Princeton's Ask The Doctor Jan-Feb 2019

Why You Can’t Sleep - 13 Reasons By Samuel Krachman, DO You know you need sleep and you can’t stop yawning. So why can’t you fall asleep?

1. Caffeine : Caffeine is the most popular known “medication” that affects your sleep. While it can give you a boost in the morning, it can affect your body’s natural chemicals, including adenosine, a neurotransmitter within the brain. Adenosine is formed through the normal breakdown of energy molecules, like adenosine triphosphate (ATP), that we use while awake during the day. As adenosine levels rise during the day, they increase our drive to fall asleep when they bind to their receptors. However, caffeine competi- tively binds to our adenosine receptors and keeps us awake. If sleep is eluding you, try cutting back on the caffeine. 2. Alcohol: Some people drink a glass of wine or beer to wind down and relax at the end of the day but alcohol can be very disruptive to sleep quality. It disturbs your sleep cycle, particularly deep and REM sleep, which can make you feel more tired the next day. Cut back if it seems to be an issue.

3. Snoring: Whether you snore or are woken up by your partner’s habit, snoring isn’t just annoying—it can signal an underlying medical condition like sleep apnea. Other symptoms of sleep apnea include struggling to breathe while sleeping and needing to use the bathroom excessively at night. Obstructive sleep apnea increases your cardiovascular risk, so it’s important to seek medical attention for the condition. Treatments have evolved in recent years beyond continuous positive airway pressure (CPAP) machines to include medications, oral applianc- es and pacemaker-style devices that stimulate the tongue. Losing weight can also help prevent snoring. 4. Multitasking in Bed: Your bed should be used for two things—sleep and sex. When you watch TV, work on your laptop or surf on your iPad in bed, you begin to associate bedtime with activities other than sleep, so reserve those activities for other rooms in the house. 5. Electronics: Similar to the tip above, blue light-emitting electronics like TV, tablets and phones can disrupt sleep patterns. While light of any kind can suppress the secretion of melatonin, a hormone that influences circadian rhythms, blue light at night does so more powerfully. In fact, Harvard researchers conducted an experiment comparing the effects of 6.5 hours of exposure to blue light with exposure to green light of similar brightness. The blue light suppressed melatonin for about twice as long as the green light and shifted circadian rhythms by twice as much. 6. Temperature: Optimize the conditions in your bedroom for sleep, beginning with the temperature. A cooler room with low humidity is ideal. 7. Light: Block sunlight as much as possible, especially in summer when it’s lighter earlier. A full moon also can make your room too bright for sleep. Light suppresses your body’s natural production of melatonin, so you’ll want to keep the room as dark as possible. 8. Apps: The U.S. Food and Drug Administration (FDA) has yet to approve an app for monitoring sleep quality. Don’t rely on an app to judge the quality of your sleep or diagnose a condition, like sleep apnea. 9. Visitors: If you frequently sleep with your children or pets, you should rethink your visitation policy. Most healthcare professionals agree that children shouldn’t sleep in their parents’ bed because it disrupts sleep habits for everyone and can lead to maladaptive behaviors. And while cuddling up with Fido or Whiskers may be comforting, pets also can disrupt sleep, and can even bring fleas, ticks, or allergens in with them. 10. Bed Bugs: If you travel frequently, be on the lookout for bed bugs in hotel rooms. To ensure you don’t let free loaders infest your home, wash your sheets regularly during busy travel times. 11. Food: A big steak or creamy pasta dish may sound delicious but heavy meals can affect your sleep. Eat larger meals at lunch instead. 12. Other stimulants: A handful of small research studies have linked stimulants like peppermint and vitamin B12 to sleep difficulties. If you think these stimulants are an issue for you, consider switching to an orange-flavored toothpaste and take your multivitamin in the morning rather than at night. 13. Other Sleep Conditions: If you find yourself falling asleep during the day, you may have narcolepsy, which is especially prevalent in younger people. Cataplexy, a type of muscle weakness, and restless leg syndrome are other medical conditions that can affect sleep. Contact your doctor if you believe you have one of these conditions. The good news is that if you’ve been “running on fumes” all week, you can catch up on restorative sleep during the weekend. However, if you feel exhausted—meaning that you feel weak and fatigued rather than just sleepy—there may be a medical reason, such as anemia or a thyroid condition. Talk with your partner about ways to optimize the conditions in the bedroom to promote a more positive sleep environment, and discuss ways to minimize stimulants and other sleep disruptors. And, lastly, if you think you have a medical condition that’s affecting your sleep, contact your doctor for an evaluation.

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