Why You Can’t Sleep
Dr. Ray Lynch works with Cortez Brokenbrough in the mobile unit. Brokenbrough is about to be tested for sleep apnea.
Photo by Ron Dubick
So you have a love-hate relationship with the Sandman? Are you one of the chronically tired that hits the snooze button multiple times in the morning? You’re hardly alone. About 70 million of us don’t get enough sleep, and nearly 10 percent experience chronic insomnia—trouble falling or staying asleep, according to the Centers for Disease Control and Prevention.
“In our busy society, we don’t view sleep as a priority,” says Dr. Oswaldo Nicastro, medical director of Delaware Family Medicine at St. Francis Hospital in Wilmington.
Indeed, getting a good night’s sleep has never been so tricky. So what’s keeping us up with the moon and the stars? Let’s count the reasons.
Worrying over sleep. Experts call it psychophysiologic insomnia, and it’s a nightmare for the working professional. Here’s what happens. You settle into bed and begin to stress over what you have to do the next day: that important early morning meeting, a project deadline or a job interview. You know you need to sleep to be at your best, but you toss, you turn and watch the clock tick away the hours. Actually, worrying about sleep is the best way not to sleep, experts say. When going to bed, it’s crucial to calm your mind and put the day on hold.
“I tell my patients to find 20 to 30 minutes after dinner when they can sit down and mentally go through what they’ve accomplished and what they need to get done tomorrow to help get it out of their heads before they go to sleep, or else it will prevent them from sleeping,” says Christiana Care neurologist Dr. Lisa Leschek-Gelman.
Conditioned or “Learned” Insomnia. Sitting in bed and watching TV, reading, texting or working on the computer might not seem like a big deal, but it can cause your mind to associate your bed with activities other than sleep. And the more mentally stimulating the activity, the more likely you’ll stay awake. “The bedroom should be used only for sleeping and sex,” says Bayhealth critical care physician and sleep specialist Dr. David Jawahar.
Caffeine. Wonderful as it is, caffeine’s kick can last way beyond that morning cup of joe. In fact, it can take six hours—more if you’re pregnant or you smoke—for your body to eliminate just half of what you’ve consumed, meaning there will plenty of it in your system when it’s time for shuteye. More than half of all American adults consume more than 300 milligrams of caffeine every day, making it America’s most popular drug, according to a study by Johns Hopkins University. And beverages aren’t the only culprits; chocolate and drugs containing the stimulant can rev you up as well.
Alcohol. Some people think a stiff drink will give them a good night’s sleep, but using booze to snooze doesn’t work, experts say. Indeed, research shows that while alcohol may make you feel drowsy, it greatly reduces the quality of sleep. “It can make somebody sleep in a very light state,” says Leschek-Gelman. “And the two stages of sleep people need the most are deep sleep and dreaming sleep.”
Exercise. Although research has shown that physical activity can reduce or even cure insomnia, too much of a good thing can be counterproductive. Exercise raises levels of stress hormones that can keep you awake at night, especially if you schedule intense workouts in late afternoon or evening, says Jawahar.
Age. Like everything else, sleep changes with age. Research shows that older individuals suffer from advanced phase disorder, meaning they fall asleep earlier, spend less time in deep restorative sleep and wake up earlier. “As you age, you tend to have less a requirement for sleep, however you tend to sleep more,” says Nicastro. “You find the aging population napping more, taking the famous siesta.”
Being a woman. Hormonal shifts during the menstrual cycle and pregnancy can cause sleep disturbances. During perimenopause, hot flashes and night sweats can disrupt sleep. In addition, women tend to suffer more from disorders that cause secondary insomnia, including depression, anxiety, fibromyalgia and some sleep disturbances, such as restless leg syndrome, says Nicastro.
Eating and drinking. Eating a big meal or something exotic too close to bedtime can result in indigestion or acid reflux, making it difficult to sleep. Filling up on fluids can cause frequent urination, further disrupting sleep. Jawahar recommends snacking on light fare a couple of hours before turning in to take the edge off evening hunger.
Environment. Everything from a sagging mattress to the temperature and color of your bedroom can affect your ability to get a good night’s sleep. Light can also be an issue, including the dim LED light coming from a digital alarm clock. “Light—any kind of light—is a sensory mechanism that impacts your brain, altering your sleep,” says Nicastro. He recommends turning the clock around so the light won’t get through your eyelids and using night lights with just enough illumination to allow you to safely navigate your surroundings.
Changes in work schedule. Travel or working a late-night or early-morning shift can disrupt your body’s circadian rhythm, the internal clock that regulates such things as the sleep-wake cycle, metabolism and body temperature. “Shift-work insomnias are very common,” says Nicastro. “But by fixing the drapes to darken the room, people can train their bodies to feel like it’s nighttime, restoring their circadian rhythm.”
Medical conditions. Individuals with chronic pain, breathing difficulties, neurological disorders, hyperthyroidism, cardiovascular disease or the need to urinate frequently can develop insomnia. Depression, anxiety and other mental illnesses can also disrupt sleep. In addition, many chemicals affect both the quantity and quality of sleep, including antihistamines, decongestants, beta blockers, alpha blockers and antidepressants.
Sleep-related disorders. There are more than 80 conditions that can affect the quality of sleep but the most common is obstructive sleep apnea. Obstructive sleep apnea occurs when the walls of soft tissue at the back of the throat collapse, blocking the passage of air until the airway opens—often with a loud choking or gasping sound—and you breathe again.
Treatment usually involves fitting the patient with a device supplying continuous positive air pressure to keep the airway open during sleep.
Untreated sleep apnea is associated with a number of health concerns, including daytime drowsiness, obesity, hypertension, heart disease, stroke, dementia and depression. Recent research has linked it to an increased risk for developing cancer. Unfortunately, most people don’t seem to take sleep apnea seriously. Eighty percent to 90 percent of cases go undiagnosed, according to the American Academy of Sleep Medicine.
That’s where Dr. Ray Lynch comes in. Lynch is director of Sleep Disorders Management in Wilmington, the state’s only out-of-center sleep testing service. The facility recently received accreditation from the American Academy of Sleep Medicine for its home testing service.
“It’s always better to test (patients) in their home where they’re comfortable and can get their best night’s rest,” says Lynch, who was diagnosed with obstructive sleep apnea 14 years ago.
Men are generally thought to experience sleep apnea more than women, but a recent study by Swedish researchers suggests that a high percentage of women experience the condition as well. Women like LeeAnn Simmons.
Simmons, who has a family history of sleep apnea, thought she might be affected when she awoke one night 10 years ago with her heart racing for no apparent reason. She got tested, but the results were negative. “They told me it was ‘positional snoring,’” says the 54-year-old from Woodstown, N.J.
But within the past five years, she noticed her snoring was getting worse and she struggled to get up in the morning. “I did caffeine all day long just to stay awake,” she says.
Simmons decided to re-test when Lynch visited her workplace with his mobile physician unit. This time the results were positive. “They told me that at one point I stopped breathing for 40 seconds,” she says.
Simmons was given a CPAP device to wear during sleep. She calls the results “remarkable.” She awakens feeling refreshed and hopes she can eventually reduce or even eliminate the medications she takes to treat her hypertension and depression.
“It’s a shock the first time you put it on, but once you see how good you feel, you’re glad to put it on,” she says.