Is insomnia or apnea keeping you awake?

DR. SUSAN LOCKE writes that there are effective treatments for sleep disorders . . .

Susan Locke

In an earlier article, I discussed the signs and symptoms of some common sleep disorders. Now I focus on treatment for the two most common sleep disorders: insomnia and sleep apnea.

Insomnia. The first steps in treating insomnia are to make sure that you have good sleep habits, also known as good “sleep hygiene.” These habits include: going to sleep at the same time each night; waking up at the same time each morning (even on weekends); avoiding naps; thinking positively (worrying only worsens the situation); avoiding caffeine, alcohol and nicotine late in the day; exercising regularly; avoiding heavy meals late in the day; relaxing before going to bed; limiting the use of your bed to sleep or sex; and ensuring your sleep environment is comfortable, quiet, and temperature controlled.

If you don’t fall asleep within 15 minutes, get out of bed and do something; return when you feel drowsy. If improving your sleep hygiene doesn’t improve your insomnia, you may need to see your doctor. He will likely ask about your sleep patterns (keep a sleep diary of these patterns). Insomnia can be treated by behavior therapies, medications (OTC and prescription) or a combination  of both.

Behavior therapies include cognitive behavioral therapy to control worries; relaxation techniques such as meditation, hypnosis, or muscle relaxation; limiting the amount of time spent in your bed not sleeping; trying not to fall asleep, thereby stopping any worries you might have about falling asleep easily; using light therapy or a light box to help readjust your internal circadian rhythms.

Medication. Antihistamines such as Benadryl are commonly used as an OTC sleeping medication. Melatonin is thought to help reset your natural biological clock, but long-term usage may not be effective.

Prescription medications and sedative-hypnotics may be prescribed on a short-term basis. Common side effects include dizziness, confusion, daytime drowsiness, amnesia and balance issues.

When using a sleep medicine, experts advise you to read the medication guide carefully, use the medicine at the time of day and the dosage directed by your doctor, do not drive or engage in activities that require you to be alert, tell your doctor about other medicines you use, call your doctor right away if you have any problems while using the medicine, and avoid drinking alcohol and using drugs.

Sleep apnea. Once sleep apnea is diagnosed by a sleep study, there are several possible treatments. For mild cases, conservative therapy may be helpful: losing weight, avoiding alcohol and sleeping pills, changing pillows, using nasal spray/breathing strips.

Mechanical therapy. Continuous Positive Airway Pressure (CPAP) is the preferred initial treatment. Patients wear a mask over their nose and/or mouth and air pressure is adjusted to prevent the airway from collapsing during sleep. These machines are small, portable and can be easily packed in a suitcase.

Oral mandibular advancement devices. For patients with mild sleep apnea, dental appliances can be used to move the lower jaw forward or prevent the tongue from blocking the throat.

Surgery.  Several types of surgical procedures are available if a patient fails to respond to conservative therapy, oral appliances, and CPAP.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

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