedule for your time zone or work schedule.

1. Delayed Sleep Phase Type - falling asleep and waking up late, and being unable to fall asleep and wake up earlier
2. Jet Lag Type - sleepiness and alertness occuring at the wrong time after travelling across more than one time zone
3. Shift Work Type - Difficulty sleeping during sleep time and being sleepy during awake time that occurs with night shift work or frequently changing work hours.

An accurate diagnosis of the type and cause of your sleep problem is essential for helping you to overcome it. Different sleep problems respond to different strategies, and using the wrong ones might make things worse.

When medications are used to improve your sleep, they might be used to correct the root cause of your sleep problems, or to make you more tired and sleepy. There are two main types of sleep medications: habit-forming and non habit-forming.

Habit-forming medications can be very effective, but are meant to be used for short periods of time, and can be dangerous when combined with alcohol. These medications tend to have very few side effects when used appropriately, but they can slow reaction time when driving. Elderly people with memory problems can become very confused with these medications. These medications are not recommended if you have experienced problems with drugs or alcohol in the past. These medications can worsen depression in some people, which also is a cause of poor sleep.

Non habit-forming medicaitons include sedating antidepressants (such as Trazodone, Remeron, or Elavil) and over-the-counter antihistamines (such as Benedryl or Unisom). These medications can be used indefinitely if needed, and do not result in potentially dangerous withdrawal reactions. These medications may have a greater variety of side effects, but can be used for very long periods of time without losing strength.

Sleep Hygiene

You can often improve your sleep dramatically by using several tried and true habits of healthy sleep practices that we call "sleep hygiene." These steps are most difficult when you first begin to use them. If you use them faithfully, they should become easier with time, and eventually will feel very natural and automatic. Most people can remember from their own experience that it is hardest to sleep at the right time just after travelling across time zones, but that after a few nights of "forcing" yourself to get into bed and get out of bed at the right time, it becomes natural.

1. Have a regular time to get in bed every night, no matter if you are already sleepy from before, or are not yet sleepy.
2. Have a regular time to get yourself out of bed every morning, no matter if you woke up hours before, or still feel you need more time in bed.
3. Unwind early in the evening. Try to deal with worries and distractions several hours before bedtime.
4. During the hours you are supposed to be in bed, you shall not engage in any activities such as cleaning, watching TV, listening to music, eating a snack, or turning on the lights. If you must go to the bathroom, you should return to bed straight away.
5. If you are tossing and turning for more than 20 minutes during the hours you are supposed to be in bed, you should transfer to a comfortable chair and sit in the dark, with no noise, with your eyes closed, and wait until you are feeling yourself getting sleepy. Then get right back into bed.
6. During the hours you are supposed to be out of bed, you should not take any naps.
7. You should not use your bedroom for any activies (day or night) except for sleeping or sexual activity. If you use your bedroom like a den (watching TV, playing games, listening to music, paying bills) then your bedroom will feel like a den when you try and sleep in it. Your bedroom should be dark and free from noises that may disturb your sleep.
8. If you work night shift during the week, then continue to get into and out of bed at your regular time on the weekends too.
9. Sleep on a comfortable, supportive mattress and foundation. It's difficult to sleep on a bed that's too small, too soft, too hard, or too old.
10. Exercise regularly. Regular exercise can help relieve daily tension and stress – but don't exercise too close to bedtime or you may have trouble falling asleep.
11. Don't smoke. Smokers take longer to fall asleep and wake up more often during the night.
12. Avoid alcohol. Drinking alcohol shortly before bedtime shortens and fragments sleep.
13. Cut down on stimulants. Stimulants, such as caffeine in the evening, can make it difficult to fall asleep.

Audio Programs

• Insomnia Podcast (hosted by Peter Hendler MD) - Listen to a discussion with Psychiatric Nurse Pam Boyer about sleep problems and how to address them (21 minutes).
• Sleep Apnea Podcast (hosted by Peter Hendler MD) - Listen to a discussion with Douglas Tapper MD about Sleep Apnea (19 minutes).