Night Shift: Take Control of Your Sleep

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You snooze, you lose? No—you win.

A good night’s slumber makes us mentally crisp. But that’s not all.

“Sleep is incredibly important,” says Jean Ghosn, MD, family medicine physician at Memorial Hermann Medical Group Needville. “It regenerates our brain, muscles, bone and even cells from the wear-and-tear of daily activities, including walking and eating.”

The younger you are, the more sleep you need, he says. Children need 12 hours, teens 9-11 hours and adults of all ages 7-9 hours. “It’s a myth that the older you are, the less you need. The truth is you may be depriving yourself of essential slumber.”

If you’ve ever slogged through the day exhausted, you know the toll of insomnia: poor work and academic performance, an inability to concentrate and crankiness.

Excessive caffeine and sweet treats spike your energy, but then it crashes.

So where did you go wrong? “To get better sleep, it’s important to define why you can’t sleep,” Dr. Ghosn says. “Are you having a hard time falling asleep, staying asleep or waking up too early?”

The Challenge: Falling Asleep

Exercise is great, but like eating and screen time, it should end two to three hours before bedtime, he says. “Often we watch TV till the last minute—and that doesn’t work. We should wind down.”

Cut off caffeine mid-afternoon to curtail an over-stimulated central nervous system. And don’t imbibe alcohol in the final four hours before bedtime.

“It’s a myth that alcohol helps you fall asleep,” Dr. Ghosn says. “Also, the quality of sleep you get is not restorative.” Plus, booze is a diuretic, leading to overnight potty breaks.

Where we are active also matters: “We need to clean up our bedtime act. How we behave in the bedroom affects how well we sleep,” says Dr. Ghosn.

He believes the bed should be used for sleep and intimacy but not working, eating, reading, TV watching or social media surfing.

“Bright lights trigger pathways in our brain that inhibit our ability to fall asleep,” Dr. Ghosn says. “You also want to associate your bed with slumber, not activity.”

Remove stimuli from the bedroom, and at least 30 minutes before bedtime, power down devices that delay dozing, he says.

You can lull yourself to dreamland with progressive muscle relaxation or meditation. You should focus on a phrase, image or your breath, noting each inhalation and exhalation. Repeat until you nod off.

Your bedroom should be dark, tranquil and at a comfortable temperature.

The Challenge: Staying Asleep

A bedroom buzzsaw—your partner’s snoring or your own—can raise a ruckus that wrecks slumber. So can other health issues, such as frequent urination or depression and anxiety.

“If you’re not sleeping well consistently, you need to see your physician,” Dr. Ghosn says.

  • Culprit: Women may be awakened by night sweats or hot flashes during peri-menopause. Dry or thinning bladder tissue may raise the risk of urinary tract infections or urinary frequency.
    • Rx: Moisture-wicking nightgowns or sheets may help, as may estrogen hormone replacement therapy.
  • Culprit: An enlarged prostate in men or sleep apnea may lead to multiple middle-of-the night bathroom trips.
    • Rx: Medications may shrink the prostate gland or relax the urinary tract, making voiding easier and less urgent. If they fail, a urologist can do minimally invasive surgery.
  • Culprit: Beta blockers, ACE inhibitors and other meds for hypertension may negatively affect dozing.
    • Rx: A change in drugs can help.
  • Culprit: Anxiety, stress, depression and panic disorders.
    • Rx: Meditation or relaxation techniques can relieve, as can visits to a psychiatrist for therapy or medication.

The following may be to blame for snoring:

  • Culprit: Excess weight.
    • Rx: Weight loss by exercise, a nutritious diet and other healthy lifestyle changes.
  • Culprit: Sleeping on your back, which can cause your tongue to block airways and airflow.
    • Rx: Widening airways via nasal strips or sleeping on your side.
  • Culprit: Anatomical issues.
    • Rx: Your primary care physician can refer you to an ear, nose and throat specialist for minor surgery in your airways.
  • Culprit: Muscle relaxants, painkillers, anti-anxiety drugs and alcohol, which can relax muscles and thus narrow your airways.
    • Rx: Your doctor may suggest you quit drinking alcohol and take you off opioids, diazepam (Valium®), alprazolam (Xanax®) or other benzodiazepines.

"Some sedatives used to treat chronic pain can increase the risk for sleep apnea. It's a difficult balance that needs to be made with your doctor," Dr. Ghosn says.

  • Culprit: Congestion due to allergies.
    • Rx: Decongestants and nasal steroid sprays.
  • Culprit: Pregnancy may cause sleep apnea due to the abdomen pressing on the diaphragm, making breathing shallow.
    • Rx: Delivery and postpartum weight loss.
  • Culprit: Sleep apnea, the most common sleep disorder, affects one in 10 American adults, according to the National Sleep Foundation. It occurs most commonly in men who are obese, have a large neck circumference or have other comorbidities such as hypertension, heart failure or kidney disease. Sleep apnea increases in women post-menopause.
    • Signs: Snoring, as well as gasps and snorting during sleep as breathing stops and starts repeatedly.
    • Rx: Sleep apnea needs to be addressed, Dr. Ghosn says. “Sleep apnea can stop breathing hundreds of times during the night.”

Sleep apnea can lead not only to morning headaches, daytime drowsiness and irritability, but also a spike in hypertension, asthma and cardiovascular disease. A sleep medicine doctor can confirm the diagnosis via a sleep study.

If weight loss and exercise are not enough to stop sleep apnea, minor surgery may be needed to remove adenoids or soft tissue in the throat. A mask or nosepiece can open airways via a Continuous Positive Airway Pressure machine (CPAP).

The Challenge: Waking Up Too Early

Schedule enough snooze time. Also, try to go to sleep and awake at the same time—on all days of the week, Dr. Ghosn says.

You might be prescribed a sleep aid, such as Lunesta® or Ambien®, or an over-the-counter alternative.

“Melatonin is safe and successful. Your doctor may recommend taking three milligrams an hour before bed,” Dr. Ghosn says. “But it cannot replace other approaches. It’s almost the icing on the cake.”

 

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