Need Some ZZZZs?

Understanding sleep disorders and seeking effective treatment may help.

By Mia James

Common sense, our mothers, and medical experts all tell us that a good night’s sleep is one of the keys to health and wellness. However, unlike some other good, clean living directives—eating well and exercising regularly, for example—getting enough sleep isn’t a behavior that we can force. There are of course things we can do to improve our chances of sleeping well and sleeping enough, but for those of us with sleep disorders (medical disorders that disrupt sleep), good slumber may remain elusive without effective treatment.

Defining Sleep Disorders

In general, says Allison T. Siebern, MD, associate director of the Insomnia and Behavioral Sleep Medicine Program at Stanford University, “Insomnia is the most prevalent sleep disorder.” Other common sleep disorders include:

Sleep-disordered breathing (SDB). Disorders, such as obstructive sleep apnea, that involve disordered breathing during sleep (pauses in breathing, for example)

Circadian rhythm disorder. An inability to sleep and wake at the times required for work, school, and social needs

Restless leg syndrome (RLS). An irresistible urge to move the legs in response to uncomfortable or odd sensations

A condition that prevents adequate or restorative sleep can adversely impact your health and well-being in many ways, such as potentially raising your risk of certain chronic diseases and compromising your immune function. Dr. Siebern says that sleep disorders, particularly insomnia, may be related to weight gain, as studies are finding that sleep may be linked to biological processes that regulate hunger and appetite. As well, your daily functioning may be affected: “Certainly, mood is impacted, and so are energy levels during the daytime, and consequently, that can impact activity levels,” she explains.

Women may be more likely than men to experience trouble sleeping, and certain sleep disorders seem to be more prevalent among women, possibly due to hormonal activity. “Typically, women will report having insomnia more frequently than men,” Dr. Siebern says. She adds that pregnant women may experience an increase in insomnia during their third trimester, and all women may experience more insomnia during menopause. Sleep-disordered breathing can also increase during pregnancy and menopause. Younger women may be wise to build their knowledge about sleep disorders and treatment options now because the nature of our sleep tends to change as we age. For example, Dr.Siebern says that as we get older we get less slow wave, or deep, sleep.

The causes of sleep disorders and the reasons they persist vary. With insomnia, for example, different types of insomnia tend to have different causes. For instance, insomnia can be a conditioned response, meaning that it’s attributed to a significant event—such as a career change, divorce, or any stressful experience. The shock or anxiety associated with that event may trigger insomnia, but the disorder persists once the event has passed due to “strategies” that we put in place to cope with a lack of sleep.

Dr. Siebern says that sometimes people respond to inadequate sleep by trying to sleep more. This won’t work, she says, because “Sleep is a biological process—you can’t force it.” So, efforts to sleep more tend to backfire by raising something called the hyperarousal system. This system is responsible for the stress response known as fight or flight, and once it’s raised the mind becomes extremely alert and the muscles are tense. Naturally, this state makes sleep increasingly difficult. As a result, says Dr. Siebern, “People become very frustrated that they can’t sleep,” and the cycle of unsuccessfully trying harder to sleep continues; insomnia is thus maintained. “There are processes that help regulate sleep,” she says, “so if you try to sleep outside the times you normally sleep, you’re physiologically in a place where you’re not able to sleep.”

Restoring Sleep

Treatment of sleep disorders depends on the type of disorder. Due to the prevalence of insomnia, Dr. Siebern uses treatment options for this disorder as examples. Treatment of insomnia often begins, she says, by ruling out other health conditions that might affect sleep. This can be done with a medical history or routine physical exam. Other sleep disorders, such as SDB, must also be ruled out before you can be treated for insomnia. If breathing issues are suspected, your doctor may recommend a sleep study, or polysomnography, where you spend the night in a sleep center and your brain activity, stages of sleep, and breathing are monitored throughout the night.

If your doctor concludes that you do have insomnia, you have several treatment options—both pharmacological (with medication) and behavioral, or psychological. Dr. Siebern says that prescription medications designed to help you sleep include Ambien® (zolpidem), Lunesta® (eszopiclone), and Sonata® (zaleplon). (There are also over-the-counter [OTC] sleep aids available, but you should use these with the same caution as you use prescription medications. Always discuss use of OTC medications, and herbal remedies or supplements, with your doctor.) Though many people find that prescription sleep aids are effective, they are associated with side effects, and Dr. Siebern says that because these drugs are fairly new, we may still learn more about their long-term effects. She also says that some patients may develop a tolerance to the drugs, making them less effective over time. Some of these medications may be habit forming, and other potential side effects include driving or eating during the night with no recollection of the event, as has been reported with Ambien. With these risks in mind, it’s important that you follow your doctor’s directions when taking a sleep aid and report any side effects.

Medication, however, is not the only way to treat insomnia, nor is it always the most effective. Dr. Siebern explains that behavioral approaches to treating sleep disorders can be very effective. “We have a very effective non-pharmacological treatment called cognitive behavioral therapy for insomnia [CBT-I], which is really moving towards being the first line of treatment for insomnia.” The goal of CBT-I is to “get sleep back on track,” as Dr. Siebern says, by changing thoughts (cognition) and actions (behavior) that interfere with your ability to get restful sleep. Dr. Siebern says that CBT-I may have the long-term edge over medication: “It’s been compared [to medication] in clinical trials; long-term it’s more effective than sleep medications.” Dr. Siebern says that it’s important that the public become more aware of CBT-I because some people are hesitant to discuss insomnia with their doctor for fear that they will have to take medications.

When it comes to treatment of insomnia and other sleeping disorders, you may choose between seeing your family doctor or a doctor who specializes in sleep disorders (a sleep specialist) at a sleep center. According to Dr. Siebern, there are several advantages to visiting a sleep center, and depending on the nature and severity of your disorder, such specialized care may help you find effective remedies. “By going to a sleep center, you get the specialized knowledge of the range of sleep disorders,” she says, and with more than 90 types of sleep disorders, a specialized approach may be critical. As well, you may find access to more options for treatment. For example, CBT-I is highly specialized, and there are only 151 providers in the United States who are certified in CBT-I by the American Board of Sleep Medicine (see www.absm.org for a list of certified providers). “It [CBT-I] is not always something general practitioners know about, nor do patients,” Dr. Siebern says.

How do you determine whether visiting a sleep center is right for you? For certain disorders, such as SDB, a sleep study at a sleep center may be your first step toward effective treatment. As well, if sleep loss due to insomnia is affecting your daytime functioning, health, and quality of life, specialized care may be a good choice. Your family doctor can help you decide whether care at a sleep center is appropriate.

Something to Sleep On

Though sleep disorders can be disruptive to your health and wellness, it’s important to know that there are effective treatment options available. So, don’t lose sleep over not sleeping! See your family doctor or a sleep specialist and look forward to many nights of peaceful, refreshing slumber.

The Pros and Cons of Sleep Hygiene

Sleep hygiene—or healthy behaviors meant to support adequate, restorative sleep—is a widely recommended way to enable good sleep. Though these practices can contribute to quality sleep, Dr. Siebern explains that once a real sleep issue has developed, sleep hygiene may be frustrating. She says that she sometimes sees patients who have followed sleep hygiene recommendations and still can’t sleep and are thus not only sleep deprived but exasperated as well. “Sleep hygiene in essence is preventive,” Dr. Siebern says, explaining that following these recommendations when you don’t have a sleep issue can help you maintain sleep. Once you have a sleep issue, however, professional treatment may be the only way that you find relief.

Sleep hygiene remains, however, a potentially important part of a good night’s sleep.  Keep up your good habits but know that if you do have a sleep disorder, your best chance of finding relief is likely with professional help.

Here are a few tips for sleep hygiene:
Go to bed at the same time each night and wake up at the same time each morning.
Make sure that your bedroom is quiet and dark.
Use your bed only for sleep and intimacy.
Avoid caffeine late in the day.
Avoid alcohol before bedtime.
Relax before bedtime—taking a warm bath, listening toncalming music, or stretching may help you unwind.
Avoid taking naps after 3 p.m., and when you do nap, do so for no more than an hour.

How Much Sleep Do We Need?

The amount of sleep we need to be alert, maintain health, and feel refreshed changes as we age, according to the National Sleep Foundation (www.sleepfoundation.org). For example, the foundation’s guidelines recommend 10 to 11 hours of sleep for teens and seven to nine hours for adults.