Good morning! How'd you sleep last night?  We hope well.  It's important.  There are some days where it seems like all of my new patients are having sleep issues.  Here are some of the things we discuss.

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

What are the signs and symptoms that we look for? Usually our 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 believe sleep studies are a pain in the backside.     

This is likely due to a fear of wearing a mask, the inconvenience of spending the night, cost, etc.  I understand.  But, on the brighter side, it's important to know that those found to have sleep apnea feel 20 years younger after treatment. They fall in love with CPAP to a degree 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 treating 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.

On a personal note, I'm convinced my dog has it. Mudge snores at night and spends a lot of the day sleeping - textbook case.  Of course, there are no dog sleep labs so I rigged up DogPAP.

Now we have a routine.  Every night after I get him in into his jammies, we wait until he's relaxed then we set up his doggie CPAP.
I'm not going to lie, he didn't like it at first and I'm also not sure how well the family is sold on it.
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.  

Part of me feels for him as we just got through getting his braces off.
I've gotten off topic. Where were we?

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

Here are my favorite 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 - 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 do 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. 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.

Why are we spending time talking about sleep?

It's huge.  It may not significantly affect the next day, but certainly the one after.

Finally, I have to share this trick my freshman roommate used. 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... 

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

Here's the handout.  

Please stay hungry and stay foolish,

David

www.walkwithadoc.org