We all need a good night’s sleep to be successful during the day. But millions of Americans — an estimated 70 million — have trouble sleeping.
Steven Brass, an assistant professor of neurology at UC Davis, knows the problem well.
A specialist in the diagnosis and treatment of a host of sleep problems, including sleep apnea, restless leg syndrome and narcolepsy, Brass recently joined the faculty of the Department of Neurology as the co-medical director of the sleep division.
“We spend a third of our lives sleeping,” Brass said, “so ensuring good quality sleep is important for our overall health.”
Brass said that research has shown an association between insufficient sleep and a number of serious health conditions, including cardiovascular disease, hypertension, diabetes and mood disorders. But it’s not uncommon for sleep disorders to go undiagnosed or misdiagnosed.
The good news is that, with proper diagnosis, sleep disorders are readily treated and improvement in sleep can be life-changing.
“Doctors have many ways to identify underlying sleep problems in patients," Brass said. "This begins with an understanding of their current sleep schedule and practices. We may also monitor the patient’s sleep overnight using a sleep study, known as a polysomnogram.”
Tips on getting a good night's sleep
Good “sleep hygiene” is imperative for getting a good night’s sleep, and Brass offered some suggestions.
People with insomnia should avoid napping during the day, limit caffeine in the afternoon, forego stimulating activities like exercise and television before bed, and maintain a cool, dark bedroom.
Although alcoholic beverages can make one drowsy, the end result is poor quality and fragmented sleep — in short, having a drink before bed can do more harm than good, Brass said.
Know your risks for sleep apnea
Brass recommended that people with sleep complaints, including excessive daytime sleepiness, unexplained nocturnal waking and choking at night, be evaluated for obstructive sleep apnea.
Snoring is another common sleep problem, Brass said, and both the snorer and anyone they may sleep with can be affected. While snoring might seem like an annoyance, it can be symptomatic of a serious health problem.
“Snoring is not always benign, and may be a sign of obstructive sleep apnea, a condition caused by closure of the upper airway in sleep,” Brass said.
Your risk for sleep apnea may also be higher if you:
• Are overweight
• Have a large neck circumference (16 inches for women, 17 inches for men)
• Are male or a post-menopausal female
• Have a chronic disease such as diabetes or hypertension
• Have a family member with sleep apnea
Snoring cessation devices
Snoring results from vibration of the tissue at the back of the throat that can become relaxed during sleep. Many people who snore may turn to over-the-counter snoring devices — including nasal strips, throat sprays and special pillows.
Brass said that studies have shown that some of these devices are not effective. And snoring can be a cause of obstructive sleep apnea. People with chronic snoring should be evaluated by a medical professional before self-treating the condition.
The use of sleeping pills
Trouble falling asleep and staying asleep, or waking up too early, may be diagnosed as clinical insomnia, Brass said. However, a patient must experience daytime symptoms — like a lack of energy and difficulty with concentration — before a firm diagnosis is made.
Mood disorders such as depression or anxiety, sleep problems such as restless leg syndrome and medical problems such as asthma can cause insomnia. And poor sleep hygiene — including the overuse of caffeine and erratic sleeping hours — also should be examined in diagnosing insomnia.
Brass said that patients desperate for a good night's sleep frequently seek quick fixes, like medication, that may be effective in the short run but in the long term have their own risks.
"Patients often turn to over-the-counter or prescription sleeping pills," he said. "But sleeping pills are are not without consequences, and must be used judiciously and under the care of a doctor."
Brass said that over time the hypnotic effects of sleeping pills tend to wear off and can lead to dependence and drowsiness the next day.
"Other side effects can include medication-induced 'parasomnias,' like sleep walking, sleep eating and sleep driving," Brass said.
Brass recommended that people suffering from insomnia consider changing their evening routines to promote good sleep — for example, not watching television in the bedroom and limiting exercise and bright lights in the evening — before turning to sleeping pills.
"One technique that can be effective is leaving the bedroom after 15 minutes to engage in a relaxing activity and then returning when sleepy," he said.
Prior to joining the faculty at UC Davis, Brass served as the associate director of the Neurology Clinic at Massachusetts General Hospital in Boston, and was an assistant professor of neurology at Harvard Medical School.
For further information about medical treatment of sleep disorders visit the UC Davis Neurology Department Sleep Medicine Division Web site.