Everything you need to know about sleep disorders

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We don’t need to tell you how important it is to get a good night’s sleep, but for many of us, that’s easier said than done. About 40 percent of Canadians will experience a sleep disorder in their lifetime and that can lead to health risks over time.

Dr. Sheila Wijayasinghe gives expert advice to soothe us into slumber.

TYPES OF SLEEP DISORDERS
There are many types of sleep disorders that are grouped into categories based on why they happen and how they affect you. Some examples include:
  • Insomnia: difficulty falling asleep or staying asleep throughout the night.
  • Sleep apnea: abnormal patterns in breathing while you are asleep.
  • Sleep movement disorders: restless legs syndrome (RLS).
  • Extreme sleepiness in the day: narcolepsy.

The good news is that with testing, we can diagnose sleep disorders, understand the root cause, and offer treatment.

SLEEP APNEA
Sleep apnea is one of the most common sleep disorders (it’s estimated 4-5% of people have it). It occurs when a person’s normal breathing patterns stop intermittently during sleep. These stops can occur hundreds of time in a night – they are generally very short periods of time, lasting seconds, but enough to often trigger a small awakening (which the individual is unaware of) which limits the quality of sleep.

It’s often identified not by the individual but by their partners who have noticed they snore, gasp for air during the night, etc.  

Sleep is a restorative time for us, so when we stop breathing, we are not getting enough oxygen to our body which is also why the sleep is not restorative and people feel daytime sleepiness.

Types
There are two types of sleep apnea:
  • Obstructive (blockage of airway – tissue in back of throat collapses) – most common
  • Central apnea (the brain fails to signal muscles to breath) – less common

The implications of untreated sleep apnea affect the heart – high blood pressure, irregular heart rate, depression, headaches, and increased stroke risk.

Also, those with untreated sleep apnea can have fatigue during the day, making it hard to function at work, school, etc.

Treatments
Treatment is CPAP (Continuous Positive Airway Pressure): it’s a mask that fits over the nose/mouth and blows air gently into the airway to keep it open. This is the most effective method we know of. If it’s not working, as it doesn’t for this viewer, you can consider trying a different fit of mask.

Some people try dental appliances that help but the evidence is limited compared to CPAP.

We also have to look at other causes if the mask does not work:
  • Extra weight on the chest/neck area will narrow the airway, so weight loss is often the first line of treatment and may reverse the apnea.
  • Alcohol use/sedatives can also contribute to the floppiness of tissue in the throat and result in apnea.

TURNING OFF YOUR BRAIN
It can be very difficult to fall asleep if it feels like our mind is working against us by staying up to think about things. A few tips:
  • Do a ‘mind dump’ before bed: we often stay awake as the mind is actively thinking about the never-completed to-do list. Keep a notebook handy and write out the concerns/to-dos by putting it down. You may not stay awake worrying that you won’t remember in the morning.
  • Disengage from the day before bedtime. Create a zone of peace/buffer zone at least 15-30min between active day and restful night. Turn off the technology, relax and prep for sleep. If all else fails – get up and do your thinking outside of bed.
  • Create a regular routine prior to bedtime, as this will help us transition to sleep: 1.Think about when you were first born and those first years of life. We generally had a routine of bathing prior to sleep, having cream applied, the lights are low, a book was read to us. This was our first sleep routine that set the stage and let our minds know that it was sleep time. We need to reclaim this again as adults! 2. Find something you enjoy – take a bath, aromatherapy, meditate (there are great sleep apps/meditation support online). The routine will alert your mind to get sleepy.

If this issue persists and the rumination of thoughts continue, you can seek support through your doctor for cognitive behavioral therapy that can help calm the thoughts. It’s evidence based and helpful.

HORMONES
Melatonin is a hormone that regulates our sleep and 24 hour rhythm. It tells us when it’s time to sleep but does not increase the drive or need for sleep.

Melatonin levels shift with exposure to light: as the lights dim, levels rise (which is why looking at our phones may interfere with this natural process) and when daylight occurs, the levels decrease.

Studies have shown that it provides about eight minutes of additional sleep per night compared to placeboes but there are some situations where it seems to work better than others, such as when your sleep pattern is disrupted:
  • Disorders of circadian (24 hour clock) rhythm
  • Overcoming jet lag
  • Shift workers
  • Those with delayed sleep patterns – sleep later in the night/early morning, can help to reset to earlier in night

Melatonin does reduce as we age – for some elderly individuals, it can be helpful to take melatonin (but check with your doctor to ensure no interactions with other medications).

Before trying melatonin supplements, try to improve your own melatonin naturally:
  • Keep lights low
  • Turn off devices
  • In the daytime, upon waking, open your windows and get good sunlight exposure to reduce melatonin and start the day alert

NATURAL REMEDIES
For some people, they wake up in the middle of the night due to a drop in blood sugar that triggers the release of adrenaline/cortisol and can wake you up. One trick that works for some people is to have a teaspoon of almond butter or coconut oil to help keep their blood sugar steady during the night.

Blue light exposure suppresses melatonin production and decreases feelings of sleepiness. The light from our devices is primarily composed of blue light – and most of us use these prior to bedtime. Try wearing UV sunglasses.

There are some blue light blocker apps that you can install or just turn off your phone/screens! 

SLEEP TALKING
Sleep talking usually occurs by itself and is most often harmless. It’s very common and is reported in 50% of young children, with most of them outgrowing it by puberty; although, in rare cases, it may persist into adulthood (about 4% of adults are reported to talk in their sleep).

If sleep-talking is dramatic, emotional, or profane, it may be a sign of another sleep disorder and testing is warranted.

SLEEP PARALYSIS
During rapid eye movement (REM) sleep, the brain has vivid dreams, while the muscles of the body are essentially turned off. While sleeping, the muscles are unable to move so that the person won't be able to act out dreams with their body. Sleep paralysis happens when a person wakes up before REM is finished but the brain is waking and the eyes open.

Sufferers become alert in a transient conscious state, but they are unable to move voluntary muscles or speak.

Triggers
It seems to be triggered by poor sleep patterns and fatigue. So, by getting more rest, it may stop these episodes. If they continue however, it’s time to see a sleep specialist.

SLEEP TERRORS
Sleep or night terrors are episodes of screaming, intense fear and flailing while still asleep. The person experiencing it doesn’t remember the episode (different from nightmares) and sleeps through the episode.
Although sleep terrors are more common in children, they can also affect adults. A sleep terror episode usually lasts from seconds to a few minutes, but they may last longer. They are:
  • Relatively rare
  • Most outgrow them by the teenage years
  • Often triggered by sleep deprivation/tiredness and/or new environments

Treatment
Occasional sleep terrors don’t need treatment. However, if they cause problems getting enough sleep, cause fear of falling asleep, or pose a safety risk, they may require treatment, as they may be a sign of an underlying sleep disorder.

MEDICATIONS AND SLEEP
Many medication groups can affect sleep patterns, including antidepressants, meds for Parkinson’s disease, cold medicine/decongestants that have stimulant ingredients, and blood pressure pills.

Pain medication can also contribute but pain itself can trigger difficulty with falling asleep so it’s important to find a balance between the two.

If you’re taking a number of medications that may be affecting sleep, have a review with a pharmacist/doctor and consider changing the schedule that you take medications to move those that may be affecting sleep to earlier in the day if possible to avoid interference with your sleep patterns. Or, switch to an alternative option that may have less of an influence on your sleep.

TEETH GRINDING
We don’t really know why people grind their teeth but some studies do show that it can be linked to anxiety, stress, smoking, caffeine and in some cases, sleep apnea.

If teeth grinding occurs during sleep, and you have daytime fatigue, it can be a sign of a sleep disorder (like sleep apnea) so if you are feeling fatigued during the day, or have poor sleep patterns, it may be helpful to get tested.


The information provided on the show is for general information purposes only. If you have a health problem, medical emergency, or a general health question, you should contact a physician or other qualified health care provider for consultation, diagnosis and/or treatment. Under no circumstances should you attempt self-diagnosis or treatment based on anything you have seen on the show. 

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