Question:
How Did You Sleep Last Night?
Answer:
How Did You Sleep Last Night?
Your sleep personality may reveal why you may not be getting enough
sleep.
By Richard Trubo
Reviewed By Brunilda Nazario, MD
WebMD Feature
For most of her life, Carol Smith has never had much trouble with sleep.
But all of that changed when she began working a 12-hour graveyard shift
-- from 6 p.m. to 6 a.m. -- as a 911 dispatcher.
At times, she says she's had to struggle to stay awake and alert on the
job. "It was very difficult for me," she recalls. "I'd get real fidgety,
and doing any kind of paperwork was hard because it was so tough to
concentrate. At times, I felt so uncomfortable that I just wanted to
crawl out of my skin."
But then Carol found relief. She participated in a sleep study at Henry
Ford Medical Center in Detroit, and was diagnosed with "shift work sleep
disorder" (SWSD), a condition that affects people whose sleep-wake and
lifestyle demands are out of sync with their normal biological
(circadian) rhythms. It consists of symptoms of insomnia or excessive
sleepiness that occur as transient phenomena in relation to work
schedules.
She now takes a prescription medication called Provigil (modafinil),
which promotes wakefulness in people with debilitating excessive
sleepiness associated with SWSD.
"I can breeze through my 12-hour shifts these days," Carol tells WebMD.
"I only take the medication on the nights I work, and now I love working
nights."
A Hard Day's Night
Sleep deprivation and related problems have become as American as
caffeine-rich Starbucks coffee and 24-hour pharmacies. In the last 100
years, there has been about a 20% decline in total daily sleep time,
says Gary Zammit, PhD, director of the Sleep Disorders Institute at St.
Luke's-Roosevelt Hospital in New York City. The blame for that sleep
deprivation rests with the fast-paced culture we live in, with more
demands on everyone's time and the emergence of an around-the-clock,
24/7 society.
So whether it's your lifestyle or your personality traits, you may have
joined the ranks of the bleary-eyed who are not getting all the shuteye
their body needs. "Many people are staying up late surfing the net, or
going to the supermarket at night because that's the only time they can
get there," says Sonia Ancoli-Israel, PhD, professor of psychiatry at
the University of California San Diego School of Medicine. "We've become
so busy that something has to give, and for many people, it's sleep that
they sacrifice."
In fact, sleep disruptions can provide clues to your health, both
physical and psychological. These disruptions can help reveal whether
you're burdened by stress or overwhelmed with high anxiety. Sleep
disruptions also give hints on what medications you're taking, or
whether you're experiencing chronic aches and pains. They can make you
unproductive on the job, and moody and irritable at home, or as with
Carol Smith before she found Provigil, they can be a sign that you're
forcing yourself to stay awake when your internal body clock is
desperately seeking slumber.
If depression is part of your personality profile, you might find
yourself tossing and turning, and not only because the depression itself
might keep you from drifting off. John Herman, PhD, associate professor
of psychiatry at the University of Texas Southwestern Medical Center at
Dallas, notes that some popular antidepressants such as the SSRIs
(selective serotonin reuptake inhibitors) can disrupt your snoozing.
"You can use sleep as something of a barometer," says Meir Kryger, MD,
director of the Sleep Disorders Centre at St. Boniface General Hospital
Research Centre in Winnipeg, Manitoba, Canada, and author of A Woman's
Guide to Sleep Disorders. "If someone's sleep is abnormal -- if they're
having a lot of trouble falling and staying asleep -- or if they're
extremely sleepy during the daytime hours -- a doctor can use these
symptoms as a clue that there may be something wrong with the person
that requires checking out."
Punching the Internal Time Clock
The body's own circadian rhythm or sleep wake cycle wages enormous
control over when it's time to rise and shine, and when it's time for
shuteye. The fact is that there's some persuasive evidence that whether
you're prone to being a morning person or a night person -- it is
programmed in your genes.
"Some people are very sleepy early in the evening, and by 8:30 p.m. or 9
p.m., they have a lot of trouble staying awake," says Kryger. "So
they'll go to sleep and frequently wake up at 3 or 4 in the morning." In
our culture, Kryger says, people may not think of these larks as having
a sleep problem -- they often exercise at the crack of dawn and arrive
at their office long before their co-workers to get a fast start on a
productive workday.
By contrast, those who tend to stay up long past midnight have plenty of
trouble getting up in the morning and typically arrive at the office
late the next morning; they often call their doctor seeking help for
staying alert through the day.
Although our sleep-wake cycles appear to be written into the genes,
don't despair if your body clock is creating chaos in your life.
Environment and personality also play important roles in influencing
your sleep-wake schedules, says Herman, director of the Sleep Disorders
Center at Children's Medical Center in Dallas.
"Light is the strongest cue that the body uses to determine when to go
to sleep and when to get up," says Ancoli-Israel, director of the Sleep
Disorders Clinic at the Veterans Affairs San Diego Healthcare System. So
people whose natural tendency is to sleep late in the morning may
benefit from bright light exposure at daybreak. And if sunlight isn't
readily available, there are bright-light boxes that can be purchased.
Rude Awakenings With Apnea
If you're a woman, female hormones might provide some protection against
obstructive sleep apnea, a condition in which obstruction of the airway
occurs during sleep. Symptoms include loud snoring and repeated
awakenings which are associated with excessive daytime sleepiness.
Apnea is increasingly being recognized as a common sleep disorder
(affecting about 12 million Americans) it's about twice as common in men
as it is in women. But in the postmenopausal years when levels of female
hormones subside dramatically, says Kryger, new cases of sleep apnea are
about equal in men and women.
If you have sleep apnea, it's not something you can afford to ignore.
"Sleep apnea can lead to high blood pressure and other medical
problems," says Kryger. "Some data show that people with sleep apnea may
develop insulin resistance, which could be a precursor to the
development of diabetes."
CPAP (continuous positive airway pressure) is an effective sleep apnea
treatment, in which a device worn at night gently propels air through
the nasal passages, keeping the airway open during the night. "It's very
effective if people use it, but because it isn't very comfortable,
compliance isn't as good as it should be," says Ascoli-Israel. Weight
loss can relieve the severity of the disease in many patients and
certain sleep positions can as well.
Optimal sleeping positions may be important in resolving problems
associated with other health conditions as well. With gastroesophageal
reflux disease (GERD), in which people experience heartburn and
regurgitation at night, "we commonly suggest that people raise the head
of their bed three to four inches using some wooden blocks, so they're
sleeping on an incline," says Zammit.
People with allergies, particularly when accompanied by postnasal drip
and congestion, may find that their symptoms worsen when they're
sleeping on their back, and thus a change in position may be just what
the doctor ordered.
I Could Have Walked All Night
Although it's a common belief that sleepwalkers are acting out their
dreams, there's no evidence of that. Instead, the tendency toward
middle-of-the-night marches through the house -- and sometimes through
the neighborhood -- may be imprinted in the genes, and thus sleepwalking
often runs in families. The medical literature is replete with cases of
families of sleepwalkers who literally bump into each other during the
night.
"Sleepwalkers can also carry out very complicated behaviors," says
Ancoli-Israel. "Some have gotten into and driven their car, even though
they're sleeping at the time."
During periods of stress -- when the pressures of work and family become
crushing, or when the threat of job layoffs or tough economic times loom
ominously in the back of their minds -- adult sleepwalkers may
experience a worsening of their problem. Nocturnal sleep-related eating
disorder (NSRED), a little understood problem in which sleepers stroll
into the kitchen and gobble up sugar-rich and high-fat foods, may affect
as many as 4 million Americans, and appears to be stress-related as
well.
Even if you're not a sleepwalker, stress can make it more difficult for
you to fall asleep and stay asleep. A survey by the Better Sleep Council
found that 51% of Americans say that stress disrupts their snoozing.
When should you seek help for a sleep problem? "At the point where it
starts interfering with your daytime functioning," advises
Ancoli-Israel. "A good night's sleep is very important." And if your
physician thinks that sleeping pills might be helpful, the newer
medications (such as Ambien and Sonata) are safer than the sleeping aids
of the past.
Published April 1, 2004.
SOURCES: Sonia Ancoli-Israel, PhD, professor of psychiatry, University
of California San Diego School of Medicine, San Diego. John Herman, PhD,
associate professor, psychiatry, University of Texas Southwestern
Medical Center, Dallas. Meir Kryger, MD, director, Sleep Disorders
Centre, St. Boniface Hospital Research Centre, Manitoba, Winnipeg,
Canada. Gary Zammit, PhD, director, Sleep Disorders Institute, St.
Luke's-Roosevelt Hospital, New York City.
© 1996-2004 WebMD Inc. All ...
It's an informative article. Explains some things I
experienced after a heart attack and just before I was dx with anxiety
and depression. My sleep patterns really changed after the MI and now,
with Lexapro, I'm pretty much back to normal.
It was informative as well as interesting. My husband
suffers from insomnia and I found a lot of helpful info for him in this
article.
