Difficulty Sleeping

I do my best to stay up (no pun intended) on the latest research and findings regarding sleep-related disorders and their treatments. New results out of Ryerson University in Toronto don’t surprise me — that taking sleeping pills or drinking alcohol is not a long-term solution for dealing with insomnia.

The study was conducted by Heather Hood, a PhD student in clinical psychology and lead author of the study, along with Dr. Colleen Carney, director of Ryerson’s Sleep and Depression Laboratory, and graduate psychology student, Andrea Harris.

Hood is an insomnia therapy specialist and had previously researched the link between anxiety disorders and “safety behaviors” — things people do to self-treat a disorder. With the new research, Hood and her associates wanted to examine the relationship between insomnia and safety behaviors, such as taking sleep medication or drinking alcohol before bed. Specifically, they wanted to uncover the belief systems of poor sleepers: how much a person with insomnia believes that their behaviors are helping them sleep, even if those behaviors are not helping them sleep at all.

According to the National Sleep Foundation, 48 percent of Americans report occasional insomnia. And a recent Harvard Medical School study determined that insomnia costs U.S. companies about $63 billion a year due to missed days and poor work performance. Clearly, lack of sleep and insomnia are an American pandemic, and the efforts of Hood, Carney and Harris to help uncover the beliefs behind the behavior of poor sleepers was resulted in some very important information.

For the insomnia/safety behavior study, the researchers asked 397 Ryerson University undergraduate students to complete an online survey that asked about their safety behaviors. The questionnaire also asked how often they performed their nightly rituals, and how much they felt they needed to fall sleep. They were also asked how they defined insufficient sleep, and to what extent they went to in order to avoid feeling tired.

The results of the study, published in the December 2011 issue of Behavior Therapy, found that 40 percent of the students polled were poor sleepers who were likely to use safety behaviors, such as taking sleep medication or drinking alcohol,  which in fact, not helping them fall sleep. They also observed that the poor sleepers felt dependent on these behaviors and believed they helped them sleep, even though the behaviors were actually compounding their sleeping problems. The students who did not experience sleep problems often didn’t think of anything — they simply fell asleep.

Based on the research, Dr. Colleen Carney, director of Ryerson’s Sleep and Depression Laboratory, believes that poor sleepers who engage in safety behaviors are actually disrupting their sleep in the long term. These safety behaviors are driven by unhelpful beliefs about sleep, but people suffering from insomnia or poor sleep feel they need to do these things to help them fall asleep.

Dr. Carney’s conclusion: That cognitive behavior therapy — not taking a pill or a drink of alcohol — is the best long-term treatment for insomnia and other sleep disorders.With cognitive behavior therapy, patients are taught to work with their physiology to help develop good sleeping habits and learn how to fall asleep naturally, rather than relying on chemicals. In our pharmaceutical society, that seems like a rogue idea … but I believe it’s the right one.

Sleeping Problems

One of the most common questions I get in the office during the winter months has to do with seasonal affective disorder: What is it? Do I have it? And what can I do about it? Seasonal affective disorder is a very real form of depression that may affect six out of every 100 people in the United States, according to the American Academy of Family Physicians.

Symptoms of SAD generally manifest in late fall, when the days become shorter and colder, and people enjoy less natural sunlight. Symptoms include, but are not limited to, feelings of sadness, hopelessness and helplessness, lack of energy, loss of sexual interest and usual pleasurable activities, irritability and restlessness, cravings for carbohydrates and overeating (which can lead to weight gain and compound negative and depressive feelings), trouble concentrating, difficulty sleeping and/or insomnia and at the extreme end—thoughts of death or suicide. Symptoms of SAD are usually most intense during the darkest months of the year, so it stands to reason that the farther a person lives from the equator, the higher the incidence of SAD occurs.

These sleep-related symptoms are of particular interest to me, and are usually the catalyst for a person with SAD to come see me for a consultation and treatment. A person with SAD who suffers from sleep problems may go to sleep early and stay in bed for nine or ten hours, but not experience refreshing sleep.  Because of a lack of restful sleep, people with SAD are often drowsy and have trouble concentrating and working during the day.

The relationship between sleep and depression is a bit of a “chicken or the egg” relationship. Which came first? SAD-related depression, or the sleeping problems? It depends. For some, symptoms of SAD occur first—for others, sleep problems appear first. Depression may cause the sleep problems, and sleep problems may cause or worsen the other SAD symptoms.

There is a common link between people with depression and insomnia. Studies have shown that people with insomnia have a ten-fold risk of developing depression compared with people who sleep well. Further, developing depression is highest among those with both sleep onset and sleep maintenance insomnia.

People with depression may also experience insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, experiencing restful sleep and daytime sleepiness. People who suffer from depression are also five times more likely to have a breathing-related sleep disorder than non-depressed people, according to a study at the Stanford University School of Medicine. The 2003 study by Stanford researcher Maurice Ohayon, MD, PhD, found that people with depression were found to be five times more likely to suffer from obstructive sleep apnea (OSA), the most common form of sleep disordered breathing. This was one of the first studies to make the connection between depression and sleep disorders.  More current research has confirmed the connection.

So, if you believe you are experiencing SAD-related depression and/or sleep disorders, please see a psychiatrist or sleep specialist about it. There are treatments such as morning light therapy that can offer some relief, so you don’t have to suffer unnecessarily through the winter blues. Call me—I’m happy to help.

Men 6.2 hours and Women: 6.8 hours

This week, I was interviewed by WCBS-TV New York for a news segment called, “Sleep: the Battle of the Sexes.” The topic was one I am very familiar with: People suffering from lack of sleep, and how it can affect daytime mood, mental acuity, job performance and relationship intimacy.

The show drilled down a bit farther and asked: who is more likely to suffer from a sleep disorder, men or women? And of the two genders, which performs better despite a lack of sleep?

What we know is that men and women have different circadian rhythms. According to an article by the Proceedings of the National Academy of Sciences of the United States of America,  “The circadian rhythms of melatonin and body temperature are set to an earlier hour in women than in men, even when the women and men maintain nearly identical and consistent bedtimes and wake times. Moreover, women tend to wake up earlier than men and exhibit a greater preference for morning activities than men.”

In other words, women tend to go to sleep and wake up earlier than men. We also know thanks to a Penn State study that women need 6.8 hours of sleep per night, while men require just 6.2 hours. While scientific studies are interesting, there is a discrepancy between these numbers and what I am seeing in my office at the Manhattan Snoring and Sleep Center.

Based on the facts, one would think women are getting to sleep earlier and sleeping longer than their male counterparts. But are women getting the sleep they need? In my anecdotal opinion, they are not, and they are suffering quietly for it. In our society, men are stressed out, but women are really stressed out. The physical demands of balancing career and family, along with the mental strain of worrying about finances and future is taking its toll on the women in our society.

Don’t get me wrong, men worry and suffer from sleep disorders too. But they seem more willing to speak up and seek treatment. Women, on the other hand, being the selfless caregivers they are, stay focused on others and what needs to be done and power through their day. Which explains another Penn State study that found sleep deprived women made fewer mistakes compared to men in a series of computer tasks. It seems that, although women need more sleep, they do better without it because, for better or worse, they’re just more used to it.

Whether a man or woman is suffering from a lack of sleep, the fact is that a sleep disorder can lead to negative health issues, including an increased chance of hypertension, heart disease, osteoporosis and inflammatory disease.

In addition to personal health issues, a sleep disorder can wreak havoc on a relationship. The partner of a patient once shared with me how his snoring and sleep apnea had impacted their relationship. It led to weeks without quality REM sleep, and she said it left her feeling groggy with low energy, cranky, unable to concentrate for long and she was more prone to getting sick. His constant snoring caused her to start sleeping on the couch, which led to resentment, lack of intimacy and loss of connection.

I have made it clear in previous blogs that I am not a marriage counselor or relationship expert. But I can tell you unequivocally that, if you or your partner snores or suffers from a lack of sleep on a consistent basis, it will negatively affect your relationship.

In the end, circadian rhythms and who performs better and the sex of the person with the sleep disorder doesn’t matter. What matters is getting it treated and keeping the relationship healthy.

This also bears repeating: Turn off the TV when you go to sleep. Falling asleep with the TV or computer on interrupts deep REM sleep because the light from the screens interfere with the production of melatonin, a hormone that tells our bodies when it’s time to go to sleep. Do yourself a favor and turn off the TV, computer and lights at night. Your brain and body will thank you for it the next day.

To watch “Sleep: The Battle of the Sexes” on CBS2 New York, click here.

I am by no means a marriage therapist. However, I hear couples complain all the time in my practice. They come in for a snoring test appointment, and within seconds the husband makes a comment such as “my wife made me come.” Snoring is more common in men than women, but the reverse is also common.

The snoring spouse who feels “dragged” to the doctor’s office is resentful that his or her snoring problem can’t be left alone. The spouse that does the dragging-in is frustrated and tired. Ordinarily affectionate couples can have a strain in their relationship caused by snoring. Sometimes if it wasn’t for their spouse, a snorer wouldn’t even know they had a problem. As one of my patients recently told me, “I was very surprised when my lovely wife first clued me in that I was snoring at night. It was disturbing her sleep, but I didn’t realize that snoring was the cause of my own fatigue.”

The reason for resentment is understandable. Snoring can cause daytime symptoms that can cause serious problems in one’s waking life, and unfortunately, it is not just the snorer that suffers – the snorer’s spouse can suffer just as much. According to the National Sleep Foundation,  39% of American adults get less than seven hours of sleep each weeknight, and more than one in three (37%) are so sleepy during the day that it interferes with daily activities. The sleep loss associated with snoring—whether it’s the snorer or the bed partner who is awakened by the snoring, interrupts important recuperative sleep which can impair a person’s ability to perform cognitive tasks involving memory, learning, reasoning, and mathematical processes. It can impair motor skills and can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

Symptoms can be even more severe for the snorer if they have sleep apnea, a condition which causes them to stop breathing often many times a night, and wake gasping for air. Sleep apnea is linked to lung and heart disease, diabetes, obesity and stroke.

The disruption of sleep from snoring is causing couples to have a hard time sleeping together. Fifty-three percent of adults say they have relationship problems because of their or their partner’s sleep disorder, the National Sleep Foundation found in a recent study. To avoid the symptoms of daytime sleepiness, many couples choose not to sleep together in the same bed.

In the book, “Two in a Bed: The Social System of Couple Bed Sharing,” author Paul C. Rosenblatt interviewed 42 couples, and examined how sharing a bed affects the couple’s relationship. Many couples described the intimacy and comfort level of sleeping in the same bed is extremely important to their relationship. As he describes in the book, in their time together before drifting off to sleep, “couples catch up on what’s going on with one another, plan, make decisions, deal with disagreements and solve problems.”

With their hectic schedules, many couples often only have this time to catch up. It is no wonder why it’s crucial to their relationship. Unfortunately snoring can force one spouse into another room for the sake of sleep, and this crucial together time is hard to replace in their busy lives otherwise.

If your marriage is suffering because you or your spouse snores, the key to reconciling is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical, in-office and minimally invasive treatments available to snorers today. Although I would never make the claim that I’ve saved marriages, I’ve heard back many times from patients who tell me that it wasn’t until after their snoring was cured did they realize how much happier they are snuggling next to their spouse again.

Otolaryngology Associates, with two locations of its ear, nose and throat (ENT) practice in New York City, is seeing a surge in patients who suffer from ragweed allergies, and expect an unusually severe and extended season. The practice is also experiencing an uptick in patients that are affected by the non-seasonal airborne allergens such as mold and dust mites.

This summer, and extending into the early Fall, residents along the East Coast experienced a record-breaking summer of high-heat and record rainfalls. When combined, they formed the perfect storm to growth of these allergens.

In August, it was reported that the Northeast experienced record ragweed pollen counts. Ragweed thrives in lots of water and sun. It blooms around August and can continue producing pollen through the late fall until a killing frost. Weather experts expect that it will be a long blooming season because for the last decade killing frosts have been occurring later and later.

Hurricane Irene, which caused record-breaking rainfall all along the East Coast, caused severe flooding of “epic proportions” according to NASA. High levels of rain are also ideal for the proliferation of another common allergen, mold. Although it is not a seasonal allergen, mold multiplies quickly in damp conditions. The Northeast typically has much dryer weather conditions in late summer to early fall, and is expected to have unusually high levels of mold this year. Dust-mites are also a widespread allergen that has reached unusual levels due to the high heat experienced this summer.

Allergic reactions to air-born allergens can range from mild to severe. Usual symptoms include stuffy or runny nose, sneezing and itchy eyes. Other symptoms can include coughing, fatigue, and sore throat. These symptoms can sometimes lead to more serious conditions such as sinus and ear infections. Due to blockage in the nose, snoring is also a very common result.

Treatment of your allergies varies according to severity. Prescription nasal steroid sprays decrease the allergic reaction and inflammation in the nose. Non-sedating antihistamines treat the body’s natural reaction when it comes in contact with an allergen by blocking histamine which causes swelling and congestion. Allergy injections or immunotherapy, are for patients with long-standing allergies, and may be identified through skin or blood tests. They gradually reduce symptoms and the need for medication. If you’re not sure what it is that is causing your allergic reaction, an allergist can identify your allergy. It is important to treat your symptoms because they can lead to more serious conditions, and if they are interfering with your breathing or sleeping, seek treatment with an ear, nose and throat specialist.