Remember the days when your head barely hit the pillow and you were out like a light? If you’re anything like me, a busy lifestyle, time pressures and the effect of our ‘24/7 society’ now seem to get in the way of such simple pleasures.
And we’re not alone. Research suggests up to 45% of Australian adults are affected by poor quality or not enough sleep.
As a GP, especially one with an interest in sleep problems, it’s my job to help you get the shut-eye you need. Proper sleep is one of the golden tickets to improving your mental and physical well-being.
With the right amount of rest you make better decisions, are less stressed and remember more. Among many health benefits, getting enough quality sleep makes you less prone to heart disease and improves your immune function.
It’s of no surprise that not getting enough sleep has the opposite effect on your mind and body.
In this post, I’ll look at four common sleeping disorders, offer insights into tackling each and suggest ways doctors can help.
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People with insomnia have trouble nodding-off at bedtime. Insomniacs can also find it hard to get back to sleep upon waking throughout the night.
Insomnia is one of the most common reasons people seek help from their GP. Older people, women and shift workers tend to be particularly prone to the condition.
Insomnia can lead to all sorts of problems during the day. This includes symptoms such as irritability, poor concentration and memory effects.
A lack of quality sleep can also take a toll on your physical and mental health. Poor sleep is linked to increased risks of some serious health problems, such as heart disease, diabetes, depression and anxiety.
HOW TO GET TO SLEEP AND STAY ASLEEP
There’s no one-size-fits-all solution in combatting insomnia. For this reason, your GP will take the time to go through your medical history and work with you to find a solution.
It’s essential to treat any underlying causes of insomnia, such as chronic pain or mental health issues, as part of managing the condition.
If such causes aren’t treated, people can find themselves trapped in a vicious cycle where insomnia worsens their underlying symptoms, which then worsens their insomnia.
Before seeing a GP, I suggest practising some basic sleep hygiene measures (outlined below) that may help with insomnia.
WHEN SHOULD YOU SEEK HELP
Talk to your GP if insomnia is impacting your happiness or ability to function properly throughout the day.
Your doctor will work with you to look at possible causes and treatment options. They may refer you to a sleep specialist, physiologist or psychologist. Some hospitals have sleep clinics where more intensive observations, diagnosis and treatment take place.
Many patients ask about medications to help with sleep. Though sleeping tablets and the like can be effective, certain medications have risks and potential side effects.
Your GP may discuss medication options with you, but only as a small and temporary part of your overall treatment plan.
Snoring is quite common, especially with men and middle-aged people. We estimate 40% of men and 25% of women snore to some degree.
We often presume snoring goes hand-in-hand with a good night’s sleep. However, studies have shown that up to 70% of frequent loud snorers suffer from tiredness and lethargy throughout the day.1
Snoring is sometimes made worse by:
- being overweight or obese,
- consuming alcohol before bed,
- sleeping on your back,
- having a blocked nose, and
- being pregnant.
IS SNORING DANGEROUS?
Current evidence suggests that the primary risk with snoring is when it’s a sign of obstructive sleep apnoea.
Snoring by itself doesn’t appear to have too many direct health consequences – though some studies suggest an association with artery damage due to vibrations.
However, persistent loud snoring can result in poor quality sleep, affecting concentration on the road and at work.
Snoring can also indirectly harm your family if they’re regularly kept awake.
WHEN SHOULD YOU SEEK HELP?
I suggest visiting your GP if any of the following signs present:
- You’re continually waking unrefreshed in the morning.
- You’re experiencing chronic drowsiness during the day.
- Your partner or family are disturbed most nights.
- You temporarily stop breathing during sleep.
There are several snoring treatments available. These range from treating underlying causes, such as obesity or allergies, through to using oral appliances and limiting alcohol at night.
For more severe cases of snoring, we may consider referring you to an ear, nose and throat (ENT) surgeon.
Obstructive sleep apnoea (OSA) occurs when breathing repeatedly stops for a short amount of time while asleep.
With OSA, normal airflow through the upper airways is reduced during sleep. Factors contributing to reduced airflow include a narrowing of the pharynx due to surrounding soft tissues and the relaxation of this tissue when asleep.
The condition is quite serious and can affect people of every age. It’s more commonly diagnosed in men as well as:
- 50+ year olds,
- smokers and excessive drinkers, and
- those who are overweight.
Loud snoring, tossing and turning, and gasping for air are common symptoms. OSA patients often have disturbed sleep and wake to feel tired and unrefreshed.
OSA is associated with an increased risk of many health issues. These include motor vehicle accidents, mental health disorders, high blood pressure, stroke, diabetes, heart attacks and liver disease.
HOW DO WE TREAT SLEEP APNOEA?
Treatment depends on the severity of OSA. We’ll typically refer patients to an overnight sleep study. Also known as a polysomnogram or PSG, the study measures airflow, blood-oxygen content and sleep behaviour.
For mild cases, we may recommend weight loss, changes to sleeping position and improved lifestyle choices concerning drinking and smoking.
An oral appliance called a mandibular advancement device (MAD) can also be effective in treating OSA. An MAD is custom-fitted by a dentist. It works by pushing the jaw forward to help keep airways open.
More severe or advanced cases may call for continuous positive airway pressure (CPAP) therapy. CPAP therapy involves sleeping while wearing a mask that helps keep the upper airways open by increasing the pressure of the air delivered through them.
In certain cases, surgery may be an option. Your GP will help you decide what’s best.
WHEN SHOULD YOU SEEK HELP?
People with OSA are often unaware they have it. Their partners usually alert them to something being wrong. If this is the case in your household, make an appointment to see your GP.
Please do the same if any you’re experiencing any of these symptoms:
- Waking overnight gasping or choking.
- Waking with a very sore throat.
- Persistent, unexplained tiredness.
- Regular headaches in the morning.
Restless Leg Syndrome
Restless Legs Syndrome (RLS) is a quite common neurological sleep disorder characterised by uncontrollable urges to move your legs. This sensation makes it hard to get to sleep and, at times, stay asleep.
RLS sufferers frequently describe experiencing a tingling or burning sensation in their legs when they’re still. The condition can also affect people when they’re awake, such as during travel or sitting still at work.
Moving around almost always relieves symptoms.
RLS is more common in women and people over 45 years old. In children, it can be misdiagnosed at growing pains. RLS is also thought to run in a person’s family.
WHAT CAUSES RLS?
We do know that certain factors make symptoms worse, such as:
- Iron deficiency
- Kidney disease
- Neuropathy – such as those caused by diabetes
- Certain medications – including anti-histamine, anti-nausea, and anti-depressant tablets
WHEN SHOULD YOU SEEK HELP?
It’s a good idea to talk with your GP if you suspect RLS is at play. This is especially the case if you’re losing sleep or feeling unusually moody, tired and sleep-deprived throughout your day.
Though RLS may not wake you at night, you might be getting a bad night’s sleep due to unconscious leg movement.
Depending on a variety of factors, we can offer treatment that may include:
- Iron supplements or infusions
- Dopamine agonists – also used to treat Parkinson’s disease
- Anti-seizure medications
I recommend patients try lifestyle changes before we go down the path of prescribed medicines. Getting regular exercise, avoiding nicotine and alcohol, and stress reduction techniques are a good start.
You may have heard of the alternative treatment of slipping a bar of soap under the covers before you hop into bed. Please don’t try this – it’s a waste of perfectly good soap and could ruin your sheets.
Tips to Improve Your Sleep Hygiene
By sleep hygiene, I mean good sleeping habits to practise and stick with. If you’re having trouble sleeping, try these suggestions:
- Go to bed and get up around the same time every day.
- Avoid caffeine and alcohol at least six hours before you go to bed.
- Use your bed for sleeping – not for working or watching TV in bed.
- Avoid exercising at least four hours before bed.
- Try to make your bedroom as dark and quiet as possible.
… a word on exercise
As any of my regular patients will tell you, I prescribe exercise for pretty much everything – sleep is no exception!
Regular exercise has been shown to improve both the quality and duration of sleep. Some people find exercising late in the day affects their ability to fall asleep. If this is the case for you, try to exercise earlier in the day – any exercise is better than none.
For more tips on good sleeping practices, have a look at this fact sheet from Headspace.