What can I do to sleep better: Part two


By: Raul J. Rodriguez MD, DABPN, DABAM Special to the Boca and Delray newspapers
So what happens when you try to do all the right things regarding your sleep, such as following the guidelines for proper sleep hygiene, and you still cannot sleep? At that point you may be suffering from one of many common sleep disorders and you may require treatment. Some of the more frequently seen problems include primary insomnia, sleep apnea, substance induced sleep disorders, and sleep difficulties as symptoms of a mental health disorder. Some basic knowledge of these conditions can help individuals identify certain suspicious symptoms, which can then facilitate seeking help for proper diagnosis and treatment.
Primary insomnia is a common disorder where individuals experience difficulty falling asleep, staying asleep, or have sleep that is not restful. This may happen over a broad range of ages and often for no obvious reason. Proper sleep hygiene is always the first thing to try, but medications may be necessary when this does not work. If there is an identifiable reason for the sleep problems, then it is not primary insomnia and the reason for the problem must be addressed.
Stress is one of the most common external reasons for insomnia. When the brain releases adrenaline in response to challenging events, areas such as the Reticular Activating System can remain overactive and keep a person up. Beyond just stress, actual anxiety and depressive disorders create problems sleeping as one of their main symptoms. In these cases the anxiety or depressive disorder must be treated effectively to give the sleep a fair chance at improving. If you just treat the insomnia then the underlying cause would persist and improvement will be limited. The lack of rest in these situations usually results in fatigue, which many people try to fix with caffeine in some form. This then violates one of the rules of good sleep hygiene and starts to feed into a vicious cycle of caffeine disrupting sleep, which worsens the fatigue, which then begs for more caffeine. Any stimulant, especially street drugs, would also feed into this problematic cycle.
A major medical condition that involves a different vicious of poor sleep and fatigue is sleep apnea. This is a relatively common condition where difficulty breathing when laying flat leads to sleep that is of very poor quality and not restful. Obstructive sleep apnea, the more common variant, is caused by a significant physical obstruction of the air passage by excess throat tissue that makes breathing very difficult and creates a partial arousal when the person has to gasp for air. The person may actually stop breathing for several seconds with a buildup of carbon dioxide in the blood stream triggering a gasp reflex. This typically happens many times during the night with a consequence of non-restful sleep. Many of those affected snore loudly and some are even seen visibly gasping for air as if they had been holding their breath on purpose. Those affected are usually very tired throughout the day and can have difficulty staying awake. If left untreated, obstructive sleep apnea can lead to a number of serious health problems including weight gain, hypertension, strokes, heart disease, diabetes, and sleep deprived driving accidents. Diagnosis of sleep apnea or other sleep disorders can be made with a sleep study that can be ordered by your physician. Effective treatments are available that can greatly improve quality of life, energy levels, and overall health.
Treatment of insomnia, when the cause is unrelated to sleep apnea, may require over the counter supplements or prescribed medication.
A physician evaluation is your best option when sleep hygiene and over the counter products were not sufficient to get a good result. Quality sleep, that is restful and of sufficient duration, will make a major positive impact on how you feel, as well as on your health. A good night’s rest is as important as exercise, good nutrition and proper hydration in maintaining a healthy mind and body.
Dr. Rodriguez is the founder, CEO and Medical Director of the Delray Center For Healing, which offers a comprehensive mental health treatment programs that consists advanced medical treatment, DBT therapy and skills training, and holistic treatments.