Staying Awake: A Doctor's Guide To Managing Sleep

Sleep is essential for our physical and mental health, and a lack of it can have serious consequences. Sleep disorders can lead to moodiness, anxiety, crankiness, and depression, as well as affecting memory and concentration. Constant sleepiness can also result in accidents and, over the long term, contribute to chronic conditions like heart disease, diabetes, obesity, and high blood pressure. Despite this, many people wait longer than necessary to seek treatment for sleep issues. There are over 100 specific sleep disorders, the five most common being sleep apnea, insomnia, narcolepsy, restless legs syndrome, and REM sleep behaviour disorder.

Doctors themselves are not exempt from sleep issues. A 2006 study found that when residents work a shift of 24 hours or more, they are three times more likely to make a significant medical error. After five 30-hour shifts in one month, the chance of making a mistake increased by 70%. A more recent study by sleep specialists found that hospitals are still failing to limit the hours of young doctors, with 80% of interns exceeding the work-hour limit.

Sleep disorders and their warning signs

Sleep disorders are conditions that affect sleep quality, timing, or duration, and they can have a significant impact on a person's ability to function during the day. There are more than 80 types of sleep disorders, and they can be caused by various factors, including medical conditions, mental health issues, genetic factors, medications, and substance use. Here are some warning signs and symptoms of common sleep disorders:

Insomnia

• Difficulty falling or staying asleep
• Daytime sleepiness and fatigue
• Difficulty functioning during the day
• Chronic insomnia is diagnosed when the above symptoms occur at least three times a week for at least three months.

Sleep Apnea

• Heavy snoring
• Choking or gasping for air during sleep
• Daytime sleepiness and fatigue
• Morning headaches and dry mouth

Narcolepsy

• Excessive daytime sleepiness, even after adequate sleep
• Irrepressible urge to sleep, resulting in sudden "sleep attacks"
• Cataplexy: sudden loss of muscle tone causing the person to slump over while nodding off

Restless Legs Syndrome (RLS)

• Tingling or crawling sensations in the legs, creating an irresistible urge to move them
• Symptoms tend to worsen when sitting or lying down, making it difficult to sleep
• Can be triggered by caffeine intake and certain medications

Parasomnias

• Unusual sleep behaviours such as sleepwalking, bedwetting, night terrors, or exploding head syndrome
• Most common in children but can also affect adults

Shift Work Sleep Disorder

• Difficulty falling and staying asleep due to work schedule
• Sleepiness at unwanted times, affecting work performance

Delayed Sleep Phase Syndrome

• Falling asleep at least two hours after the desired bedtime
• Difficulty waking up in time for school or work

REM Sleep Behaviour Disorder

Acting out dreams during the REM stage of sleep, such as talking, walking, or swinging arms

If you experience any of these warning signs or symptoms regularly and they interfere with your daily life, it is important to consult a healthcare provider for proper diagnosis and treatment.

When to call a doctor about sleep disorders

Sleep disorders can have a detrimental impact on your physical and mental health, as well as your quality of life. If left untreated, they can lead to chronic health issues such as heart disease, diabetes, obesity, and high blood pressure. Therefore, it is important to recognise the signs and know when to seek medical help.

Signs and Symptoms of Sleep Disorders

Anyone can experience sleep problems from time to time, but if you are regularly exhibiting the following symptoms, it may be a sign of a sleep disorder:

• Struggling to fall asleep
• Struggling to stay asleep
• Feeling tired during the day, even after a full night's rest
• Finding it difficult to carry out regular daytime activities
• Falling asleep while driving
• Feeling sleepy when inactive, such as when watching TV or reading
• Difficulty concentrating at work, school, or home
• Poor performance at work or school
• Memory problems
• Changes in mood, energy, and appetite

When to Call a Doctor

If you are experiencing any of the following, it is recommended that you consult a doctor:

• Your symptoms have lasted longer than 4 weeks or are interfering with your ability to function
• You wake up multiple times during the night gasping for breath
• You suspect that a new medication is interrupting your sleep
• You experience an uncomfortable, painful, or "crawling" sensation in your legs when trying to sleep or when your legs are inactive for long periods
• Heartburn is keeping you awake
• Physical pain is disrupting your sleep
• You are experiencing changes in your mood, energy, or appetite

What to Expect from a Doctor

Your doctor will likely perform a full physical examination and ask about your symptoms, lifestyle, medical history, and any other illnesses. If there is no obvious cause for your symptoms, or if your sleep problems persist, your doctor may suggest a sleep study. This involves sleeping in a special room where a medical team can monitor your brain and body activity. They will look for possible sleep disruptions and analyse the data before discussing the results with you.

Sleep therapy products and solutions

One option is sleep therapy, which involves using the latest technology and clinical expertise to enhance sleep quality. For example, Performance Home Medical offers sleep therapy equipment and services, including CPAP devices, masks, and supplies. CPAP, or Continuous Positive Airway Pressure, is a common treatment for sleep apnea, a disorder characterised by interrupted or abnormal breathing during sleep. In addition to CPAP, there are other innovative solutions, such as Inspire therapy, a mask-free treatment for obstructive sleep apnea. This treatment involves a simple system, including an implant, remote, and app, allowing users to control their OSA treatment conveniently.

In addition to medical interventions, there are natural sleep aids that can be effective in improving sleep quality. These include:

• Drinking warm milk, chamomile tea, or tart cherry juice before bed. Warm milk, for instance, is believed to contain chemicals that simulate the effects of tryptophan, a building block for serotonin, which plays a role in the sleep-wake transition.
• Engaging in physical activity can improve sleep quality, particularly moderate aerobic exercise, which increases nourishing slow wave sleep. However, it is important to avoid exercising too close to bedtime, as it may interfere with sleep due to the release of endorphins.
• Taking melatonin supplements can be helpful, as melatonin is a hormone that naturally induces sleepiness. However, it is important to purchase melatonin from a trusted source, as supplements are unregulated and dosages may vary.
• Maintaining a cool and dark bedroom environment is ideal for sleep. A temperature between 65 and 72 degrees Fahrenheit is recommended, and minimising light exposure from electronic devices or light fixtures is crucial to support melatonin production and a healthy sleep cycle.

By utilising sleep therapy products, such as CPAP or Inspire therapy, and incorporating natural sleep aids, individuals can significantly improve their sleep quality and overall well-being.

The effects of sleep deprivation on doctors

Sleep deprivation can have a range of detrimental effects on doctors, impacting their performance, mood, and overall health.

Performance and Alertness

Doctors who are sleep-deprived may experience cognitive slowing, more variable performance, neglect of non-essential tasks, decreased learning ability, and a decline in motivation and problem-solving skills. They may also have slower reaction times and find it challenging to stay awake during inactive tasks. These factors can compromise the quality of patient care and increase the risk of medical errors, potentially affecting patient safety.

Mood and Emotional Regulation

Lack of sleep can lead to increased negative moods, such as anger, hostility, depression, confusion, tension, and sadness, while positive moods like vigor and happiness tend to decrease. Mood changes can influence how doctors interact with patients and colleagues, potentially affecting the work environment and patient care.

Health Risks

Chronic sleep deprivation can contribute to or worsen various health conditions. These include an increased risk of developing high blood pressure, high cholesterol, Type 2 diabetes, and a weakened immune system. Sleep deprivation can also lead to higher pain sensitivity and a decline in mental health, with individuals experiencing symptoms of depression and anxiety more frequently. Additionally, it can contribute to conditions involving psychosis and increase the risk of developing Alzheimer's disease.

Decision-Making and Patient Safety

Fatigue and sleep deprivation can impair decision-making abilities, similar to the effects of alcohol intoxication. This impairment can impact a doctor's ability to make sound judgments and increase the likelihood of errors, potentially compromising patient safety.

Long-Term Effects

While short-term sleep deprivation may not have significant consequences, chronic and prolonged sleep deprivation can lead to a sleep debt that accumulates over time. This can result in a range of health issues and negatively impact a doctor's overall well-being and ability to function effectively.

How to talk to your doctor about your sleep

Sleep is essential for your health and well-being, and if you're experiencing sleep difficulties, it's important to address them. Here's a guide on how to talk to your doctor about your sleep:

When to Talk to Your Doctor

Recognize the signs that indicate it's time to consult a doctor about your sleep. Look out for these red flags:

• You regularly struggle to fall asleep or stay asleep.
• You often wake up earlier than intended.
• You don't feel refreshed when you wake up.
• You experience excessive daytime sleepiness, even after a full night's rest.
• You need frequent daytime naps to feel rested.
• Your daily activities are affected by your sleep problems.
• You fall asleep during activities like driving, watching TV, or reading.
• Your sleep partner reports loud snoring, gasping, sleepwalking, or abnormal movements during sleep.

If you experience any of these issues more than once a week for multiple weeks, it's advisable to schedule an appointment with your doctor.

Preparing for Your Appointment

To make the most of your doctor's appointment, it's helpful to come prepared. Here's what you can do:

• Keep a sleep diary: Record your sleep patterns, including bedtime, wake-up time, total sleep duration, the number of awakenings during the night, and how long it takes to fall back asleep. Also, note your daily activities, meals, and exercise routines. A sleep diary provides an objective account of your sleep issues and helps your doctor identify patterns.
• Try different strategies: Experiment with different approaches to improve your sleep, such as changing your bedtime routine, adjusting your diet or exercise habits, or creating a relaxing sleep environment. Take note of what works and what doesn't, and share these findings with your doctor.
• List your medications: Make a list of any medications you're currently taking for other health conditions, as they may impact your sleep.
• Write down your questions: Prepare a list of questions you want to ask your doctor about your sleep. This ensures you cover all your concerns during the appointment.

What to Expect from the Doctor's Questions

Your doctor will ask specific questions to understand your sleep issues better and make a potential diagnosis. They may inquire about:

• The nature of your sleep issues and how long you've been experiencing them.
• Any life changes or stressors that coincided with the onset of your sleep problems.
• Your definition of a good night's sleep before these issues began.
• How your sleep issues affect your daily life and activities.
• The amount of time it takes you to fall asleep and your typical sleep and wake-up times.
• Whether you experience early morning awakenings and difficulty falling back asleep.
• Your pregnancy status or menopause.
• Your consumption of substances like coffee, alcohol, or cigarettes, including quantities and frequency.
• Your physical activity habits and the types of exercise you engage in.
• Your mental health, including feelings of stress, anxiety, or depression.

Next Steps After the Appointment

Based on your history and examination, your doctor will determine the appropriate course of action. Here's what you can expect:

• Alternative treatments: Doctors often recommend lifestyle changes and alternative treatments before prescribing medication. This may include improving your sleep hygiene, such as maintaining a consistent sleep schedule, making dietary changes, developing a calming bedtime routine, or creating a sleep-conducive environment.
• Cognitive-behavioral therapy for insomnia (CBT-I): This approach focuses on identifying and modifying the thoughts and behaviors that disrupt your sleep, such as stress, worry, or caffeine consumption.
• Referral to a sleep specialist: If your doctor suspects a sleep disorder, they may refer you to a specialist for further evaluation and diagnosis. Sleep specialists have advanced training in sleep medicine and may perform an overnight sleep study to monitor your sleep patterns, brainwaves, breathing, and movements.
• Treatment of underlying conditions: In some cases, your sleep issues may be a symptom of an underlying medical condition, such as chronic pain, cancer, acid reflux, diabetes, depression, or hormonal changes. Treating the underlying condition may help resolve your sleep problems.

Remember, seeking help for your sleep issues is essential for improving your sleep quality and overall health. Don't hesitate to talk to your doctor if you have concerns about your sleep. They can provide guidance, recommendations, and treatment options tailored to your specific needs.

Frequently asked questions