Good morning! How did you sleep last night?  I hope you slept well.  It's important.  There are some days where it seems like all of my patients are having sleeping issues.  What do we tell them? Here's what I do.

First, many of these patients get screened for sleep apnea.  Ironically, a lot of patients that end up testing positive for sleep apnea say they sleep great.  During the office visit, it is usually the spouse that speaks up regarding snoring, or less commonly, periods when the patient is not breathing (apnea) while asleep.

What are the signs and symptoms that we look for? Usually the patient is burdened with fatigue during the day, often to the point where they say, "Doc, I am WIPED OUT! Is it my age or what? I have NO energy." 

In addition to excessive daytime sleepiness; headaches, swollen legs, forgetfulness, and heartburn (or sour taste in your throat) are some other associated symptoms.  We ask about snoring because it is caused by compression on the trachea (windpipe) and that is the "obstruction" in obstructive sleep apnea (OSA).    If the warning signs are there, the next step is usually a sleep study. 

Some people find sleep studies a pain in the rear. 

I imagine this is a combination of not wanting to find out you have to wear a mask, the inconvenience of spending the night, and the cost - in that order.  I understand.  But, on the brighter side - let me please say this. 

Those that do find they have sleep apnea and get treated feel 20 years younger.  

They fall in love with the CPAP to the point that they end up refusing to come into the hospital or go on vacation without it or whatever device ends up helping them.  The biggest myth about this is that sleep apnea is just for a good night's sleep.  There are many studies linking OSA to hypertension (high blood pressure), atrial fibrillation, coronary artery disease, stroke, diabetes, and pulmonary hypertension.  Sleep apnea is dangerous and needs to be addressed.

A matter of fact I'm convinced my dog, Mudge, has sleep apnea. He snores at night and spends a lot of the day sleeping - textbook case.  I looked for the closest Poodle Sleep lab and I can't find anything.  So, I rigged something up myself - Dog CPAP.

Now we have a routine.  Every night after I get him in into his jammies, I wait until he's relaxed then I set up his doggie CPAP.

I'm not going to lie, he doesn't like it.

I'm also not sure how well the family is sold on it, but I refuse to buy into what my wife says.

"David, that's what dogs do during the day - they sleep."

I'm sorry, but not MY dog. I didn't buy a dog to have it sleep all day. Mudge is going to be a productive member of the house just like everybody else.

Part of me feels bad as we just got through getting his braces off .

I fear I've gotten off topic. Where were we?

Okay thanks, had my sleep study - it's not that.  What should I do?

I'm not a sleep doctor, but here are my favorite unsolicited tricks (followed by a link to a handout. ) You may have tried them all, but it doesn't hurt to revisit.

Exercise - remember, this is like a medicine, it has a million positive effects on our bodies - do this in the morning.  Exercising late at night releases those great catecholamines (adrenaline) and serotonins that keep us "fired up".  We want that during the day to enable a peaceful night.  Another reason, I strongly recommend exercising in the am.

Caffeine - Overdone, but for completeness sake. We are all different, but if you're having sleep issues - keep this before noon.  Many will fall asleep fine but wake at 2am ready for work.  Not good for the 7-5'ers.

Read a book - A book you don't really care for that much. We all know and have those.  We have a friend that reads instruction manuals.  Boring I know, but how bad to you want to sleep?  Do this in a place separate from the bedroom

Make a list - I love this one.  The majority of us have too much stuff going on.  Too many people we want to keep happy (am I sounding like Dr. Phil yet?).  Anyway, write down all those things spinning through your head.  Once they're on paper, we don't have to worry about them.  They are not going anywhere. 

Medicines - Personally, I don't like or prescribe them.  Melatonin, however, is non-addictive and seems to mellow most.  I'm not a fan of Ambien, Lunesta, etc.  With these you are patching the problem.  They are certainly okay for isolated events, but they are addictive and not something you want to use to fix the situation.  Benzodiazepenes (anything ending in -azepam)?  Ugh, not for sleep.  Again, isolated incidences fine.  Should not at all become a routine.

Here's the handout: http://www.sleepeducation.com/Hygiene.aspx

Why are we spending time talking about sleep?

Come on - it's huge.  It may not affect the next day, but certainly the one after.

Finally, I have to share this trick my freshman roommate used, Brian - great guy.  It worked every time for him. 

Brian says to take a deep breath and hold it for a second.  When you exhale, envision and feel all your energy leaving one of your arms or legs.  With each breath, rotate focus to a separate limb.  See what you think - pretty powerful technique.

Ok, now I'm embarrassed - you didn't hear any of this from me.