Sleep Like A Baby

The one-third of your life you spend between the sheets can be a key to good health in the other two-thirds. Here are two problems to watch out for.

Do you sleep enough—and well enough? It’s common to have difficulty falling or staying asleep from time to time. But when sleep problems cause ongoing issues—including daytime sleepiness, loud snoring, choking, gasping or coughing during the night—it’s time to consult your doctor about it, says Jeffrey Barasch, M.D., medical director of The Center for Sleep Medicine at The Valley Hospital in Ridgewood. And if such symptoms persist for three months or more, adds Srikant Kondapaneni, M.D., a pulmonologist at Englewood Health, a visit to a sleep specialist physician is in order. Just in time for Sleep Awareness Week (March 13–19), BERGEN tapped these two doctors’ expertise on what they say are the two most common conditions seen by sleep specialists: obstructive sleep apnea and insomnia.

• Obstructive sleep apnea. This is a serious sleep disorder in which there are repeated breathing interruptions during sleep. Sleep apnea occurs when muscles in the upper airways relax during the night; this causes tissues in the upper airways to cave in, blocking the airways. When this happens, oxygen levels in the body temporarily drop, causing the person to repeatedly stir and awaken. “This pattern can occur from five times an hour to more than 100 times,” says Dr. Barasch.

Sleep apnea affects a person’s quality of life, increases the risk of many chronic illnesses such as hypertension (due to the drops in oxygen level and rises in adrenaline) and raises the risk of accidents. Most cases of sleep apnea are undiagnosed. “Some patients have few or no symptoms and are notified by their bed partner of their loud snoring or visible apneas,” notes Dr. Barasch.

But for those with symptoms, symptoms can include:
• snoring
• waking often at night
• episodes of gasping, choking or coughing during sleep
• breathing pauses during sleep
• excessive daytime sleepiness or fatigue
• drowsy driving
• poor memory and concentration

To diagnose sleep apnea, an in-laboratory sleep test is preferred over a home sleep test. A doctor will order a nighttime sleep study, an EEG (electroencephalogram, or brainwave test) and an EKG (electrocardiogram, which measures cardiac rhythm), monitor muscle tone and eye movements and take other biologic measures during sleep, says Dr. Barasch. “The test also detects the apneas and drops in oxygen levels.”

The “gold standard” of sleep apnea treatment for the past 40 years has been the continuous positive airway pressure, or CPAP, machine. This is a device—more technologically advanced now than it was at the start, of course—that delivers air under pressure to the upper airway via a nose mask or face mask, keeping the airway open during sleep.

People with moderate or severe sleep apnea who have tried and failed with CPAP could be candidates for Inspire, an implantable upper-airway stimulation device. It is inserted under the skin beneath the collarbone and is similar in theory to a pacemaker. “The patient turns it on when going to sleep, and during each breath the pacer sends an electric pulse that stimulates the tongue to move forward,” Dr. Barasch says. “This prevents the airway collapse in the throat, which results in apneas.”

However, notes Dr. Kondapaneni, “Inspire is not for everyone. There are some limitations to its use if you have some medical issues (such as already having a pacemaker), and there are also weight limits.” Ask your doctor if you’re a good candidate for this treatment.

• Insomnia. A person with insomnia has difficulty falling or staying asleep or may wake up too early, and the condition has become more prevalent since the pandemic. “Sleep routines are changing due to a decrease in structure during the day,” says the Englewood doc. “For example, we’re doing more late-night bingeing of TV shows since we don’t have to wake up early to commute, and doing more work in our bedrooms.” Causes of people’s insomnia vary, but can include:

• restless leg syndrome
• medical problems that cause body aches, pain or difficulty breathing
• certain medications or drugs, especially caffeine, asthma medications and decongestant cold or allergy medications
• anxiety, depression and/or stress “Insomnia can also have behavioral causes such as poor sleep hygiene, like watching TV in bed, doing work in bed, having pets/ kids in bed or using your phone/email/social media,” says Dr. Kondapaneni.

He notes that adults should aim for seven hours of a sleep per night, on average. “There is a group of people who are genetically predisposed to need less than seven hours of sleep,” he says. “As long as you’re refreshed after sleep, not fatigued or sleepy during the daytime and are healthy, then most likely you are getting enough sleep.”

TIPS FOR BETTER SLUMBER
OK, we admit it. The term “sleep hygiene” can make it sound like it’s your fault that you’re not getting enough good sleep. Not necessarily! But as you decide whether to pursue medical assessment and treatment of your snoozing difficulties, it’s simple good sense to do what you can to improve your chances of a restful night. How well, for example, are you following these seven tips?

• Go to bed at the same time every night and wake up with an alarm to stabilize the biologic clock. Avoid sleeping in by more than an hour on weekends or after a poor night’s sleep.
• Avoid physical or mental stimulation, including caffeine and exercise, half an hour to one hour before bed.
• Avoid alcohol and eating just before going to bed.
• Avoid light exposure for half an hour before bed, including from a TV, computer or video games.
• Avoid watching the clock or checking the time during the night.
• Avoid daytime napping, especially long naps or naps late in the day.
• If you’re unable to sleep for more than 30 minutes, get out of bed and do something relaxing, such as listening to music or an audiobook.

Sources: Jeffrey Barasch, M.D.; Srikant Kondapaneni, M.D.

THE DANGERS OF LOSING SLEEP
Yes, you risk being cranky and fuzzy-minded tomorrow if you don’t get your proper Zs tonight. But long-term, it can be a bigger deal than that. Persistent lack of sufficient quality sleep can increase your risk of:

• diabetes
• heart disease
• high blood pressure
• impaired memory
• lack of alertness
• obesity
• stroke