Nighttime woes can lead to wearisome days. We spend about a third of our lives sleeping, and the quality of that sleep affects our health tremendously. Dr. Asim Roy from the Ohio Sleep Medicine Institute answers your questions on insomnia, snoring and how to get a good night’s rest.
How many hours should I sleep per night?
Most adults should sleep between seven and nine hours. You can potentially get away with six, but there are few people who can get away with less than six. You can judge whether you are getting enough sleep based on how refreshed you feel afterward. You should be able to get through the following 12 to 16 hours without much difficulty, without relying on caffeine and without dozing off or feeling sleepy.
What causes insomnia?
Psychophysiologic insomnia, perhaps the most common type of insomnia, occurs when you identify your bed or bedroom as a place of frustration. As a result, individuals with this insomnia experience a hyperarousal state, most often triggered by a previous stress or life event such as a death in the family or abuse. Often that major stressor fades or even goes away, yet sleep never gets better and bad habits or behaviors maintain the insomnia.
How is insomnia treated?
Those with insomnia should practice good sleep hygiene behaviors. Exposure to light is a big part of it. Any light exposure at night will get the brain revved up – and that’s not just the lights in your house, but especially screens such as laptops, computers, television or even cell phones. Limit light exposure an hour before bedtime.
Don’t lie in bed more than 20 to 30 minutes if you can’t sleep. If you can’t sleep, get out of bed and do something relaxing, such as read a boring book, while sitting in a separate environment. Do that until you feel drowsy again and then try going back to bed. Practicing this technique helps to break the association of your bed as a place of frustration. You’re teaching the brain that the bedroom is for sleep.
We also use sleep restriction therapy to treat insomnia. For example, if prior to coming to treatment, patients are getting six hours of sleep, but they are in bed for seven to nine hours, we restrict the amount of time they’re in bed to six hours. The key feature is really the wake-up time and not the bed time. Your wake-up time should be set at the same hour seven days a week. People who vary that wake-up time by just an hour can have their bodies’ rhythms thrown off-kilter.
Are over-the-counter sleep aids helpful or harmful?
Melatonin is the most common natural aid and has minimal side effects. Melatonin is a naturally occurring hormone with levels that rise in the evening. It’s cueing the brain to say “Hey, sleep should be coming soon.” We try to supplement that natural rise. Some patients take it very close to bedtime, but often it’s better to take it three to five hours before bed.
The majority of pharmaceutical sleep aids are based on diphenhydramine, an antihistamine. The negatives of taking these are that most patients experience a morning hangover with these types of drugs. In addition, there’s a psychological dependence that starts developing when your brain relies on taking something to sleep, so we try to avoid that. These drugs may help you sleep, but they’re not treating the underlying cause of your insomnia.
Can what I eat, drink or do during the day affect my sleep at night?
Yes. First, you should eat at generally the same times of day each day. Each organ in our body has its own rhythm, and we are learning more about the genes that control these rhythms. They are important to cueing our bodies into a normal sleep pattern. Maintaining a healthful diet is very beneficial as well.
Minimize caffeine. It should be consumed mostly in the morning, so limit your afternoon intake. For some people, caffeine can last as little as five to six hours, but it can last nine to 12 hours in some people, and that can really impact sleep.
Exercise is very critical to sleep. Daily or frequent exercise helps maintain energy levels throughout the day. One of the largest surveys done on exercise and sleep showed that people who exercise a minimum of 10 minutes a day showed improvement in the quality of their nights’ rest and how they felt throughout the following day.
What are the symptoms of sleep apnea? How is it diagnosed?
Snoring is usually the most obvious symptom of sleep apnea. Other common symptoms we look for are waking up with a dry mouth, grinding teeth at night, heartburn or acid reflux at night, waking up with a headache, lack of energy during the day, waking up gasping or choking or with a racing heart and, in men, erectile dysfunction. Some people report weight gain or difficulty losing weight.
Sleep apnea can also be connected to high blood pressure. The risk for sleep apnea increases with age, and smokers tend to have a higher incidence of sleep apnea.
In children, sleep apnea can present as snoring. Kids should not be snoring at all. Children with sleep apnea can be hyperactive when they don’t get enough rest at night or can have trouble controlling their moods. It can also show up as difficulty concentrating at school.
Your partner may notice you snoring or have even seen you stop breathing, but the only way to diagnose sleep apnea is a sleep study – either an overnight study or a home sleep test. These tests monitor your breathing and your oxygen level. In a lab setting, we can also measure what stage of sleep you’re in, whether you’re dreaming or in light sleep and how that affects your oxygen status during the night, if you have any irregular heartbeats or if your apnea is due to your body position.
How is sleep apnea treated?
For moderate to severe sleep apnea, we consider CPAP – continuous positive airway pressure – to be the gold standard of therapy. CPAP delivers a low pressure of air into the airway through a small mask over the nose to keep it from collapsing during sleep. CPAP requires another night in the sleep center while we adjust how much air pressure is necessary to keep your airway open.
For more mild sleep apnea that’s due to an upper airway problem or snoring with resistance in the throat, one option is a dental or oral appliance for mandibular advancement. An upper and lower mold of your teeth is taken and the created appliance has a mechanism to pull the lower jaw forward using hinges. Adjustments are done by a dentist over the course of a few weeks.
In children, the most common cause of sleep apnea is enlarged tonsils, so surgery to remove them is our first choice if that’s what’s causing their snoring or sleep apnea.
Weight reduction is still a critical feature if the patient’s weight plays a role in the apnea.
Bio
Asim Roy, MD is a clinical and research associate at the Ohio Sleep Medicine Institute. Board certified in sleep medicine and neurology, he works in close collaboration with health care providers to deliver continuous and coordinated sleep medicine care to adult and pediatric patients. Roy completed his neurology residency at Georgetown University as chief resident and his sleep and neurophysiology fellowship at the Cleveland Clinic Foundation.
Roy decided to specialize in sleep medicine following a rotation he spent at the Ohio Sleep Medicine Institute as an intern. Under the mentoring of the late Dr. Helmut Schmidt and Dr. Markus Schmidt, he discovered the world of sleep medicine.
Roy trains medical professionals on sleep disorders management. He serves on the board of directors for the committee on accreditation for polysomnographic technologist education. He is a member of the American Academy of Sleep Medicine, American Academy of Neurology, American Medical Association and Columbus Medical Association.
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Asim Roy, MD
