How insomnia makes us sick, and how to put the problem to rest

From bangordailynews.com

There’s nothing like a good night’s rest to get you off to a fresh start on a new day. But for many people, especially those in middle age and older, that sweet sleep is an elusive dream.
Jann Jones, 62, of Glenburn remembers clearly the last solid night of sleep she got.
“It was in 1986,” she said. “I was visiting a friend’s mother in New York, and I slept right through the night.” Jones, a registered nurse, said people who suffer from insomnia hold on to the memory of a sound sleep.
“Because they’re so unusual, we remember them for a long time,” she said.
Insomnia — defined as a persistent inability to fall asleep, stay asleep or both — can strike at any age, including, rarely, in early childhood. But the likelihood of insomnia increases with age, in association with changes in health status and activity levels, as well as the influence of medications, emotional stress and the normal processes of advancing age.
Jones’ thinks her insomnia took root during a time of acute anxiety, long ago, over the well-being of her aging parents, who lived across the country.
“Finally, I told myself I could lie here and worry all I want and it wouldn’t change anything,” she said. “Eventually I was able to just shut the door on that anxiety.” Her mind has quieted on that issue, but her sleep habits have never returned to normal.
“You learn to live with it,” she said. “But those of us on the quest [for a cure] leave no stone unturned.”
While individuals differ, most adults need at least seven hours of sleep every 24 hours to be at our healthiest and most alert. Missing a night’s sleep once in a while or even a few weeks of choppy sleep because of real-life stress or anxiety is unlikely to cause serious problems, according to Dr. Ganesha Santhyadka, a board-certified sleep medicine specialist at St. Joseph Healthcare in Bangor.
“Situational insomnia can result from the loss of a loved one, the loss of a job, worries about children, parents or finances,” Santhyadka said. “That’s actually normal. But if it lasts for more than a couple of months, we label it chronic insomnia.” And that’s another story.
Chronic insomnia, especially in older individuals, can lead to debilitating fatigue; a dangerous decrease in cognitive functions, such as judgment, memory and problem-solving; and an increased risk of heart disease, diabetes, depression and other illnesses.

Prime suspect: Sleep apnea

When older adult patients with chronic insomnia consult him for help in re-establishing healthy sleep patterns, Santhyadka said, he first rules out medical causes. Chief among these is obstructive sleep apnea. In sleep apnea, often characterized by loud snoring interrupted by episodes of not breathing at all, muscles at the back of the throat relax to the point that the airway is completely blocked. Breathing may stop 30 or 40 times an hour or more for several seconds or even minutes at a time. Decreasing blood-oxygen levels jolt the brain back to activity to open the airway and resume breathing — and snoring.
Sleep is broken many times a night by these repeated apneic episodes, preventing the deep, restful slumber needed to refresh the body and brain. While bed partners and other members of the household may be kept awake by the snoring, the person with sleep apnea is most often unaware of the disruptions. The biggest tip-off is typically chronic fatigue and waking up exhausted every morning. Sleep apnea becomes more likely as we age, especially — but not exclusively — among individuals who are overweight or obese. It is also associated with underlying health conditions such as congestive heart failure and the use of alcohol and certain pain medications.
Diagnosing sleep apnea is best done through a monitored overnight sleep study performed in a clinical setting. A positive diagnosis likely will result in the patient being outfitted with an all-night sleeping mask that delivers continuous positive air pressure, or CPAP. The masks range in size from bulky “Darth Vader” models that completely cover the nose and mouth to less cumbersome ones that seal neatly around each nostril. An air hose provides pressurized room air from a quiet tableside compressor.
Gerald “Corky” Potter of Orono reported one recent evening to the St. Joseph Healthcare Center for Sleep Medicine in Bangor. Generally active and fit, the 71-year old sea kayak guide and business consultant suffered some recent health problems and hasn’t bounced back.
“I’ve always been a physical person, a worker,” he said, waiting for the sleep technician to wire him up for the study. “But recently, I’ve just been really fatigued and low energy.”
While he wasn’t looking forward to the possibility of having to use a CPAP machine, Potter acknowledged the quality of his sleep has been poor lately, impacting his mood and his ability to work, garden and enjoy outdoor activities.
In Bucksport, 73-year-old Jack Corrigan started using a CPAP about two years ago. He was reluctant at first to strap the big mask on, even though his wife had been using one for a couple of months to good effect.
“It’s just not normal to sleep with something like that on your face,” he said. But he went with it, and after just a few nights he noticed that a longstanding pain in his legs was gone. “I had been cutting off the flow of oxygen to my legs at night,” he said.
Now, he said, he feels better rested in the mornings and more alert and energetic during the day. “I don’t feel like I’m pushing a rope uphill any more,” he said. “I’m committed to it now. I think everyone should be tested for sleep apnea.”

Other causes and treatments

While sleep apnea is one common, age-related cause of chronic insomnia, there are many others. Untreated depression, anxiety and pain; gastric reflux; frequent nighttime trips to the bathroom; and many medications are all culprits.
Santhyadka said it’s important to address these issues. Light therapy, cognitive behavioral therapy and careful medication management can help. Pharmaceutical sleeping aids, including over-the-counter and prescription drugs, come with so many side effects and negative interactions with other drugs that they should be used only occasionally, he said. The hormone melatonin offers an alternative that is relatively free of side effects, he added.
But, he said, there are some basic “best practices” that can help almost anyone sleep more soundly, starting tonight.
First, make sure you’re getting enough exercise during the day. “A tired body needs sleep,” Santhyadka said. But don’t exercise vigorously late in the day, because that will excite your brain. Mornings are a better time.
Don’t drink stimulating caffeinated beverages — coffee, tea, soda or “energy drinks” — after noon. Chocolate, especially dark chocolate, also contains caffeine. Some people are so sensitive to caffeine they can’t tolerate it at all. Smoking, in addition to all its negative health impacts, also has a stimulant effect.
Enjoy your main meal at noon and a light supper in the early evening; this will help empty your stomach and reduce acid reflux and general discomfort at bedtime. Avoid any foods that cause you gastric distress. This list typically includes spicy-hot foods, garlic and onions, fatty foods and acidic foods. Eating salty snacks in the evening will keep you thirsty and uncomfortable.
Don’t drink water or other fluids after 6:30 or 7 p.m. This will help limit nighttime trips to the bathroom. Especially steer clear of alcohol in the evening. It may make you sleepy, but it very often causes you to wake up in the middle of the night and not get back to sleep.
Stop watching television, texting or using your computer at least an hour before bedtime. Studies show the light from these devices, as well as the mental stimulation of engaging with them, may contribute to sleeplessness.
Establish a soothing bedtime routine to signal your brain it’s time for sleep. This could include a warm shower, some gentle yoga and meditation, 10 minutes of relaxing reading and a quiet bit of music. Keep your bedroom cool, uncluttered and dark, with no television or pets.
If you wake in the night and are unable to get back to sleep after 20 minutes or so, don’t lie there fretting. Get up, go to another room and read, meditate or listen to soothing music until you feel sleepy enough to try again.
These practices take time and patience to establish, Santhyadka said, but often pay off in long-term improvement in the quality and quantity of sleep, without the disturbing side effects of medications.
“There are three essentials in life: water, food and sleep,” he said. “Sleep really is an essential thing.”

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