Posted on November 29, 2011
by Eileen Marie Wright, M.D.
Our bodies truly need restorative sleep to function at an optimal level. What serves as enough sleep varies from one individual to the next, as well as from one stage of life to another. But, regardless of how much sleep we need to feel at our peak, if we deprived of it for too long, we suffer functionally, physically, and emotionally.
Occasional sleep disturbances are a natural consequence of life stresses. Periodic excitement, anticipation, grief, or anger can all disrupt sleep. If these disturbances are sporadic, our bodies can usually compensate for them. Frequently disturbed sleep, however, interferes with health. It causes problems in the equilibrium of our nervous system leading to fatigue, irritability, lack of focus, and eventually disturbs our endocrine (hormone) and immune systems as well.
Sleep can be disturbed in many different ways and for many different reasons. I'll discuss a number of these below. But I will also suggest that if you suffer from disturbed sleep, you read the information on good sleep hygiene because the many sleep disturbances begin to improve when these guidelines are followed and they are a positive compliment to all other sleep therapies.
Difficulty falling asleep—a “sleep initiation” problem—is a common complaint. For many, the problem is an over active mind that just doesn't want to “shut off.” Our hectic, fast-paced lifestyles, the need to bring work home in the evening, working late, working off-hour shifts, eating late, or excessive mental stimulation too close to bedtime can all contribute to this problem. Some types of depression and anxiety may also cause problems with sleep initiation.
Another issue involves difficulty staying asleep. In this case, falling asleep may be easy but there may be intermittent nighttime awakenings or early-morning awakening associated with difficulty returning to sleep. (Look for an upcoming blog on “second sleep”) Bladder irritability or prostate problems are a common cause of frequent awakenings through the night, and if this occurs only once or twice and falling asleep again is not difficult, it may not represent a problem. For some, however, the awakenings are too frequent to allow for restful sleep in between, or they cannot fall back to sleep easily after getting up. In these cases, having the underlying bladder or prostate issue treated is the best remedy. Another helpful hint is remembering to keep the light low if you are forced to get up in the night. Bright light, even for a short period of time in the middle of the night, may be enough to decrease melatonin production, making it harder to return to sleep. Anxiety problems or restless leg syndrome may also be associated with frequent awakenings. Some types of depression are associated with early-morning awakening between three and five a.m. with the inability to return to sleep—causing several hours of sleep deprivation night after night.
For others, the problem is not falling asleep or fully awakening during the night, but rather restlessness that leaves them unrefreshed when they awaken—even if they have been sleeping for eight hours. This problem can be associated with a number of environmental issues. Distracting noises from inside or outside the sleeping area, uncomfortable temperatures (too cold or too hot), poor ventilation of the sleeping area, poor mattress comfort, chronic pain, and nasal or other airway obstruction (simple snoring or sleep apnea), electromagnetic disturbances can all contribute to unrefreshing sleep, even if the person is not aware of frequent awakenings. I can recall one patient with a particularly frustrating issue with unrefreshing sleep that had failed many different potential solutions. Her ultimate “fix” was moving her bed so that it no longer shared a back wall with her refrigerator! Most of these issues are best addressed by manipulating the environmental problem, treating the allergies or other causes of nasal congestion, or if snoring is the issue, arranging to be evaluated for possible sleep apnea. (Your physican can arrange for you to be tested for this at home. Chronic low-grade pain that leads to unrefreshing sleep is another issue that may need to be solved before sleep can improve.
The last common cause of disturbed sleep that I will discuss here is the use of over the counter stimulant medications, stimulant prescriptions or street drugs, and stimulant foods or herbs—such as sugar, chocolate, caffeine, nicotine, ginseng, and phenylalanine, a common additive to sodas and energy drinks. If you use any of these substances and your sleep is disturbed, limiting or eliminating their use can often resolve the problem. If you are regularly using stimulant prescriptions or street drugs, withdrawal should be medically monitored to be safe. Most smokers experience withdrawal symptoms or cravings when they try to stop smoking and often seek help from nicotine gum or patches. Even withdrawal from a serious caffeine habituation can cause intense headaches if done too rapidly so take some time or seek help from someone experienced with addiction issues.
Please remember that unconsciousness does not necessarily equal quality sleep. Our bodies are meant to cycle through several different stages of sleep during the night and this cycling is essential to awakening refreshed. Many prescription sedative hypnotic drugs commonly prescribed for insomnia disturb this natural cycling process even though they induce sleep. Many of these drugs have the potential of causing "side effects" in the endocrine and immune systems when used chronically.
