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Is there anything more frustrating than spending an entire night listening to the tick of the clock on your bedside table?

Stress and every day life events can often create periodic restless nights that can sap your vitality and zip. Without enough rest, you become more forgetful, have difficulty concentrating, become more accident prone, and often feel irritable. As we get older, the natural aging process, certain chronic conditions, and medications can all erode your chances of a good night's rest.

Sleep Disorders

Sleep disorders are more common than you might think. There are many sleep disorders, but the most common are:

Insomnia

Long-term insomnia is common, affecting nearly 20% of Americans at any time. It includes problems with sleep, such as difficulty falling asleep and/or staying asleep, frequent night wakings, sleepiness during the day, and sleep that is not refreshing. Long-term insomnia affects your quality of life and how you perform day-to-day.

Sleep troubles may seem like just an inconvenience, but if left untreated, complications from insomnia can affect your overall health

Treatments for insomnia include changing your sleep habits, avoiding stimulants, and if necessary, sleep medication.

Sleep Apnea

Sleep apnea is a potentially serious sleep disorder that has detrimental affects on your health. It is a disorder marked by complete or partial airway blockage during sleep. The blocked airway reduces the amount of oxygen in your blood several times an hour throughout the night, causing frequent awakenings. Although you may not fully awaken each time, sleep is disrupted and fragmented enough to create chronic daytime sleepiness. Complications include hypertension , heart disease, and early death.

People with sleep apnea often snore loudly or wake up gasping for air. If you or your bed partner has any of these symptoms, call your doctor.

Sleep apnea can be successfully treated with a continous positive airway pressure (CPAP) machine, dental devices, lifestyle changes, medications, or surgery. Treatment will also reduce your risk of complications.

Why Sleep Becomes Elusive

If you do not have a sleep disorder, and still have trouble sleeping, you are not alone. According to the National Sleep Foundation, a number of health problems can make sleeping difficult:

  • Pain—People with arthritis may have difficulty falling asleep or staying asleep because of painful joints. If you suffer from arthritis, ask your doctor about treatment for the pain.
  • Heartburn—Nighttime heartburn may cause symptoms of wheezing and chronic cough, with repeated awakenings and daytime sleepiness. Raising the head of the bed may alleviate symptoms, or medication may be needed.
  • Respiratory ailments— Asthma , chronic interstitial lung disease, and various neuromuscular diseases can cause awakening.
  • Menopause —The hot flashes and breathing changes associated with menopause appear to disturb sleep. In one study, hot flashes were associated with arousals once every eight minutes on average.
  • Medication—Ask your doctor or pharmacist if your medications can cause insomnia or drowsiness, and if changing the time the drug is taken could help overcome these problems.
  • Going to the bathroom—An enlarged prostate or other conditions cause an increased need to get up and go to the bathroom through the night. These multiple trips can disturb your sleep. If you are going to the bathroom multiple times per night, discuss this with your doctor.
  • Chemical changes—Production of the hormone melatonin , which influences sleep and wakefulness, changes as we get older.
Establishing Good Sleep Habits

Whether or not you have short- or long-term insomnia, your first steps will be to change the way you approach sleep. Generally, it is a combination of establishing good habits and using some common sense. Some habits may take a little longer to establish than others, but in the end, it will be worth the investment. Good sleep habits include:

  • Go to bed at the same time each night, even on your days off.
  • Reserve your bed for sleep and sex. Watch television or read in another room.
  • Avoid caffeine , alcohol , and cigarettes, especially in the evening.
  • Do not lie in bed watching the clock. If you cannot fall asleep within half an hour, get up, go to another room and listen to calming music or read.
  • Try to get some exercise every day, even if it is just for a walk, but not too close to bedtime.
  • Try to avoid naps. If it is necessary, limit it to 30 minutes and not too late in the day
  • Sleep in a cool, quiet, dark room. Wear earplugs or eyeshades to block out light and sound.
  • Sleep on comfortable bedding.
  • Limit drinking liquids a few hours before bedtime.
  • Do not go to bed hungry or overstuffed. Both may cause physical discomfort.
  • Turn off cell phones, tablets, and computers. Lights and sounds can interrupt sleep.
Sleep Medications and Herbal Remedies

A study reported in the Journal of the American Medical Association found behavioral changes provided longer-lasting benefits in the treatment of insomnia than did sleep medications. Your doctor may suggest you keep a diary of your sleep and wake habits to help determine the cause of and solution to your sleeplessness.

Melatonin supplements are not approved by the Food and Drug Administration (FDA) and lack sufficient evidence proving that they can aid sleep. However, research indicates that melatonin might be beneficial for people with jet lag. Valerian , an herb, has been used all over the world to induce sleep. There is mixed evidence to how effective it is though. Inform your doctor if you are taking any herbal supplements.

Lights Out!

Remember that sleep is a necessity, not a commodity. It is as much a part of overall health as good nutrition and regular exercise, so do not settle for a few hours per night. Crawl into a comfortable bed, don your earplugs, and turn off all the lights. Sleeplessness and sleep disorders are treatable. If you try different methods and you still have problems, make an appointment with your doctor.

Resources:

American Academy of Sleep Medicine
http://www.aasmnet.org

National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES:

Better Sleep Council Canada
http://www.bettersleep.ca

Canadian Sleep Society
http://www.css-scs.ca

References

Bradley TD, Floras JS. Sleep apnea and heart failure: Part I: obstructive sleep apnea. Circulation. Apr 2003;107(12):1671-8.

Brennan R, Jan JE, Lyons CJ. Light, dark, and melatonin: emerging evidence for the importance of melatonin in ocular physiology. Eye. Sep 22, 2006.

Can't sleep? what to know about insomnia. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep. Accessed June 3, 2014.

Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 28, 2013. Accessed June 3, 2014.

Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/biomedical-libraries/natural-alternative-treatments. Updated August 22, 2013. Accessed June 3, 2014.

Morin CM, Koetter U, Bastien C, Ware JC, Wooten V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep. Nov 1, 2005;28(11):1465-1471.

Tasali E, Mohkalesi B, VanCauter E. Obstructive sleep apnea and type 2 diabetes: interacting epidemics. Chest. 2008;133(2):496-506.



Last reviewed June 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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