Good Night
How to cure the most common sleep disorders so you can (finally!) catch some z's

By Wendy DuBow, PhD

Americans are clearly tired. According to the 2002 Sleep in America Poll conducted by the National Sleep Foundation, 40 percent of Americans say that after a full night's sleep they wake up feeling unrefreshed, and 88 percent report they are sleepy during waking hours at least a few days a month. Sleep troubles affect females more than males: 63 percent of women report symptoms of insomnia a few nights a week, as opposed to 54 percent of men, and 20 percent of adult women experience daytime sleepiness, compared with 13 percent of adult men. So many of us feel tired, in fact, that we consider it a normal way to be. Sleep experts, however, say if we get enough deep, continuous nighttime sleep, we should feel well-rested the following day.

But just how much sleep is enough? The average 6.9 hours Americans say they get each weeknight doesn't cut it, according to Robert Ballard, MD, director of the Sleep Disorders Center at National Jewish Medical and Research Center in Denver. From what experts can tell, most people need between seven and nine hours of sleep each night. "Americans used to average one and a half to two hours more sleep each night," says Ballard. "The bottom line is that sleep disorders are increasing," as people either deprive themselves of the rest their bodies need or simply can't get their bodies into a slumbering state.

Is It Insomnia?
Fifty-eight percent of U.S. adults report experiencing symptoms of insomnia—the inability to get to sleep and stay asleep—at least a few nights a week. Most of us experience acute phases of sleeplessness periodically, when we are stressed or sick, for instance. Women often report increased sleeplessness before and during their menstrual periods. But the person with true insomnia experiences sleeplessness regularly—sometimes weekly, sometimes nightly.

A Quest For Rest
Feel tired all the time? Find out how sleepy you are by getting a rating from the Epworth Sleepiness Scale, provided by the Kathryn Severyns Dement Sleep Disorders Center at St. Mary Medical Center in Walla Walla, Washington, at www.smmc.com/sleep/sleepweek/epworth.html. Surprisingly, how we perceive sleep can be as much a factor in our sleeplessness as how we actually sleep (Sleep, 2001, vol. 24, no. 5). According to Ballard, some people have "dysfunctional sleep perceptions," which cognitive-behavioral therapy can modify, helping people fall asleep and sleep soundly. As with other aspects of our health, our own self-narratives can have a large impact on how our bodies feel and act. For example, you're bound to become anxious if you tell yourself, "I can't get to sleep no matter what I do. And if I don't get eight hours of sleep tonight, then I won't be able to work at all tomorrow. And if I can't perform well tomorrow, I will lose my job." Yet many people who suffer from insomnia tell themselves just these sorts of things. Cognitive-behavioral therapy can help people realize that they are misperceiving the effects of sleep, and can help them gain more control over their rest.

Numerous online sleep support groups offer help for those who are having trouble catching some z's. For example, visit www.sleepquest.com/c_support.html for information on support groups and national sleep organizations.

—W.D.

Insomnia is really an indicator or a symptom of something else gone awry, according to Chris D. Meletis, ND, dean of the National College of Naturopathic Medicine in Portland, Oregon. He attributes most of the insomnia he treats to three problems: anxiety, depression, and stress. Pinpointing the exact cause can take time. "I start by playing detective with my patients," says Meletis. "First, we look at when the symptoms started," going back six months prior to the start date to identify any changes in the patient's lifestyle that may have preceded the sleep symptoms. Frequent culprits that Meletis has identified include weight gain, menopause, oral contraceptives, and major life stressors, such as the death of a loved one or a divorce. He has even found that a change in pillow size, texture, or filling can precipitate sleep troubles. For instance, he cautions that a down pillow "may be contributing to allergies and, hence, respiratory congestion, which causes more tossing and turning and a less-deep sleep."

Sometimes "psychological vitality" is a cause of sleeplessness, Meletis points out. To calm a racing mind, he recommends that his patients write down all the things they need to do or worry about on a piece of paper and place it beside the bed. He assures them they can pick up the list first thing in the morning, so they needn't contemplate their troubles all night long.

In his practice, Meletis also sees many patients complaining that their own snoring or restless legs keep them awake. Restless legs syndrome (RLS) refers to unpleasant, tingling sensations in and movement of the legs that 18 percent of U.S. women and 14 percent of men experience, usually in the middle of the night causing them to wake up, according to the 2002 Sleep in America Poll.

Empathy For Apnea
In some cases, our bodies' physical structures cause us to lose sleep, as in the case of sleep apnea. Sleep apnea refers to a cessation of breathing for ten seconds or more when soft tissue in the throat or the nose blocks the airway. People suffering from sleep apnea usually snore loudly through part or all of the night. Sleep experts estimate that the condition afflicts 30 million Americans, including one out of every two men.

Obesity, large neck girth, a recessed chin, and use of sedatives and alcohol are all risk factors for sleep apnea (American Family Physician, 1994, vol. 49, no. 2). Because of the physical attributes that contribute to apnea, more men than women tend to suffer from it (American Family Physician, 1996, vol. 53, no. 1). However, the condition becomes more common in women after age 50, perhaps due to decreases in estrogen levels after menopause. Authors of a new study to be published in the American Journal of Respiratory and Critical Care Medicine examined the sleep patterns of 2,852 postmenopausal women age 50 or older. The prevelance of sleep-disordered breathing among hormone users in the group was approximately half that of nonhormone users. This further suggests a connection between hormones and sleep problems.

Reducing your weight, cutting back on the use of sedatives, alcohol, and cigarettes, and sleeping on your side are all effective ways to treat mild forms of apnea. For more severe apnea, however, continuous positive airway pressure (CPAP) exerted by a nasal mask worn during sleep is effective because it exerts a light pressure that enables air to pass through the throat continuously. A chin strap keeps the mouth closed. Although the device merely manages symptoms and doesn't cure the disorder, CPAP is widely used and effective (American Family Physician, 1994, vol. 49, no. 2). Some people, however, cannot become accustomed to the apparatus; in this case, surgery is an option. Types of surgeries range from trimming excess tissue from the back of the throat to a tracheostomy, in which an incision in the trachea forms a temporary or permanent hole. Relatively few people, however, are good candidates for such invasive treatments (American Family Physician, 1994, vol. 49, no. 2; 1996, vol. 53, no. 1). A recent study published in Archives of Otolaryngology—Head and Neck Surgery (2001, vol. 127, no. 4) found that one-third of patients who underwent surgery experienced worsened symptoms one year later.

Real Relief
For chronically sleep-deprived people, herbal remedies may present a source of hope. For abetting sleep, practitioners often suggest valerian (Valeriana officinalis), ginseng (Panax ginseng), hops (Humulus lupulus), chamomile (Matricaria recutita), and lavender (Lavandula angustifolia). Few well-designed studies have examined these herbs as sleep aids; however, evidence suggests that valerian, ginseng, and kava (Piper methysticum) can bring on the z's (Alternative Medicine Review, 2000, vol. 5, no. 3). Always consult with a qualified herbalist to find an appropriate dose and to help you monitor any side effects. Avoid long-term use.

Melatonin is another oft-chosen antidote to sleeplessness. When our bodies produce increased levels of this hormone, we feel less alert and therefore more sleepy. Studies of over-the-counter melatonin, however, have not conclusively proven its helpfulness. Additionally, the difficulties inherent in identifying personally appropriate dosages, as well as product impurities, make melatonin a questionable sleep treatment (Alternative Medicine Review, 2000, vol. 5, no. 3).

The best way to help yourself sleep more soundly, as Ballard and Meletis both point out, is to make changes in your approach to sleep. You can try many strategies at home without the guidance of a health care practitioner: progressive muscle relaxation (tighten, then relax, each body part, beginning at your feet and moving up your body), focused imagery (picture sunbathing near the ocean or lying beside a quiet creek—whatever image calms you), abdominal breathing (deep breaths to pull air down into your belly), and meditation (either with a tape or on your own). All of these therapeutic approaches are noninvasive, inexpensive, and proven to help.

Wendy DuBow loses sleep on a regular basis as a result of her two young children and one talkative, nocturnal kitten.