Most people experience trouble sleeping from time to time, but when sleep problems interfere with the ability to function, it’s time to see a doctor. Sleep issues can be both the symptom and the cause of serious health issues. Fortunately, treatment options are available, from alternative approaches to prescription medication.
[sleep & aging]
According to WebMD, half of people age 60 and older experience sleep problems. But don’t ignore it, because lack of sleep can lead to cardiovascular disease and decreased cognitive ability.
an age old problem
It’s a misconception that seniors need less sleep, says Dr. Oscar Schwartz, a sleep medicine specialist and pulmonologist at BJC Medical Group Center for Sleep Medicine. In fact, Schwartz says poor or inadequate sleep can make you feel older—affecting your cognitive ability and causing you to feel more pain. “Just like diet and exercise, getting good sleep can promote longevity and life,” he says.
Biological changes as we age can make it more difficult to get a good night’s sleep, says Dr. Joseph M. Ojile, medical director of Clayton Sleep Institute. He says we tend to spend less time in the deep REM (rapid eye movement) sleep and have more disruptions in sleep. The hormonal changes of menopause also can lead to awakenings and hot flashes, and restless leg syndrome also becomes more prevalent. “Sleep apnea goes up dramatically in the elderly,” Ojile notes. “The tissues in the back of the throat get looser, which can cause obstructive sleep apnea. Certain medications can play a role, too.”
Finally, the aches and pains that frequently come with aging can make it difficult to sleep. “As we get older, more things hurt. Chronic pain, arthritis and diabetic neuropathy can make it difficult for the body to relax,” Schwartz says.
your own worst enemy
“Napping during the day for more than an hour or after 3 p.m. can disrupt sleeping at night and lead to a nonconsolidated sleep pattern,” Schwartz warns. He also sees patients who change their sleep patterns after retirement, staying up too late. Unfortunately, their internal clocks are still set for the work week, so they wake up early and don’t get enough sleep.
Others fall into the opposite routine—going to sleep so early that they don’t sleep during the night. Known as ‘advanced sleep disorder,’ this pattern is a problem only if the individual is so out of sync that it affects their socializing, Ojile says. “The key is that within a 24-hour period they get the correct amount of sleep. If it’s not bothering them, there’s nothing biologically wrong with an atypical pattern,” he says. One treatment for advanced sleep disorder is light therapy in the afternoon, which prompts patients to stay up longer.
the chicken or the egg
Not only can pain and disease cause sleep problems; lack of sleep also can make symptoms worse. “Quality of sleep and the duration of sleep can markedly increase sensitivity to pain,” Ojile says. Additionally, poor sleep can lead to memory loss similar to Alzheimer’s disease, increased risk for heart attacks and stroke, and a number of other diseases.
Because sleep problems can drastically affect quality of life, Ojile says doctors are beginning to recognize the importance of treating sleep problems as part of the patient’s holistic care.
treatment, a tricky business
As people get older, they tend to not tolerate sleep medicine as well. “Prescription sleep aids are only recommended when the benefits outweigh the risks (i.e. increased risk of falling). It’s better to find out what is causing the problem and address that,” Schwartz says. He says cognitive behavioral therapy can be very effective in treating insomnia. “Psychologists are wonderful at teaching people how to sleep better. They can help you identify things you’re doing throughout the day that affect your sleep at night. Some people are worriers and have trouble turning their brains off to sleep.”
[on the horizon]
Sleep disorder treatment options have improved greatly since the introduction in 1981 of continuous positive airway pressure (CPAP) for obstructive sleep apnea. Here’s a look at the four biggest research areas in sleep medicine and how they may improve patient care in the near future.
sleep & alzheimer’s
Dr. Yo-El Ju, a researcher and sleep medicine specialist at Washington University Multidisciplinary Sleep Medicine Center, says the next 30 years hold amazing promise for the field. Ju is one of the researchers currently studying whether amyloid beta protein levels in the brain are influenced by quality of sleep.
Amyloid plaques (or build up of the protein) are one of the hallmarks of Alzheimer’s. In earlier studies, researchers found that amyloid beta levels go down during sleep and then steadily rise during awake periods. According to Ju, one hypothesis is that during sleep, the brain clears out toxic waste, including the protein associated with Alzheimer’s. Poor sleep could lead to a build-up of the waste.
sleep & diabetes
According to Dr. Raman Malhotra, co-director of the SLUCare Sleep Disorders Center, sleep plays an important role in regulation of blood sugars, and research suggests that poor sleep may be a contributing factor in developing diabetes or pre-diabetes. “We know that many patients who have diabetes have poor sleep. This can be from getting up to go to the restroom or nerve pain. It is also very common for diabetics to have sleep apnea, which could be causing poor sleep and worsening blood sugar control,” Malhotra says.
Conversely, people who are not getting good sleep have increased appetites and have a higher chance of being obese, both of which can lead to diabetes. Poor sleep also affects hormone levels at night.
sleep & brain volume
“We know that some sleep disorders, such as sleep apnea, can lead to decreased brain function (sleepiness, concentration difficulties, mood changes) and permanent structural changes in the brain,” says Malhotra. “It is also true that patients who suffer from neurological disorders (i.e. Alzheimer’s or Parkinson’s disease) have poor sleep due to the symptoms of their neurological disorder, or direct damage from the condition to sleep controlling regions of the brain.”
Sleep plays a vital role in recovery and repair of the brain. “We should value our sleep. It may seem like a good idea to stay up late to finish a task or do something fun, but this is not healthy for your body in the short and long term,” Malhotra says. “If you suffer from a neurological disorder, it is likely that you also suffer from a sleep disorder.”
home sleep studies
Advancements in technology have improved the ability to store and transmit large amounts of data through sleep studies at home. Patients like these because they’re more convenient; insurance companies like them because they’re more cost-effective. But not everyone is in favor. “As a sleep physician, my goal is to get as much data as possible and the best quality data, so I’m biased in favor of getting studies in the lab.” Ju says.
According to Malhotra, home tests are recommended for people who are otherwise healthy and do not have any other suspected sleep problems or health conditions. “Home sleep testing is not appropriate in patients with heart failure, stroke, emphysema or where there is a concern for another sleep disorder besides sleep apnea. In addition, home sleep testing is not approved in children,” he says.
[treatment options]
Alternative medicine has been growing in popularity for years. Local practitioners say they’ve seen an increase in patients looking for less pharmaceutical approaches to their problems with sleep.
to state the obvious
It’s important to look at your lifestyle before you add supplements or pharmaceuticals, says Alethea Eller, D.C., a natural health care physician specializing in Chinese medicine, nutrition and chiropractic at Innovative Health Partners. “Unfortunately, most Americans receive their fair share of ‘uppers’ or stimulants throughout the day. I find that many sleep issues can be traced to caffeine consumption,” she notes. “While caffeine also negatively affects cortisol levels and fat storage, its sleep-hindering side effect tops the list.” Eller advises keeping caffeine levels as low as possible when trying to improve quality of sleep. Also, when people add 30 minutes of exercise to their day, improved sleep is one of the first benefits they notice.
other natural options
Teas, herbs, oils, homeopathic remedies, massage, body work, acupuncture, meditation, and even pillows and devices can help you sleep better, according to Eller. She recommends consulting a physician before adding herbs, which can have a powerful medicinal effect. “I love using the essential oil combination of lavender and marjoram (dilute and spritz on your pillow or massage into neck and upper back muscles). Magnesium and L-Theanine are both nutrition products that are incredibly safe to try to help relax the body. I use herbs that have a sedative effect like valerian, jujube and passion flower,” she says. She also cautiously prescribes melatonin. “In small doses up to 3mg, it can be helpful. It is a hormone so it should only be used for short duration.”
For select patients, including those who experience anxiety and have a hard time shutting off their brain at night, acupuncture is another option. Eller says acupuncture also can be helpful when pain and discomfort are factors in sleep loss. “Sleep is such a critical component of your health. Many of your repair processes and hormone productions anchor on a solid eight hours of deep sleep,” Eller says. “Natural products can provide relief, and sometimes a permanent solution. Good sleep is worth attaining. As your quality of sleep improves, the quality of your overall health will improve as well.”
hypnosis
If lifestyle changes are not enough, there are natural therapies available, including hypnosis. “Hypnosis can be very helpful to treat some sleep disorders,” says Joan Krueger, a certified hypnotherapist. “It works well for delayed sleep phase disorder and for advanced sleep phase disorder (circadian rhythm sleep disorders that affect the timing of sleep). It also can be helpful for people who suffer from sleepwalking.” Krueger says most patients come to her with the goal of quitting their current sleep medications. “The subconscious part of your mind is like a big filing cabinet,” she says. “It holds a record of everything you’ve ever experienced: all of your habits, behaviors, responses, reactions, memories and emotions. When you are in hypnosis, we get the subconscious part of your mind to open up intentionally (open the filing cabinet) so we can put a new ‘file’ in about how you want to function. After the session is over, your mind has new information from which to work.”
As for choosing a hypnotist, Krueger recommends seeing someone who is certified with one of the national hypnosis organizations like the National Guild of Hypnotists. Also, ask how much experience the practitioner has and where he/she practices to make sure you’re comfortable.
