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Sleep Disorders And Management
David Claman, MD
What is a Sleep Disorder?
Reasons for a Sleep Evaluation
Sleep Issues Specific to Cancer Patients
Sleep Hygiene Guidelines
Sleep is a basic human need, which is as important for good health as diet and exercise. Getting an adequate amount of good quality sleep is vital for alert mental functioning during the daytime. While a person sleeps, the body rests but the mind remains active. Despite our knowledge of how important sleep is to good health, researchers still do not know why we sleep, nor the exact mechanisms of how sleep restores the mind.
Any condition causing inadequate levels of restful sleep can affect daytime functioning and is considered a sleep disorder.
Obstructive Sleep Apnea is a common sleep disorder. The most common symptoms include loud snoring, sleepiness during the day, high blood pressure, and obesity. Job Analysisbed partner will often report that the patient stops breathing during the night. Untreated sleep apnea may cause cardiovascular disease, risk of automobile accidents, and deceased quality of life and work productivity.
Insomnia is a difficulty falling asleep and/or difficulty staying asleep. Brief periods of insomnia are extremely common but a smaller group of people are chronically affected and may benefit from a formal sleep evaluation and treatment.
Periodic Leg Movements during sleep are kicking movements of the legs which occur every 20-90 seconds all during the night and may disturb the normal sleep of both the sleeper and the bed partner.
Restless Leg Syndrome can be a source of insomnia and is due to leg discomfort usually described as aching or as a crawling sensation, which makes the sufferer feel they must continually move their legs.
Narcolepsy is less common than sleep apnea. The main symptoms of narcolepsy are excessive and uncontrollable sleepiness, weakness during the day and vivid dreams during daytime naps. Proper diagnosis and treatment are essential with this disorder.
Treatment is individualized to the specific sleep disorder. Treatment options include continuous positive airway pressure (CPAP), behavioral modification, medication and surgery.
Common reasons for formal sleep evaluation include:
- Excessive daytime sleepiness.
- Excessive fatigue.
- Pauses in breathing during sleep.
- Loud snoring.
- Excessive leg kicking during sleep.
- Insomnia lasting more than six months.
- Sleepiness interfering with work or social relationships.
- Abnormal nighttime behaviors.
- Night terrors.
Pain may be present, which can be related to the underlying cancer or may be related to treatment. If present, pain can make it more difficult to get sleep, more difficult to stay asleep, and/or it may interfere with sleep quality, therefore making sleep less restful. Effective relief of pain may improve all of these issues.
Breathing Issues are frequently important to cancer patients. Again, breathing may be more difficult due either to the underlying cancer, or to treatment or to other conditions such as asthma, emphysema, or congestive heart failure. Treatment focused on improving breathing should improve sleep quality, and help a person feel more rested.
Anxiety and Depression can seriously disturb sleep, and these issues can often complicate the sleep of cancer patients. Most commonly, these issues would cause insomnia. At times, medications to treat anxiety or depression can be prescribed, but improved sleeping habits (see below) may improve sleep without need for medications.
Medication side effects can disturb sleep. Examples of this would include pain medicines causing daytime drowsiness and antidepressants causing insomnia. Caffeine and alcohol may also disturb sleep quality. A detailed discussion of medications and potential side effects with your physician is often of value.
Treat any underlying physical condition that disturbs sleep. Pain and breathing problems are examples noted above.
Good sleep habits (also known as sleep hygiene)
Avoid sedating medications if possible.
Formal sleep consultation and/or sleep testing could be of value if symptoms are either severe or persistent.
- Establish and maintain a regular bedtime and wake-up time every day.
- Find the amount of sleep you need to feel consistently refreshed.
- Create a comfortable, quiet, clean, and dark environment for sleeping. Your bed and the temperature of the bedroom should be comfortable.
- Establish a regular pattern of relaxing behaviors for 10-60 minutes before bedtime.
- Use the bed and bedroom for sleeping and sex only.
- Exercise on a regular basis.
- Don't nap during the day or evening.
- Don't eat heavy meals or drink large amounts of liquid before bedtime.
- Don't dwell on intense thought or feeling before bedtime.
- Don't lie awake in bed for long periods of time. If not asleep within 20 or 30 minutes, leave your bedroom and do something relaxing until you fall asleep again.
- Don't allow your sleep to be disturbed by your phone, pets, family, etc.
- Don't use alcohol, caffeine, or nicotine. All of these worsen sleep.
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