(Philadelphia, PA) - Ilene Rosen, MD,
and Richard Schwab, MD, with the University
of Pennsylvania Division of Sleep Medicine, spend their
days examining and explaining to patients what may be causing their
lack of sleep. As we approach National Sleep Awareness Week, set
to begin on March 27th, these sleep physicians are offering up some
“Wow, I didn’t know that!” factoids when it comes
to us and our very treasured zzzzz’s.
Little Known Fact #1 - Alcohol is a terrible sleep
Explanation - Although alcohol will cause sleepiness
and may help a patient to initially fall asleep, it actually causes
significant sleep disruption later in the night. Any type of alcohol
(beer, wine, liquor) will disturb sleep. Alcohol will also worsen
snoring and sleep apnea. Alcohol should never be used as a sleeping
Little Known Fact #2 - Getting up during the night
to urinate may be a sign of sleep apnea.
Explanation - When you stop breathing because of
closure of the passageway between the back of the throat and the
windpipe, the brain works very hard to keep your oxygen levels up.
It sends signals to your respiratory muscles, especially your diaphragm,
to work harder. This increased work of the muscles of the chest
cause pressure changes in the chest, which are felt by the heart
muscle. The stress on the heart muscle causes the muscle cells to
secrete a substance, which fools the kidneys into making urine!
Little Known Fact #3 - Decreased interest in sex
or impotence can be a sign of sleep apnea.
Explanation - Patients with sleep apnea often complain
of decreased libido and lose their interest in sex. Some of this
is related to sleep deprivation that results from sleep apnea. Sleep
apnea can also cause impotence. Treatment of sleep apnea can improve
libido and may help impotence. (Schwab)
Little Known Fact #4 - Waking up and feeling awake,
but being unable to move, may be a sign of a serious sleep disorder.
Explanation - Sleep paralysis is sometimes also
referred to as the "witch is riding your back." It occurs
when the brain awakens from Rapid Eye Movement (REM) sleep. During
normal REM sleep, the brain is very active (it is the time of the
night when dreaming often occurs.) During this stage of sleep, the
brain sends a signal to the skeletal muscle in the body and paralyzes,
or immobilizes, them. The only muscles that work are the diaphragm,
the main muscle that helps us breathe and the eye muscles (hence,
the name “rapid eye movement” sleep). If the brain awakens
before the signal that immobilizes the muscles is turned off, the
person will wake-up but still be paralyzed. This can be a very scary
experience that lasts for a few seconds and then breaks. Although
normal people can have sleep paralysis, this can also be a symptom
of sleep deprivation, sleep fragmentation and narcolepsy. (Rosen)
Little Known Fact #5 - If you need two or more
medicines to control your blood pressure, you may have obstructive
sleep apnea. This is even more likely if you are overweight.
Explanation - Studies have shown that patients
with difficult-to-control hypertension (defined as requiring two
or more medications) have a higher prevalence of obstructive sleep
apnea. While we don’t know the cause, patients with refractory
hypertension who also have sleep apnea are noted to have decreases
in blood pressure and better-controlled blood pressure once they
are placed on CPAP (continuous positive airway pressure masks worn
to improve and prolong sleep). (Rosen)
Little Known Fact #6 - Exercise or eating within
three hours of going to bed could be the reason you are having trouble
Explanation - While exercise will help you relax,
in general, and usually helps consolidate sleep, exercising too
close to bedtime will delay the time your body unwinds and is able
to fall asleep. The chemicals that increase in your body immediately
after exercising and eating are associated with increased wakefulness
and will delay the time your body feels ready to sleep. (Rosen)
Little Known Fact #7 - Heartburn during sleep
may be a sign of sleep apnea.
Explanation - Patients with sleep apnea often complain
of heartburn during sleep and treatment of sleep apnea will improve
the heartburn. (Schwab)
Little Known Fact #8 - If you work the night shift
and are having trouble going to bed during the day, try wearing
dark sunglasses -- in all types of weather -- on the commute home.
Explanation - Our ability to stay awake and fall
asleep is a function of two processes. First, there is a homeostatic
switch that drives sleep that is located in the brain. As soon as
we wake up, chemicals build up in our brain. The build-up of these
chemicals is associated with the need to go back to sleep at the
end of the day. Counteracting this drive for sleep is the biological
clock. The clock function with a rhythm that drives our wakefulness,
known as the circadian rhythm. Early in the morning, after being
up all night, the sleep hemostat is primed for sleep. However, although
the circadian clock has just hit its lowest point in its curve,
the exposure to daylight on the commute home "reminds"
the clock that the day is beginning and the circadian drive for
wakefulness increases. Thus, wearing dark sunglasses will "fool"
the clock into thinking it is still dark and delay the clock enough
to allow for sleep to occur after the night shift is over. (Rosen)
Little Known Fact #9 - Falling asleep at movies
or watching TV can be a sign of sleep apnea.
Explanation - Patients with sleep apnea have frequent
arousals at night secondary to recurrent apneas (no airflow). These
arousals cause significant sleep fragmentation, which results in
daytime sleepiness. Commonly, patients with sleep apnea will fall
asleep after dinner, watching TV or at a movie in a theater. Such
patients can also fall asleep at red lights while driving. (Schwab)
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