Author: erlacwty

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Insomnia III

There are other sleep disorders like Restless Legs Syndrome (RLS) which cause fragmentation of  sleep. That just means that it ‘messes up’ your normal sleep cycles which you need to be your daytime best . The other reason I mention this, is that OSA can actually cause Insomnia.

Insomnia

Evidence (and common-sense) shows that choking and the inability to breathe at night often unconsciously (or otherwise), predisposes the sufferer to not want to go to sleep when this potentially fatal disease takes place. After all, if you were strangled every time you went to sleep, you might not be in a hurry to go to sleep either!

Anxiety and depression are frequently seen in association with OSA. Of course, if you’re suffering from insomnia and the resultant signs of sleep deprivation, it’s not likely that you’ll be on top of your game during the day either. Being ‘cranky’ with mood swings is a sign of poor sleep. The good news is that BSM and CBT-I is usually useful even if you have mild to moderate signs of anxiety or depression which makes sense when you think about it. Perhaps not surprisingly, those people may see greater overall benefits too!

But we have to be realistic, there will always be some for whom this won’t work – who are they?

So, those with Insomnia may also have SDB. Obviously if this is a component, failure to treat the SDB will likely compromise your Sleep Quality and likely resolution of Insomnia too.

Of course, it also leaves the SDB sufferer (or their bedpartner) vulnerable to the consequences of that disorder.

OSA is heavily associated with High Blood Pressure (Hypertension), Heart Attack,

Stroke and Diabetes. As mentioned earlier Anxiety, Depression and Mood-Disorders are often associated.

Decision making and cognitive function are (not surprisingly) affected and the chance of a car crash is increased in those that have just moderate Obstructive Sleep Apnea, by op to 7 times the rate of healthy sleepers.

While there are different management tools for SDB, you will need to find someone who is not selling you their particular management tool, be it CPAP (mask, hose and pump), Oral or dental device (OAT), laser, surgery or one of a million unproven devices out there that border on snake oil sold by charlatans without any regulation, or on their part, often ethics either. However, having said that, management is crucial and for some it will be like having a new life, just be sure to ask questions. Unfortunately, even physicians can be heavily biased.

I also mentioned it was generally OK to use CBT-I to treat insomnia in those with mild to moderate anxiety and/or depression . If someone has serious (major) depression so that they are unable to work, find no pleasure in life and may even have suicidal thoughts, jumping over such issues to address insomnia management  first may be dangerous. Cases of severe anxiety, depression or other mood problems should be reviewed by your physician. Bi-polar disorder is another example that affects sleep.  Studies show poor medical recognition of Bi-polar Disorder, just as there is poor medical awareness of SDB.

Your family physician should always be your first port of call for these disorders in order that you can get care by referral, which may include counselling, psychotherapy, CBT or even medicines (usually not sleeping tablets). It is important not to overlook the presence of these issues, especially in someone suffering from insomnia.

What are some of the other issues that we should be aware of?

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Insomnia II

I mentioned that Sleep Disordered Breathing (SDB) , which Includes Obstructive Sleep Apnea (OSA) is a common sleep complaint too. Insomnia and OSA have a strong association and it is wise to arrange a “sleep test” if you’re undergoing care for insomnia to rule out SDM. Anything that fragments sleep will make you feel dragged out and often lacking energy, sometimes with Excessive Daytime Sleepiness (EDS) too.

Insomnia

SDB is a disorder where there is limitation of airflow at night while you’re asleep and unable to protect your airway yourself. Snoring is a type of SDB and can cause the sufferer fragmented sleep. Often times it is their bedpartner who suffers insomnia! However, many studies have shown that heavy snoring can be the cause of cardio-vascular disease, especially heart attack and stroke. Alas, as medical awareness is poor, many snorers are not treated and their disorder goes on to cause a catastrophic even which is then blamed on to something else.

SDB comprises snoring, OSA and a disorder called Upper Airway Resistance Syndrome (UARS). OSA is a disorder where there can be complete blockage of the airway (called an apnea) as well as a partial blockage which as it allows some passage of air, cases snoring. Snoring and OSA often appear together but can exist separately, hence the value of a sleep test. A sleep test can often be performed at home (home test) although admittedly they tend not to promote sleep themselves – still diagnostically, they can be worth their weight in gold!

UARS is an interesting disorder because it occurs (not infrequently) in people you wouldn’t expect to have OSA. Therein lies the problem. One tends to assume that someone suffering from OSA will be male, middle aged and overweight. Because of this most of the screening tools used are for that stereotype, so UARS may get missed on the radar!

Only a decade or so ago, Upper Airway Resistance Syndrome was not on the radar and only a few years ago, I’ve heard physicians arguing against its existence! Still, I’ve also heard a physician claim that she “didn’t believe in OSA” although exactly what she meant by that I’m still not sure. There is still much misunderstanding out there and so it pays for you to find out what issues may be affecting you, if you want a better sleep.

UARS can be seen in the young, the slim, the fit and the healthy. Young women may also be affected yet everyone assumes that they can’t have OSA because they’re not middle-aged men, yet they do have it. Their breathing problem is more due to airway collapsibility than the blockage (usually the tongue and pharyngeal tissues) found in OSA.

UARS is also not so easily diagnosed as standard garden variety OSA which can also pose a problem. Sometimes a little common-sense may be required.

So, are there other problems we should know about before we look at insomnia?

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Insomnia

Insomnia

Are you just about all in? Are you close to your wits end in not being able to get a decent night’s sleep? You’ve tried just about everything, from reading, to music and even herbal teas! May be there’s something you missed, but what is it? You’d buy it if you thought it would work! Hang in there, there’s light at the end of the tunnel, there’s hope for even the worst sleepers out there, let alone you! Continue reading “Insomnia”