Sleep – Good Sleep Hygiene and Common Sleep Disorders. By Our Student Pharmacist, Madeline VanLoon.

June 30th, 2020

Why do we sleep?

If the average person sleeps for approximately eight hours every night, it can be predicted that they will sleep for one-third of their life. This is time well spent, however. Sleep is essential for maintaining good health and prolonging life.

On an average night, we will cycle through different stages of sleep. Stages consist of Rapid Eye Movement (REM) sleep, and four non-REM stages of sleep. The deeper stages of sleep are restorative and critical for learning.

What happens when we don’t sleep?

Sleep deprivation can lead to:

fatigue
depression
difficulty learning new things
high blood pressure
high blood sugar
cardiovascular disease
obesity
infections

Sleep deprivation can even shorten your overall lifespan. Daytime sleepiness can make you less productive, and also can be dangerous while driving or carrying out other daily tasks.

Good Sleep Hygiene

The best way to improve your sleep is to make sure that you are using “good sleep hygiene,” which is basically a set of good habits that prepare your body for a good night’s rest. The Centers for Disease Control and Prevention (CDC) recommends the following best practices:

Go to bed at the same time every night, including on the weekends.
Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
Remove electronic devices such as TVs, computers, and smartphones from the bedroom.
Avoid large meals, caffeine, and alcohol before bedtime.
Increase your exercise. Being physically active during the day can help you fall asleep more easily at night.

Sleep Disorders – Insomnia

Insomnia is defined as a dissatisfaction with sleep quantity or quality, complaints of poor daytime functioning, and at least one of the following: difficulty falling asleep, difficulty staying asleep, or waking up early in the morning with the inability to return to sleep. These conditions must occur at least three nights per week, for at least three months, despite good sleep hygiene and no known other causes. Certain medications and medical conditions can cause insomnia.

Treating insomnia

First, resolve any underlying causes for insomnia.
Next, use non-drug treatment options, including good sleep hygiene.
Talk to your doctor or pharmacist about over-the-counter sleep aids.
NOTE: Data shows that medications to help insomnia are only modestly helpful, and may carry more risks than benefits. Be cautious while taking these medications.

Caution

Avoid using alcohol to help you sleep – it may fragment your sleep, and chronic use may lead to dependence.
Avoid antihistamines such as diphenhydramine (Benadryl) and doxylamine (Unisom) if you are over 65. You may be more susceptible to dry mouth, confusion, constipation, dizziness, and fatigue.
Avoid long term use of antihistamines to sleep – tolerance may develop in 4-7 days of daily use, and may not continue working for you after that.
Melatonin may help regulate circadian rhythm, but it is not FDA regulated.

Sleep Disorders – Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a condition where breathing while sleeping is stopped periodically throughout the night due to a blockage in the upper airway. This condition results in an extensive list of daytime and nighttime symptoms, including:

Daytime Symptoms of OSA:

Sleepiness
Fatigue
Aches
Dry mouth
Nasal congestion
Depression
Erectile dysfunction
Cognitive impairment

Nighttime Symptoms of OSA:

Disrupted sleep
Loud snoring
Snorts and gasps
Frequent awakenings
Increased nighttime urination

While these are all uncomfortable symptoms, the most concerning consequence of OSA is the risk of heart problems like heart failure and irregular heartbeat.

Risk Factors for OSA

If you have three of the following eight risk factors for OSA, you may be at high risk for developing the condition:

Snoring
Tired
Observed while breathing stopped
High blood pressure
BMI greater than or equal to 35
Age over 50
Neck circumference (distance around neck) greater than 40 cm
Male gender

Treatment for OSA

The best treatment for OSA is using a Continuous Positive Airway Pressure (CPAP) machine every night. The machine allows the airway to remain open, allowing for consistent breathing throughout the night, and is superior to treatment with medications. If you believe you are experiencing OSA, talk to your doctor about treatment options.

References:

CPAP side effects. Sleep Association. https://www.sleepassociation.org. Accessed June 22, 2020.

Explain that insomnia meds are only modestly effective. Pharmacist’s Letter. 2020. https://pharmacist.therapeuticresearch.com. Accessed June 23, 2020.

Management of obstructive sleep apnea in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Obstructive sleep apnea and cardiovascular disease in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Pathophysiology of obstructive sleep apnea in adults. UpToDate. Wolters Kluwer. Available at https://www.uptodate.com. Accessed June 22, 2020.

Sleep and sleep disorders: tips for better sleep. Centers for Disease Control and Prevention. https://www.cdc.gov/sleep/. Accessed June 22, 2020.

Sleep Apnea Information Page. National Institute for Neurologic Disorders and Stroke. https://www.ninds.nih.gov/Disorders/All-Disorders/Sleep-Apnea-Information-Page. Accessed June 22, 2020.

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