Are you sleeping well?

We all know how important sleep is, right? But are you aware that poor sleep can be responsible for many detrimental physical and mental issues?

Poor quantity and quality of sleep, such as Obstructive Sleep Apnoea (OSA) or insomnia, can be disruptive. Not only does it affect how we feel – with foggy thinking, fatigue and poor memory – there can be more serious physical consequences such as hypertension, diabetes, and weight gain.

Occasional inadequate sleep is unlikely to result in long term consequences, so long as you’re not drinking or driving, but once the sleep loss is ongoing or chronic, more serious problems may result.

So what causes poor sleep?

Snoring with sleep apnoea and insomnia are common causes.

Poor sleep culprit 1: snoring with sleep apnoea

First of all, what is the difference between snoring and apnoea? Well, snoring is when the airway muscles relax and vibrate with normal breathing, whereas OSA is when a person snores so badly their relaxed airway partially or completely sucks shut, called an “apnoea” or “without breath”.

Snoring itself can result in broken sleep, especially for the bed partner, but someone who snores loudly is almost certain to suffer from some degree of sleep apnoea. While snoring is annoying, severe OSA is more likely to result in physical problems as described above and commonly causes daytime sleepiness.

“Sleep apnoea may be affecting the sleep of your bed partner.”

 

While sleepiness can result from many causes – from a hectic lifestyle, stress, shift work and many medical conditions – it may also be the result of poor broken sleep from OSA. Commonly, the snorer will be completely unaware of this condition, having just been told that they snore. However, treatment of OSA can very frequently result in a number of amazing benefits, especially feeling more refreshed in the daytime.

OSA is most commonly associated with being overweight, but in fact 20% of those with OSA are not overweight. Also, up to 3% of children suffer from OSA and this can have a significant impact on their growth and cognitive processing. Chronic tiredness from OSA has a significant effect on both learning and behaviour, much like Attention Deficit Hyperactivity Disorder (ADHD). So, regular snoring in children is not ‘normal’.

Most of the time, it is a partner who will report the snoring as, interestingly, although snoring can be extremely loud, the snorer is rarely disturbed by it. Simple testing can identify most cases of significant OSA, although hospitals tend to require more complex overnight tests.

Can OSA be treated?

Yes. Treatments involve keeping the airway open, and this is most effectively achieved with either a Mandibular Advancement Device (MAD), or Continuous Positive Airway Pressure (CPAP). Although the latter looks cumbersome, it is actually not difficult to use with sufficient initial support.

Poor sleep culprit 2: insomnia

Insomnia is the other major sleep disorder that impacts between 10-15% of adults. It might include difficulty falling asleep, waking frequently and struggling to return to sleep, early morning waking or any combination of those difficulties.

Insomnia is often associated with anxiety or depression, and is often called ‘hyperarousal syndrome’. Those who suffer from insomnia frequently wake, and spend the day extremely fatigued, but not sleepy.  They can’t switch off and sleep either in the day or at night.

Sleeping pills can be very effective, but that can be part of the problem – unfortunately, whilst very effective in the short term, they become increasingly less effective with time.

“Insomnia is the other major sleep disorder that impacts between 10-15% of adults.” 

 

Can insomnia be treated?

Effective ways to treat insomnia are the behavioural strategies known as Cognitive Behavioural Therapy for insomnia (CBTi).

This begins with ‘sleep hygiene’, including learning habits that help you have a good night’s sleep such as listening to your body clock, avoiding alcohol and caffeine and improving your sleep environment.

These are really important basics but often those with more chronic insomnia will need to consider further strategies. These include ‘Stimulus Control’, which strengthens the association between bed and sleep, and Sleep (Bed) Restriction Therapy, which is designed to improve ‘sleep efficiency’, the amount of time that you spend asleep while in bed. Both of these techniques are designed to improve confidence in being able to go to bed and sleep.

If you find it difficult to sleep well, try these:

1. During the day, spend as much time outside as possible, especially in the morning.
2. Have your main evening meal at least 3 hours before bedtime.
3. Limit alcohol as drinking more than 3 units in the evening after a meal is likely to result in poor quality sleep and snoring.
4. Spend some time in the evening writing down (not on the computer) any emotional worries that are bothering you at night, and then throw them away. These thoughts are not for anyone else to see! Do this well before you go to bed.
5. Write or check the diary for the next day.
6. Go to bed with warm hands and feet.
7. Go to bed when sleepy. This may be later than you would normally consider going to bed, but you are more likely to sleep quickly if you go to bed later. 
8. Avoid screen time for at least 1 hour before bed. It is the blue/green backlighting of sceens that will suppress melatonin and affect your ability to fall asleep. It is not just the light that affects sleep but also being interactive and the screen being close.
9. Avoid clockwatching at night. You may need an alarm clock in your room, but ensure that it is both out of sight and out of reach.
10. If you can’t sleep within approximately 20-30 minutes, get up, undertake something non-stimulating, and return to bed after 15 – 20 minutes or when feeling sleepy.

Good quality and adequate quantity of sleep is vital to performing at your best, not just ‘getting by’. If your sleep is not as good as you would hope, there is help available that can make a huge difference to how you feel and perform in the daytime.

Sleep well.

Dr Alex Bartle

MB BS, Dip Obst. FRNZCGP

MMed (sleep medicine)

Director of Sleep Well Clinics, www.sleepwellclinic.co.nz

 

Reference:

Kasai, T., Floras, J. S., & Bradley, T. D. (2012). Sleep Apnea and Cardiovascular Disease A Bidirectional Relationship. Circulation, 126(12), 1495-1510.