Sleep disorders may pose risks to health and safety. Automobile accidents related to sleepiness pose a serious safety risk for patients whose sleep has been disrupted. Additionally, diminished alertness and impaired performance cause increased safety hazards both at home and in industrial settings, particularly if dangerous machinery or equipment is involved.
Avoid all tobacco products, and reduce or eliminate caffeine intake. Caffeine found in coffee, tea, and cola drinks is known to hinder sleep. Caffeine consumption can both delay the onset of sleep and cause more frequent arousals. For example, a few cups of coffee can reduce total sleep time for eight to 14 hours after consumption. Some individuals are more sensitive to the effects of caffeine than others.
Smoking tobacco products may worsen physical conditions such as asthma, thus leading to disturbed sleep. The nicotine found in tobacco is also known to interfere with sleep.
Patients should avoid illegal recreational drugs and use nonprescription “over–the–counter” preparations with caution. Amphetamines and cocaine reduce REM sleep and total sleep time. Marijuana can also lead to insomnia.
Many over–the–counter medications, such as cold and cough preparations, also contain caffeine or caffeine–related compounds. Their use can lead to impaired sleep.
Individuals should use over–the–counter sleeping pills with caution, as they can diminish alertness and pose a threat to personal safety.
Because alcohol contributes to sleep disorders, people who have trouble sleeping should eliminate or drastically reduce their intake. Although alcohol ingestion can increase drowsiness and cause one to fall asleep more rapidly than usual, even small amounts of alcohol can interfere with the brain’s ability to maintain sleep, resulting in numerous awakenings throughout the night.
Patients with sleep apnea are advised to avoid alcohol consumption shortly before bedtime because of the sedative effects of alcohol on upper airway muscles.
Minimize stress when possible. Patients should try to remove unnecessary stress and try to avoid stressful situations, particularly in the evening. What constitutes a stressful event will vary from individual to individual. For example, those who find paying bills to be a stressful event should consider handling them well before bedtime.
Moderate exercise earlier in the day helps to increase sleep. Moderate exercise earlier in the day is a healthy habit. Because exercise raises the heart rate and causes adrenaline production, it is best to avoid strenuous exercise within six hours of bedtime.
Good sleep habits can help promote sound sleep Table 04.
Many chronic forms of insomnia require multiple approaches to treatment that include what sleep disorder specialists refer to as sleep hygiene recommendations.
Patients with transient insomnia often will improve after the stressful events that triggered the insomnia are removed. Good sleep hygiene can assist the healing process. Timely detection and treatment are essential to prevent transient insomnia from becoming a chronic disorder.
Table 4. Sleep Recommendations
Reduce time in bed Avoid trying to sleep Obscure any bedroom clocks Exercise approximately six hours before bedtime Establish a regular sleep schedule Avoid coffee Avoid alcohol Avoid tobacco Eat a light snack before bedtime Deal with worries before bedtime
Your doctor is the best source of information on the drug treatment choices available to you.
A behavioral treatment called sleep restriction therapy involves reducing the time actually spent in bed. The time you spend in bed will be adjusted gradually until it approaches the amount of time actually required for sleep.
This type of treatment includes going to bed only when sleepy, and restricting use of the bed for sleeping (not reading, watching television, or eating).
Bright–light therapy may help reset the circadian pacemaker. Bright–light phototherapy during the morning hours may help to realign the neural pacemaker for patients with circadian rhythm disorders, especially delayed sleep phase syndrome.
Surgery may help some patients with sleep apnea. Surgery is usually not necessary for sleep disorders, although patients with sleep apnea may require throat surgery to clear up their problem.
Weight loss and prescription drug therapy may not be sufficient to correct the cause of sleep apnea. Patients who have significant obstruction of the retropalatal airway may benefit from surgical resection of excess palatal and oropharyngeal tissue (palatopharyngoplasty).
Melatonin or other alternative substances may be used with caution Table 05. Melatonin is being evaluated for treating circadian rhythm disorders, and some benefit has been observed in jet lag and shift work. Some researchers caution against the careless use of unlicensed preparations.
Table 5. Alternative Substances Used to Promote Sleep
Common name Scientific name Comments Valerian, English valerian, allheal Valeriana officianalis Purported sedative and sleep aid used since Medieval times Skullcap, blue pimpernel, madweed Scutellaria lateriflora Purported herbal remedy for insomnia. Efficacy not established. Passion flower Passiflora incarnata Purported herbal remedy for restlessness and insomnia. Efficacy not established. Chamomile Matricaria chamomilla Purported remedy for insomnia and other conditions. Used by Egyptians. Efficacy not established. Melatonin ? Hormone synthesized by the pineal gland. Hypnotic and circadian rhythm effects have been documented. Its safety for use in various sleep disorders has not been established by double blind, placebo?controlled large?number studies. Available as ?nutritional supplement,? but indiscriminate use is discouraged
Stress reduction techniques such as breathing exercises, massage therapy, and warm baths may aid sleep. Deep breathing exercises may help induce drowsiness. One such exercise involves lying on the back or side with the eyes closed, deeply filling the lungs with air, and then exhaling while drawing in the abdomen to push out as much air as possible. This pattern is repeated three times, and at the end of the third exhalation, holding one’s breath as long as possible. The breathing exercise is repeated two or three times until the onset of drowsiness.
Massage therapy is another way to relieve muscular tension before going to sleep.
A warm bath before bedtime can help to relax the muscles. Baking soda in the bath water can help soothe the nerves on the surface of the skin. Additionally, a few drops of eucalyptus oil or pine needle essence can help a person to relax. A cloth bag of herbs, such as chamomile, linden flowers, or lavender added to the bath water also helps to promote relaxation.
Determining and eliminating any food intolerances or food allergies may help alleviate some cases of insomnia. Some researchers believe that intolerance to certain foods can cause histamine release that disturbs the body’s biochemistry and can lead to sleep disturbances in some individuals. Histamine replaces neurotransmitters in the brain, creating a disruption in the biochemical pathways of the brain. A symptom of this disruption is insomnia.
The Traditional Chinese Medicine approach emphasizes following the body’s natural cycle. The Traditional Chinese Medicine approach emphasizes the importance of observing the natural daily cycle of the body. According to this approach, it is essential to rest through the night to restore energy to particular organs.
Acupuncture may aid sleep. Patients undergoing acupuncture may become relaxed, as acupunture is thought to be associated with increased levels of central nervous system endorphins. The efficacy of acupuncture as a self–promoting aid, however, has not been established.
Some alternative health practitioners believe that minimizing the effects of electromagnetic pollution may affect sleep. According to this theory, you should move all electrical appliances at least six feet from the bed, and avoid using electric blankets.
Elderly patients require special consideration, especially for pain and any underlying physical problems that may affect the quality of their sleep. Sedative use for elderly patients is controversial, and should be carefully considered. For example, longer–acting hypnotics prescribed for insomnia have been shown to result in a higher risk of falls and hip fractures in elderly patients.
Women should inform their physician if they are pregnant or intend to become pregnant. Because of potential risks associated with drug side effects and toxicity, women of child–bearing age who are undergoing drug therapy for sleep disorders should be certain to inform their physician if they are pregnant or intend to become pregnant.
Most sleep disorders can be treated successfully with a combination of good sleep habits, behavior therapy, and prescription drugs.
It is essential to follow the prescribed drug dosages carefully, and to report any recurring or new problems to a physician.
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