Episode 8 - Sleep
Insomnia = Sleep difficulties
Multiple causes of sleep disruption: Obstructive sleep apnea, the need to urinate, medication side effects, restless leg syndrome, heart burn, worry, mood disorders (anxiety, depression), uncontrolled asthma
Caffeine can disrupt sleep. If having difficulties would limit intake to before noon.
Alcohol- poor sleep quality even if you feel helps you get to sleep
Medications that can disrupt sleep: decongestants, antihistamines (allergy and cold meds), nicotine replacement, inhalers, stimulants, some antidepressants
Obstructive Sleep Apnea: pause in breathing, snoring, morning headaches, awaken feeling unrefreshed, fall asleep easily if driving, reading, watching tv. Underdiagnosed so bring attention to symptoms of concern. Untreated leads to uncontrolled hypertension, heart failure, weight gain, atrial fibrillation, etc
Restless leg syndrome can lead to poor sleep - discuss symptoms with your PCP
Lack of sleep leads to poor decision making, poor concentration, increased accidents, poor ability to deal with life stressors
7.5-9 hours sleep is considered adequate
Sleep Hygiene:
Exercise daily but not within 2 hours of scheduled bedtime
Consistency in bedtime and wake time.
Prebedtime routine: quite time away from lights (screens included)
Limit total time in bed to 9 hours no matter if you have slept or not
Reserve bed for sleeping only – read, tv should be done elsewhere
If not asleep in 30 minutes or not feeling sleepy leave bed and do something quiet. Return when tired
Limit daytime naps to 30 minutes or less
Cooler temperature
Dark room
Quiet environment or white noise
Cognitive Behavior Techniques
Squeeze muscle groups from head to toe 30 sec and relax
Imagery
Meditation- new apps like Calm or CBT-i coach
Set aside worry time or worry journal
Work with cognitive behavioral therapist
Other things to try
Sleepy time tea
Melatonin 3-6mg
Blue lights during day time
Usually recommend avoidance of over the counter PM meds that contain Benadryl or diphenhydramine because of side effect profile- if use do so for short term/limited basis
Prescription options: never intended for chronic daily use
Mirtazapine: especially in older adult with low appetite, and low mood
Ramelteon: works on melatonin receptors, cost has been prohibitive
Trazodone low dose often helpful
We are often avoiding medications like Ambien and Lunesta because of side effects- reasonable if using short term for certain conditions. Can be habit forming. Also avoiding benzodiazepines like clonazepam and lorazepam except for short term/intermittent use in certain conditions. Would avoid long term nightly use as linked to dementia etc.
Health Pearl: check out The Blue Zones www.bluezones.com