Sleeping Disorders
by Dr. Mo Lerner

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It can be a safe haven from the trials of living, representative of all that is peaceful and secure. It can be a playground, a place of fantasy, love, and dreams. For some it can be a sensory deprivation tank where all the evils of the mind plague them with ruminations of what they lack, and what could have been. I speak, of course, of that special place where we spend almost one third of our lives-the bed.
What is considered a normal amount of sleep? Some people need very little. Einstein only slept a few hours a night. But modern research indicates that six to eight hours of sleep is best for most people. The body, including the brain, needs time to recharge. One third of North Americans suffer from some sort of sleep disorder. It affects females slightly more than males for unknown reasons.
Sleep occurs in stages. Much of the scientific focus has been on the so-called rapid eye movement (REM) stages. Although dreams appear to last forever, in reality they occur during approximately seven episodes of REM a night, lasting only a few moments each. With REM the brain is actually in a very deep sleep mode where many of the areas are resting and replenishing energy. Other areas, like the memory and imagination centers, are busy generating dreams. No one is sure about the purpose of dreams. Perhaps they are a form of mental exercise, getting us toned for the tribulations of daily living. The brain is like a powerful computer with billions of wires communicating via messenger chemicals. If something goes wrong with the chemical balance, some of the wires may misfire, slow down, or not fire at all. As we get older, the messenger chemicals dwindle and REM sleep diminishes. The elderly often sleep poorly, taking longer to fall asleep and waking up more frequently.

There are other interesting conditions that can hinder sleep. Restless Leg Syndrome might sound appealing to rock stars, but it is a common problem for others trying to fall asleep. Legs feel uncomfortable, tingly, or irritated, and only movement offers relief. A sleep partner might complain of being kicked. The cause is unknown, but avoiding heavy meals, sugar, or other stimulants before bed time helps. Certain antidepressants and drugs for psychosis can make the legs restless and need supervised adjustment or discontinuance.

By far the most common cause of insomnia involves difficulty in switching off thoughts. Ruminating about a predicament can become a vicious cycle of anxiety, sleeplessness, anxiety about the sleeplessness and so on. Learning relaxation techniques or getting emotional support will go a long way to solving the problem. Early awakening with inability to get back to sleep is one of the most common signs of depression. If you find yourself in bed, angry with the way things are going, full of self-hatred and bitterness or with a sense of not wanting to face the chores of daily living any longer, this means you must get help.

Snoring and sleep apnea are often related to body fat. The tongue and soft tissues in the throat can get fat, obstructing air entry. When you fall asleep all the muscles that normally maintain tone in the throat relax, allowing these areas to collapse, and the tissue closes the opening considerably. As air is sucked in and out it vibrates against a smaller opening creating snoring and whistling sounds. Apnea means "without breath" and on rare occasions breathing may momentarily cease followed by a sudden snorting and sputtering as respirations resume. The resultant lack of oxygen can put a strain on the heart and increase blood pressure. Apneics often wake up several times a night and feel robbed of sleep in the morning or have a throbbing headache. Often there are uncontrollable bouts of dozing off during the day. Happily, there are treatments available, including a face or nose mask that keeps the airways open during sleep through steady back pressure of air. Traditional therapy includes stopping all medication, which might decrease the respiratory rate, and advice to "lose weight." Enlightened physicians will tell you that you do not have to lose large amounts of weight; a few pounds often make a big difference. Surgery to remove some of the obstructing tissue may be advisable in some cases.

In order to find out what your particular sleeping problem is, if any, you may want to attend a sleep laboratory. The doctors and technicians observe your sleep pattern overnight. They measure your brain waves to see if you have the right mixture of REM and other stages. Blood and oxygen pressure gauges as well as heart heat tracings are observed for variations related to snoring and apnea.

Contrary to popular belief, alcohol is not a great sleep tonic. True, it has a sedating effect at first but when it wears off the wires are jumpy. This irritability alters cycles of REM and can cause withdrawal. Wake-up can be painful, with headache, malaise and shaking. And don't look to caffeine, nicotine, or late night refrigerator raiding to help you fall asleep. All of these things are stimulants, making sleep more difficult.

For most of us, sedatives or hypnotics do the trick in the short term. Yet I have never seen a patient come to me for a one-time only prescription. Valium and its relatives are amongst the largest selling drugs in the world and for good reason-they tend to be habit-forming. The problem is rebound i.e. when the medicine is stopped sleeplessness is worse.

Probably the best technique is graduated sleep restriction. Many people go to bed before they are ready. They might have had naps during the day which have altered the natural sleep cycle. Try avoiding naps during the day and adjusting the hours of wakening. If you normally get up at eight, wake up half an hour earlier. The body will be more prepared for sleep at night. Don't force your bedtime at first; if you stay awake for a couple of nights it will not harm you. Fatigue will eventually set in and you will soon fall asleep in a more timely fashion. Remember that the bed is for sleeping, except for the occasional bit of intimate "recreation." Lying in bed playing video games or watching television is not a good hypnotic. Go to bed only when it is time to sleep. If you still have a problem sleeping, get up and go for a walk. Mild exercise before bed can stimulate the secretion of endorphins, the body's natural narcotics. The word narcotic means "promoting sleep". Also, the muscles tend to relax after mild exercise.

Sometimes nothing seems to work. You have heard some people describe themselves as "night owls." Researchers now acknowledge that people's internal sleeping clocks vary. Some people naturally tend to fall asleep and rise later. Those affected should gradually adjust their lives and type of work accordingly. Gradual adjustment in lifestyle in this situation including family noise habits is a part of chronotherapy (chronos=clock) and requires the help of professionals.

Finally there are, shall we say, less orthodox methods of sleep therapy. Why not try self hypnosis? Many bona fide health care professionals are trained in clinical hypnosis. Hypnosis, after all, means "to induce sleep." Try a course in self hypnosis and/or other relaxation techniques. Being fat does not mean that you can't enjoy all the pleasures of life, including a rejuvenating sleep. ß



Heretic Physician