To Sleep Per Chance To Dream

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To Sleep Per Chance To Dream

• Robert Grimshaw MD FACP

A Lifetime of Quality Care Thats Convenient
Complete
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Insomnia

• Insomnia is one of the most frequent complaints
  we hear. In fact, most Americans sleep too
  little the average adult sleeps just under 7
  hours during the work week, according to a 2000
  survey by the National Sleep Foundation.  The
  recommended amount of sleep is 8 hours. One in 3
  sleeps 6.5 hours or less.  

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Sleeping Driving Diseases

• Drowsy driving is estimated to cause 100,000
  crashes annually.  Not surprisingly, 62 have
  trouble sleeping a few nights a week.  43 say
  that daytime sleepiness interferes with their
  activities a few days a month.  
• Some sleep problems will come from
  diseases Heartburn  (gastro-esophageal reflux
  disease) wakes up many.  People with lung
  disease, heart failure, arthritis, and certain
  neurological conditions including strokes
  commonly have trouble sleeping.  By far the most
  common is use of some medications, caffeine, and
  rebound from alcohol.

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So what can be done?  

• From Dr. Joseph Kwentus writing in the Clinical
  Geriatrics, some thoughts on sleep hygiene
• Dr. Kwentus Sleep Hygiene Guide
• Dont go to bed until sleepy
• Do your bedtime rituals of washing up, brushing
  your teeth etc at the same time every night Get
  up at same time every day
• DONT NAP!!
• Exercise daily, early in the day
• Dont use your bedroom except for sleep and
  romance
• Dont ruminate about problems at bedtime - do it
  in the morning
• Avoid heavy meals at bedtime STOP SMOKING! (At
  first your sleep will be worse, then better)
• Drink coffee, tea, chocolate, colas, or other
  caffeinated beverages only in the morning and in
  limited amounts
• No alcohol 4 hours before bed

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So what can be done? (continued)  

• Take diuretics earlier in the day
• Waking up with pain? Tell us!
• Empty your bladder before bed
• Limit night light, noise and temp
• Get a comfortable mattress
• Wear comfortable bedclothes
• DONT WATCH THE CLOCK!
• Try reading or music at bedtime
• Get some sun (or bright light) during the day.
• Dont exercise 2 hrs or less before bedtime
• Ask us about any medicines (or supplements such
  as ephedra) that might be keeping you up,
  including decongestants, and asthma inhalers.

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When All Else Fails  

• We have medications which can help
• Antihistamines such as diphenhydramine
  (Benadryl, etc) - but tolerance develops after
  1-2 weeks, some men have trouble urinating, and
  some feel a daytime hangover.
• Valerian is an herb which is sometimes helpful,
  200-1000 mg ½-1 hr before bed its unregulated
  by the FDA.
• Melatonin 0.3-1 mg 2 hrs before bed may help,
  particularly seniors its also unregulated by
  FDA.
• Antidepressants such as Elavil, Sinequan,
  Desyrel, Remeron, or Serzone can be helpful, even
  for long periods. Side effects include dry mouth,
  constipation, etc.
• Benzodiazepines such as Sonata, Ambien, or
  Restoril can help for 4 weeks or less. Side
  effects include early morning awakening,
  short-term amnesia and rebound insomnia if
  withdrawn abruptly.