By David Schulman, MD, MPH
Every night, thousands of Atlantans have difficulty falling asleep. In some cases, the problem will be severe enough that they will seek medical advice, though many more will choose not to, believing either that the problem isn’t that big, or that there aren’t any effective therapies available. Others end up using either prescription or over-the-counter sleep aids on a regular basis. That may come with its own set of problems.
When a patient comes to my clinic, I begin the evaluation by looking at three key components of the bedtime process: the environment, evening behaviors and patient attitudes. Are the bed and pillow comfortable? Is the bedroom dark, quiet and cool (People tend to sleep better in cooler weather; making sure the ambient temperature is dropping around bedtime can often improve sleep quality). Are there other noises in the area, coming from outside or the person in bed next to you? Correction of these factors does not require much work and can often improve symptoms of insomnia.
But, some insomnia patients engage in behaviors before bedtime that make it harder to sleep. A large meal within one-to-two hours, exercise within three hours and caffeine within 12 (!) hours of bedtime can all contribute to difficulty falling asleep. Another common mistake is to use television or a computer just before going to bed – such activities can make your body more alert and cause insomnia. I am constantly amazed at the number of people who leave the television on to help them fall asleep, in almost all cases, this does more harm than good.
I spend a great deal of time focusing upon the attitudes of patients as they approach bedtime. Depression is very common amongst people with insomnia, and treatment of the underlying mood problem can improve sleep quality. Is my patient nervous or anxious? Often, underlying stress can be the major contributor to poor sleep, even if the affected individual doesn’t feel “stressed out” during the day. Indeed, many patients with chronic insomnia begin to see their bedrooms as a stressful place, and going to bed each night becomes a chore. These attitudes contribute further to anxiety, making insomnia even more likely. Breaking this cycle is a key component of the treatment of insomnia.
Treating insomnia with medication is common. The National Sleep Foundation says that 25 percent of Americans take some type of medication at least once per year to help them sleep. While occasional use of such medications is likely to be safe, the regular need for sleep aids may suggest an underlying sleep or mood disorder that should be evaluated by a specialist. The use of non-prescription sleep aids such as melatonin and valerian is also quite common. It is important to remember that these compounds are not regulated by the Food and Drug Administration, and their effectiveness or safety has not been reliably demonstrated.
Why is all of this important? There is growing evidence that sleeplessness can contribute to illness such as diabetes or heart disease, and many problems can arise when someone has not gotten a good night’s sleep – such as falling asleep while driving or while on the job. We all want to be as healthy as we can – eating right, exercising – and I can tell you that getting a good night’s sleep is just as important to overall health. If you have regular sleep problems, discussing this problem with your doctor may be the first step to finding a solution.
Atlanta, what has been your experience? Share your stories, share your ideas. Post.
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