Daily Health Center

Sleep Your Way to Great Health

"Doctor, I can't sleep" is one of the most frequent complaints I hear from my patients. 

And no wonder: approximately 40 million Americans suffer from chronic sleep disorders, with another 20 to 30 million experiencing intermittent sleep disturbances. Yet, good sleep is vital to your health, especially if you have a heart problem.

Poor sleep can cause chest pain and cardiac arrhythmias. In fact, research has determined that sleep disturbances can increase mortality in patients with a known history of cardiovascular disease.

So let's look at what's causing you to toss and turn and what you can do to get your ZZZs.

But first...

What is Disrupted Sleep?

All of us have had the experience of waking two or three times during the night, occasionally not falling asleep at all or getting up too early. When we are anxious or depressed, we are particularly vulnerable to sleeplessness.

This is normal, but when interrupted sleep or the inability to sleep becomes a way of life, you have a problem. Some of us have even more serious difficulties, such as chronic insomnia, sleep apnea (a common breathing disorder that interrupts sleep) or narcolepsy (sudden, uncontrollable "sleep attacks").

For these situations, I recommend that you be evaluated by your doctor or even a sleep disorder center.

Since obstructive sleep apnea syndrome is sometimes misidentified as "heavy snoring," I'd like to take a moment to talk about it.

Obstructive sleep apnea syndrome occurs in about two percent of women and four percent of men. This disorder results when a blockage in the upper airway causes you to temporarily stop breathing. The problem is frequently first recognized by a spouse who may fear his or her partner is asphyxiating.

Signs of obstructive sleep apnea syndrome include excessive snoring or early morning headaches. If you suspect you or your partner may have this disorder, see a doctor. The remedy for sleep apnea can be as simple as weight loss, assessment of thyroid function, and/or the omission of alcohol or drugs known to cause apnea and insomnia.

What's Coming Between You and Your ZZZs?

Speaking of drugs, let's take a look at some that come between you and your sleep.
Perhaps the best known of these is caffeine, a stimulant guaranteed to keep you awake after hours. Many of my patients say they can't fall asleep after drinking coffee or eating other caffeine-containing substances such as chocolate. The combination of a cup of coffee in the evening with a piece of chocolate cake can come back to haunt you as you're trying to fall asleep. Also, beware of over-the-counter drugs—such as cold and cough preparations—that often contain caffeine.

Another drug known to cause insomnia is alcohol. Believe it or not, alcohol is probably the leading cause of insomnia in America today. There is a false notion that alcohol induces good sleep. Although alcohol may anesthetize you so that you feel as though you are in a relaxed state, the resulting sleep pattern is not a healthy one.

But alcohol isn't the only culprit. Prescription drugs can interfere with good sleep. Some of the more common ones include:

• beta blockers,
• steroids,
• antidepressants,
• diuretics,
• bronchodilators (including inhalers),
• the nicotine patch and nicotine gum, and
• some cholesterol-lowering drugs, such as Mevacor.

Sleep and the Cardiac Patient: Nothing to Snooze At

Do you ever wake up with chest pain?

If you have a coronary blockage, an increase in heart rate during the REM sleep cycle or even frequent awakenings can cause reduced blood flow to the coronary vessels. When this happens, you may wake up with chest pain, shortness of breath or sweating.

This is a form of nocturnal angina pectoris or heart cramp. If you experience any of these symptoms, ask your doctor for a spray or sublingual nitroglycerin to help keep your blood vessels from constricting during the night.

In addition to nocturnal angina, research has confirmed a link between frequent awakenings and cardiac arrhythmias. Early morning awakenings, particularly as a result of bad dreams or nightmares, have been associated with a high incidence of cardiac arrhythmia and angina.

So what can you do to improve the quality of your sleep?

10 Tips for Getting a Good Night's Sleep

Probably the most important advice that I can give you is that if you cannot sleep, don't get into a war with yourself. Blaming yourself won't help you relax. If you wake up in the middle of the night, resist the impulse to look at the clock. Clock-watching creates a sense of vigilance that inhibits sleep and can make you more anxious.

Here are 10 suggestions to help you sleep better:

• Avoid daytime napping.
• Maintain a regular bedtime and waking time. Research has shown that turning in before 11 p.m. induces better sleep.
• Avoid heavy meals before bedtime. However, an evening snack, particularly of tryptophan-containing foods, such as a half turkey sandwich or a banana with milk, can induce sleep. Tryptophan is an amino acid that produces a calming effect in the brain.
• Create a late-evening environment conducive to the way you like to sleep. For example, the humming of an air filter in my room often lulls me to sleep.
• Make sure your bedroom is dark. A very dark room stimulates natural production of melatonin, the hormone that tells your brain it's time to sleep. Even low light from alarm clocks, cable TVs and open shades can interfere with melatonin production.
• Try to avoid nonsleeping activities in your bedroom like paying bills and watching TV. Reading in bed is an exception, since books can help lull you to sleep.
• Herbal preparations and teas can help you sleep. Try a cup of chamomile tea with herbs like valerian root, passionflower, or hops 45 minutes before bedtime.
• Exercise early in the day. Be careful not to exercise too late in the evening since you may be too energized to sleep.
• Unwind with a relaxing bedtime ritual like taking a warm bath, listening to soothing music or breathing deeply for 10 minutes.
• Meditate, pray, or perform breathing exercises before turning in for the night. These are great ways to rid your psyche of the day's stresses and worries (which can spark bad dreams) and enter sleep from a positive, relaxed state.

Words to Sleep By

Keep in mind that our need for sleep is highly individualized and changes over time. There is no "right" amount of sleep for everyone. Some people may require eight to 10 hours, while others may feel great with only four or five. And, I believe the quality more than the quantity of sleep matters most.

Rest assured that most sleep disturbances are treatable. You may find relief by incorporating just one or two of my suggestions. But, don't be afraid or embarrassed to share your sleep problems with a professional. After all, good sleep is good medicine.

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