Dr. Swiner’s Medical Notes, Jan.2013–Problems Sleeping?

Problems sleeping?

working mother and wife, I rarely have this problem. However, as I’ve seen more patients, the more I discuss this topic. It’s a difficult one, because the causes can be multi-factorial.

The most common one I see is the “busy person” syndrome. This, to me, seems to happen more for my female patients, as we all strive to be the best, busiest, most efficient mothers/wives/daughters we can be. Most of us right now are working a full time job and trying to balance our marriage/home/children with it. After 8-12 hours of work, the job doesn’t end. Your second job begins as you come home to prepare meals, pick up the kids, or take care of elderly loved ones. You’d think that by nighttime our bodies would be ready to wind down and rest, and they are, but our minds aren’t. Once the exhausted bodies lie down to essentially pass out, the brain’s motor is still running. Lists of what didn’t get done today, what was forgotten, or what has to be accomplished tomorrow continue to lengthen in our minds. Sometimes, it’s nonstop. This can disrupt sleep tremendously.

Things I normally suggest have to do with relaxation in these situations. We need a “wind down” period to get our bodies ready to rest well. That includes turning off the things that stimulate us, including the TV, loud music, computer, and bright lights at least an hour before bedtime. Even if you’re not actively working, your eyes and brain continue to process data as if you are. Having relatively the same routine at night helps as well. This notion, called “sleep hygiene”, means training your body to recognize your same pattern every evening. Eat your last meal, exercise (no closer than an hour before bedtime), take your shower, read, and get into the bed around the same times every day, and this leads your body and mind to expect the same routine, just a baby’s would. This leads to better, more consistent rest. Some like to pray, stretch, do yoga, or meditation before bedtime. Do whatever works well for you. I wouldn’t suggest watching your most exciting, most dramatic TV show as the last thing you do (as I’ve often done). That doesn’t help to relax the mind much at all.

If your busy mind won’t turn off, write your ‘to do’ list before going to bed and keep it next to you on the bed stand. If you awaken with another item on your mind, write it down and then turn over to return to sleep.

Another thing I’ve read about in studies is to use the bed only for sleep. This may sound funny, as there are many other things we do in bed, but for the purpose of better rest, it is suggested that reading, working, being on the computer, or other activities in the bed, lead our minds not to think of the bed as our resting place. As noted above, it has to be trained to think so.

If you’re a caffeine fiend like I am, cut yourself off from caffeinated beverages at 3pm or earlier. Yes, that means no iced tea with dinner or caffeinated coffee with dessert. Our bodies need many hours to get that out of our system. A similar effect is true for alcohol. That nightcap that often relaxes you after dinner and before bed may help you rest initially, but the effect of alcohol after a few hours is actually stimulating. You’ll soon begin to awaken in the middle of the night, unable to go back to sleep if you use this method too often.

Lastly, if nothing else helps, there are medications. One I always start with is Melatonin, which is a natural element that already occurs in our body. Its level rises when it’s time to rest. With this action in mind, if we take it as a supplement an hour or so before bedtime, it can help usher in sleep without causing a ‘hangover’ the next morning. We all know that medicine ‘hangover’ feeling; the feeling of grogginess and drowsiness that doesn’t go away when you wake up the next morning. This commonly occurs with the over the counter medicines, such as Tylenol PM (the PM=Benadryl), Unasom, and the like.

Prescription medications exist, such as Ambien, Lunesta, and Rozerem, but there are side effects. I don’t use Ambien as much as I used to as more and more of my patients complained of strange side effects, such as nightmares and sleep walking, as time went on. Clearly, those effects didn’t help them rest. However, some situations do call for use of prescription medicines, so please talk to your healthcare providers first before trying your friend’s or spouse’s pills.

Most importantly, there are medical conditions associated with insomnia that we don’t always think about. These would include hypothyroidism, menopause, depression, anxiety, enlarged prostate, overactive bladder, and sleep apnea, to name a few. So, as you can see, a sleepless night may not be just a sleepless night. Chronic insomnia can lead to chronic fatigue and other poor health conditions so don’t ignore the signs if they are long standing. Let’s toast to good rest for all of us this year.

Be healthy and be blessed,

Dr. Swiner

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