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Many causes, effects linked to troubled sleep

GRAND FORKS — Sleep should be simple, but not getting enough of it frustrates many Americans and can lead to health problems, said Tammy Bauduin, a physician assistant in the Pulmonary/Sleep Disorders Clinic at Altru Health System in Grand Forks.

Insomnia is “disturbed sleep or trouble falling asleep or staying asleep,” she said. “It can be short-span or chronic. ‘Chronic’ means it’s lasted longer than 30 days.” 

About 10 percent of middle-age adults and about 25 percent of the elderly have it.

In the general population, alcohol and stress are common factors, she said. In the elderly, medications, loneliness and physical pain may be to blame.

“Most insomnia lasts one month or less and goes away,” Bauduin said.

Effects of poor sleep are wide-ranging and can influence one’s physical and emotional health and cognitive abilities, she said.

“It can affect your alertness during the day and the social areas of your life. You have increased risk of accidents, irritability, daytime fatigue, anxiety, depressed mood, reduced concentration and memory decline.” 

For people whose jobs demand concentration — truck drivers and pilots, for example — the condition may be particularly troublesome, she said.


Underlying health issues could cause insomnia, including fibromyalgia, arthritis, acid reflux disease, chronic obstructive pulmonary disease and sleep apnea, a condition in which blood oxygen levels drop, she said.

People wake up to use the bathroom, but it could be that their blood oxygen is low, she said. When that happens, “the brain sends a signal to wake up.”

Those diagnosed with sleep apnea are at risk for heart arrhythmia and heart attacks and becoming overweight, she said. 

Insomnia may be the result of a neurological, or brain-based, condition such as Parkinson’s disease, dementia, stroke or restless leg syndrome, she said. “Any nighttime pain” can cause it. 

Sleeplessness has been caused by depression, anxiety, medications, the use of alcohol or coffee, or too much daytime napping, she said.

“Situational insomnia” stems from specific events such as a death, financial woes or a job change, she said. The condition can affect anyone who works the night shift. 

Environmental factors, such as sleeping with a snorer or a pet, may hinder sleep, she said.

“People say they sleep better with a pet,” Bauduin said. But she recommends barring them from your bed because their nocturnal movement may disrupt sleep.  

Identifying the reason for one’s insomnia is crucial to appropriate treatment, she said.

“There are so many causes. Let your physician know the circumstances of your life.”

‘Sleep hygiene’

To improve the quality of sleep, Bauduin suggests making sure your bedroom is cool, dark and noise-free.

“Have a set time to go to bed and to get up. Seven to eight hours is optimal.”

It’s normal for a person to fall asleep less than 30 minutes after going to bed, she said.

“If you’re not asleep in 20 minutes, get up and do something boring, maybe read in a soft light — no bright light, though. That makes the brain think it’s time to get up.”

For a good night’s sleep, avoid drinking liquids after 8 p.m., thus reducing the need to urinate in the middle of the night, she said.

“Caffeine can last in the system 14 hours. It affects many things.” 

Avoid late-evening snacks, which can trigger acid reflux. “The body is still trying to digest food after you’re gone to bed,” she said. But “it’s OK to have a light snack, if you’re hungry.”

For four hours before bedtime, refrain from exercise, she said. “And a good six hours before bedtime, avoid caffeine, alcohol and nicotine.”

Nicotine in high doses can be a stimulant and negatively affect sleep, she said.

Sometimes, her patients are asked to keep a “sleep log,” a written record of when they got up at night and what they did, she said.

Relaxation techniques, such as biofeedback or listening to soft music, can restore quality sleep patterns, she said.

Natural sleep hormone

Mother Nature supplies each person with an inborn mechanism for prompting sleep, she said. 

“When the sun goes down, our bodies produce melatonin, a naturally occurring hormone that helps us sleep.” 

Natural melatonin levels slowly drop with age, according to Some older adults make very small amounts of it or none at all. 

As a result, “in older adults, their sleep patterns are broken somewhat,” Bauduin said.

As an over-the-counter supplement, melatonin “sometimes can help,” she said, but “I would advise people to check with their doctor before starting any medication because, if they’re on other meds, there can be drug interactions.”

Even though it’s a natural supplement, melatonin can lead to dependency, she said.

It can also cause dizziness, nausea and confusion, and in men, it can cause larger breasts and decreased sperm count, she said.

“For anyone who has jet lag or who is traveling longer than a week or two, it’s probably OK” to take melatonin tablets short term, she said.  

Sleeping pills should be used only as a last resort and temporarily, she said. “They can sometimes be addicting.”

They can also mask the problem, she said. “We need to find out what’s really causing the sleep issue.”

Because sleeping pills can lead to dependence, “generally, we don’t like to (see patients) use them more than four weeks,” she said. “After that length of time is when it becomes a concern.”

Anyone who has chronic sleep problems, lasting more than 30 days, should be evaluated by a health care provider, she said.  

Talk to your doctor

People should discuss insomnia symptoms with their doctors, “because the doctor doesn’t always ask you,” Bauduin said.

Some patients “may be at risk for sleep apnea, which puts them at risk for heart arrhythmia and heart attacks,” she said. “The heart suffers because it has to work harder to pump oxygenated blood to keep up with the body’s needs.”

Primary care providers will also check for medical, emotional and neurological problems that may be causing insomnia, she said.

Their recommendations may include behavior therapy or counseling to first find out the underlying cause, she said. “Or it could be that a pulmonary disease is not being treated properly.” 

The patient may be referred to a sleep specialist in the Sleep Disorders Clinic, she said.

Insomnia is a growing problem in America because depression is on the rise, Bauduin said. “It’s (related to) the stress, anxiety, recreational drugs on the street, and the alcohol (adults) and kids are using.”

But it may be resolved with thoughtful self-care, she said.  

“Good sleep hygiene is about taking good care of yourself. Sometimes, insomnia is the result of choices we make.”