Sleep disturbances are one of the most common patient complaints in medical offices today. Chances are high that most providers have a large number of patients frustrated by the inability to obtain a good night’s sleep, so familiarity with tools to ensure optimal sleep is priceless.
Impairment of sleep is not just an issue of annoyance or daytime discomfort. Several negative health consequences of sleep deprivation have been studied, including cardiovascular disease, delayed healing, disruptions in metabolism, gastrointestinal disorders and HPA axis dysregulation. Sleep impairment has even been studied as a public health issue, with links to increased motor vehicle accidents and critical job errors.
A recent study published in January of this year, highlights sleep deprivation’s potential impact on the endocrine system. The study, published in the Journal of Clinical Sleep Medicine, notes sleep debt resulted in long-term metabolic disruption and may promote progression of type 2 diabetes in newly diagnosed patients. Patients in this study were more likely to suffer from obesity when sleep debt was present. Another interesting study, in a murine model, suggests a continuous environment of light may be implicated in the pathogenesis of hyperandrogenism and polycystic ovarian syndrome, implicating poor sleep habits may be an important factor in the development of PCOS.
Insomnia, blood sugar instability, sleep apnea, restless leg syndrome, sleepwalking, jet lag, bruxism, medication effects, narcolepsy, nightmares, neuroendocrine imbalance and disruptions in melatonin phases are several of the possible etiologies behind sleep disturbances. While some etiologies require more extensive treatment, consider prioritizing sleep hygiene to create the foundation of a healthy sleep wake cycle. Sleep hygiene may sound like a term used to describe the act of showering before bed or falling asleep in freshly laundered sheets; however, this is a term commonly used to refer to the behaviors and habits surrounding sleep preparation. When utilized appropriately, sleep hygiene can improve not only sleep quantity, but also sleep quality.
- A bedtime that allows for 8 hours of sleep (the average adult, ages 18-40, requires 7-8 hours of sleep each night)
- Consistent daily sleep and wakes times, even for weekends and vacation days
- Daily exercise
- Adequate exposure to natural light during the daytime to encourage proper melatonin levels
- A pleasant and relaxing bedroom environment (a cool temperature, dark, quiet, and free of distractions such as pets and electronics)
- A pre-bedtime routine: a warm bath, meditation, stretching or a non- rigorous yoga session are possible options
- Association of bed with sleep. Limit other activities such as reading, writing, eating or electronic utilization to areas outside of the bedroom
- Keeping a notepad beside the bed to jot down thoughts or ideas and clear the mind
- Napping during the day
- Caffeine consumption after lunch
- Alcohol consumption within six hours of bedtime
- Nicotine use due to its stimulatory effect
- Large meals and/or large quantities of water close to bedtime. If blood sugar dysregulation is present a few grams of protein before bed can be helpful
- Light exposure (especially blue light) in the evening time, which decreases melatonin levels
- Strenuous exercise within six hours of bedtime
- Use of sleeping pills, which can be habit forming
Clinically, optimization of sleep hygiene is an effective place to start with patients as it is low of therapeutic order and may address sleep issues before more potent treatments are needed. Remember that daily habits performed throughout the day, not just those performed close to bedtime may affect sleep-wake cycles.
When sleep disturbances run deeper than simple sleep hygiene habits, testing for salivary melatonin and cortisol levels may be the key to restoring altered circadian rhythms while allowing for targeted treatments. Melatonin testing is now available through The Medicine Shoppe. . For more information on how to order melatonin testing give me a call at 636-278-6561 and my Name is Frank Nuber
505 Salt Lick Road. • Saint Peters, Missouri 63376