These Medications Will Disturb Your Sleep

In my last article, I talked about insomnia and some of the diseases that Medicationscan cause this debilitating disorder. This time, I’ll address some of the medications prescribed for various diseases that can also disrupt your sleep. I won’t be providing any alternative forms of treatment here as the focus is on medicines that cause sleep disruptions.

But first, let’s briefly talk about sleep itself.

What causes us to Sleep?

How does sleep ‘work’?  What causes you to fall asleep? And what wakes causes you up?

One way to look at it is that you gain a sleep debt while awake. When you’re awake, you accumulate a sleep debt. As this debt rises, the need to sleep becomes stronger. Eventually the need to sleep becomes stronger than the need to stay awake. At that point, you fall asleep.

Then as you sleep, you ‘pay off’ this sleep debt. As this debt gets paid off, the need to sleep naturally becomes weaker. Finally, it gets to the point where the need to sleep becomes less than the need to stay awake; and you wake up.

What’s the Reason for Sleep?

Sleep isn’t just a time to ‘stop and rest’. A lot of things happen while you snooze. As a matter of fact, different stages of sleep provide both physical and mental benefits. For instance, memories are processed in REM sleep. While slow wave sleep produces certain hormones that aid in growth and restoration of your body. Our bodies are created to self-heal. And part of that healing process involves quality sleep.

So then, ideal sleep is necessary for your health and well being. Therefore, poor quality sleep isn’t good. Thus, if you have a disease that’s disrupting your sleep, and you’re taking medications that further disturb that sleep, you’re kinda fighting against the healing process.

With that in mind, let’s take a look at some of the more common medications and how they disrupt your sleep pattern.

Allergies

Many medications for allergies cause drowsiness; however, there are some that don’t. Benadryl (diphenhydramine ) is a common over the counter medication that does cause drowsiness.

Anxiety

In addition to causing drowsiness, some of the medications prescribed for anxiety- also impair performance, such as driving. However, there isn’t solid evidence these impairments continue with long term use. Some of the more common medications are Xanax (alprazolam ), Klonopin ( clonazapam ), and Valium (diazapam ).

Depression

If you struggle with depression, you also have sleep disturbances. You’re most likely fighting sleep when you should be awake, and yet finding it hard to stay asleep. Additionally, the very medications you are prescribed can cause further sleep disruptions.

Additionally, drugs like Nardil ( phenelzine ), and Marplan ( isocarboxazid) can greatly reduce REM sleep. Keep in mind that REM sleep is where memory is processed; kind of ‘brought together’.

Epilepsy

Drowsiness is more common with the older antiepileptic medications; less so with the newer ones. Also, cognitive impairment is more common with Luminal (phenobarbital ) than with other medications.

Heart Medications

Some medications for your heart can cause tiredness and fatigue. Other side-effects can include vivid dreams, nightmares, depression, and mental confusion. In some studies, medications such as Inderal (propranolol), Lopressor (metoprolol), showed an increase in wake time.

Additionally, most medications prescribed for your heart decrease REM sleep.

Mental Illness

People with Schizophrenia usually suffer from insomnia and other sleep disturbances. While most medications prescribed for this disorder cause drowsiness. Although, the older drugs, such as Haldol ( haloperidal ), Mellaril (thioridiazine ), and Thorazine ( chlorpromazine ), are more sedating than the newer drugs.

Parkinson’s

Daytime sleepiness, along with trouble sleeping at night are some of the characteristics of this disorder. some of this is due to abnormal movements during sleep cause numerous awakenings.

The main drug used to treat Parkinson’s is Sinemet( levodopa/carbidopa ). Ironically, some of the more common side effects of this drug include unusual and uncontrollable body movements.

Pain medications

Pain is kind of a double edged sword. On the one hand, it disturbs sleep. On the other hand, lack of sleep can increase pain. And while pain medication can cause drowsiness, many of the diseases that cause pain also cause sleep problems.

Narcotics such as Vicodin and Morphine can cause you to breathe more slowly, which can lead to  central sleep apnea which can cause your oxygen levels to drop; sometimes to dangerous levels.

Conclusion

Some disorders cause sleep disturbances. However, sometimes the very medications you take for a disorder further complicate things by causing even more disruptions to your sleep. And because good quality sleep is essential to your health, this can be a bit of a problem.

Therefore some medications themselves become a double edged sword. Helping the disorder, while hindering the sleep you so desperately need. Hopefully, further research will solve this dilemma.

Till next time…Blessings.

 

 

How to Beat Those Insomnia Blues

In this article, we’ll take a look at insomnia. What it is and what causes it; as well as what it can cause. We’ll also explore some treatment options.Insomnia

You’ve had a sleep study, but they say you don’t have sleep apnea. And yet, you’re still not sleeping. Laying in bed, the thought keeps rolling over in your head “What’s wrong with me?”

What is Insomnia?

Simply put, insomnia is defined as difficulty falling asleep and remaining asleep. It also includes some form of impairment during the day. And even though it’s the most common sleep disorder, insomnia is also the most underdiagnosed, and undertreated. Actually, according to some statistics, approximately 10% of the general population suffers from chronic insomnia, while 30% do so occasionally.

Actually, according to some statistics, approximately 10% of the general population suffers from chronic insomnia, while 30% do so occasionally. Additionally, there are different degrees of insomnia, from mild to moderate to severe. It can also briefly appear from time to time, or come and stay awhile.

But just what causes insomnia? Let’s take a look.

Risk factors

The typical person with insomnia is an elderly white female. There’s also some evidence that it might run in your family.

Some other factors include:

  • Cancer
  • Chronic pain
  • Depression
  • Medications
  • Menopause
  • Restless Legs Syndrome

Although the #1 cause of insomnia is long term Stress.

However, the most common disorders associated with insomnia are anxiety and depression.

Furthermore, if you have insomnia, you’re more likely to be involved in a fatal car accident . You’re also more likely to miss work. And when you are working, you’ll tend to make more mistakes.

In addition to this, insomnia itself is a risk factor for other diseases. Which in itself can make it difficult to properly diagnose.

Let’s look more closely at that.

Diagnosis

Insomnia can be difficult to properly diagnose. This is because it’s hard to determine if it’s a symptom of another disorder or a disorder all by itself. It’s important to find out what caused what so that proper treatment can be made.

For instance, depression can cause insomnia. However, insomnia can also cause depression. But which came first? If insomnia caused the depression, then treating the depression won’t entirely solve the problem.

Another reason for its difficulty involves something known as sleep state misperception. In other words, you can be in a very light stage of sleep, and feel as though you were lying awake the whole time.

Also, there are beliefs about sleep. In reality, some people need more sleep, some need less. The average is around 8 hours. So, if you believe you need 8 hours, but really only need 7, you could lay awake for an hour wondering why you can’t sleep.

Moreover, a diagnosis is made based mainly on what the patient describes, and includes reports of:

  • Attention, concentration and/or memory problems
  • Daytime Sleepiness
  • Difficulty with social interaction
  • Fatigue
  • Irritability
  • Poor school performance
  • Tension headaches

Your Doctor will make a diagnosis based on your sleep patterns. Also the use of some sleep questionnaires. Such as something called an  Epworth Sleepiness Scale

A sleep study could also be ordered if the cause of your insomnia is unclear. Additionally, your Doctor might order some blood work, if (s)he suspects some other medical condition that might be the underlying cause. Such as thyroid disease or iron deficiency anemia.

Once a diagnosis has been made, it’s time to look at some treatment options. We’ll start with changing the way you think and act.

Self Perpetuating Insomnia

Insomnia can be started by something that causes you concern. but continue long after the initial problem is solved. Here’s how.

Some life event causes some concern. In fact, you lay awake in bed worrying about this. Your concern is now making it difficult to fall asleep. After awhile, the initial cause of worry is taken care of. However, you’ve now been in a pattern of not being able to sleep so long that you now have concerns about your inability to sleep.

So now your worry about not being able to fall asleep is causing difficulty falling asleep. And so the cycle continues, long after the initial event that caused it. To further complicate this, now your lack of sleep can lead to depression.

Next, we’ll take a look at some treatment options.

Cognitive Behavior Therapy

Insomnia responds better to behavioral changes then to the use of medicine. However, a combination of treatments can be even more effective. Let’s start with something called Cognitive Behavior Therapy or CBT. This basically involves changing the way you think and behave. There are different forms of CBT, depending on your specific needs. These include:

  • Biofeedback
  • Improve your sleep space- This includes not having a tv, clock, or other electronic devices in your sleep area.
  • Mindfulness meditation
  • Relaxation training
  • Remaining passively awake-Simply try not to fall asleep It’s basically letting go of the worry that you can’t sleep. As mentioned earlier, it can sometimes be the worry of not being able to sleep that keeps you awake. Let go of that worry.
  • Sleep hygiene-Establishing good sleep habits
  • Sleep restriction-You builds up a ‘sleep debt’ while awake. When that ‘debt’ reaches a certain point, your brain tells you it’s time to go to sleep. However, any nap will ‘pay off’ some of that debt, leaving you more awake at bed time.

Also, keep in mind that body position is really important. For example, laying on your back is actually the best sleep position. This is because it properly aligns your spine and neck. As well as puts the least amount of strain on your body. Again, and I can’t stress this enough, there really should be no t.v. or other electronic devices in your bed room. And if noise is a factor, the use of a fan or other white noise machine can be helpful.

Next, we’ll take a look at some of the more common medications your Doctor might prescribe.

Medications

conventional

The 3 main medications are:

  • Allergies make it hard to breathe, which can be at least some of the cause of your insomnia. So if you have allergies, your Doctor might prescribe something like Diphenhydramine (Benadryl), or an over the counter med such as Doxylamine (Unisom).
  • Sedatives-Zolpidem (Ambien). Temazepam Lorazepam (Ativan)
  • Antidepressants-Trazadone. Mirtazapine (Remeron)

Alternative

There are some herbal supplements that have shown positive results. They include Melatonin, Valerian Root, and Chamomile.

And while medicine just relieves your symptoms, Cognitive Behavior Therapy will actually get at the cause of your sleeplessness. However, it will take time and effort on your part to get results.

As you can see, there are many good treatment options available. Talk with your Doctor, as you probably would benefit most from using a combination of treatments together.

Conclusion

We’ve looked at insomnia, and discovered some of the reasons it can be hard to properly diagnose. If you suffer from insomnia, I hope this article helps you understand it a little better. Also, if you know anyone suffering from this debilitating disorder, please share this article with them.

Till next time…Blessings.

 

and

I’ve had a Sleep Study but I Still Can’t Sleep- Now What?

If you’ve had a sleep study, but still can’t sleep, this article will offer you Can't Sleephope. We’ll take a look at some of the reasons why you’re still not sleeping well. And we’ll also address some things you can do to possibly improve your sleep.

Unfortunately, for some people, having a sleep study and being started on CPAP doesn’t restore good quality sleep. There are many reasons why this is so, and usually, these things can be remedied. There’s also the issue of insomnia, which is actually different than sleep apnea. However, in this article, we’re focusing specifically on sleep not improving with CPAP.

With that in mind, let’s take a look at some things.

You slept Better initially After Your Sleep Study, but now you Can’t Sleep

To begin with, think about things that have changed since your sleep study. How long ago was it? If it’s been a few years since your last sleep study, just the natural changes you go through as you age, such as weight gain, for instance, could make your sleep apnea worse.

Another thing to consider is the use of medications. Unfortunately, many medications can disturb your sleep and cause daytime sleepiness. So, if you were started on a new or different medication since your sleep study, talk to your Doctor about possible side effects.

In women, estrogen and progesterone help keep your airway open. However, after menopause, these hormones are gone, leading to an increase in sleep apnea.

Other physical disorders that can disturb your sleep, or cause a change in the way you breathe include:

  • Heart Disease
  • Certain lung diseases
  • Stroke
  • Fibromyalgia
  • Some stomach and intestinal disorders
  • Anxiety and/or other mood disorders

But what if you never did feel any better even right after your sleep study?

You Can’t Sleep any Better Immediately After your Sleep Study

Of all the reasons you can’t sleep, stress might be your biggest issue. Stress is quite common and can be the cause of more than just not sleeping well.

There could also be some, as of yet, undiagnosed underlying condition; such as Narcolepsy, for instance. Additionally, the use of alcohol and/or tobacco can cause sleep disruptions and drowsiness during the day as well.

Furthermore, did you tolerate your CPAP mask well during your sleep study, but now you’re struggling with it? It could be as simple as the wrong type of mask. Maybe they used a nasal mask on you during the study, and that particular night, you were able to breathe through your nose fine. Now, however, for some reason, you can’t breathe through your nose anymore. Perhaps CPAP is now drying your sinuses, causing mouth breathing.

Or maybe you just don’t have the mask fitted right and it’s leaking. This could cause frequent arousals. Also, if the leak is big enough, it would decrease the amount of pressure that actually reaches you. And that reduced pressure might no longer be enough to hold your airway open.

In fact, one of the more common problems people with nasal masks is mouth breathing. This can be a source of frequent waking. It can also cause less pressure to be delivered to you, thus making your CPAP less effective. Therefore, maybe you can’t sleep because of a mask and/or mouth breathing issue.

A mask issue can usually be remedied by properly adjusting your mask, or changing to a different one. But what about mouth breathing?

Causes of Mouth Breathing

We are naturally nose breathers. So for most of us, a nasal mask works quite well. However, there are a few things that can cause you to breathe through your mouth. Many people with nasal CPAP masks struggle with sinus congestion, dry nose, and throat.

Can you breathe through your nose while awake, but once you’re asleep your mouth pops open? The reason for that is usually because your airway is collapsing (see diagram).can't sleep This causes you to open your mouth in order to pull in more air.

In that case, CPAP, which holds your airway open, should restore nose breathing in your sleep. However, the cause of mouth breathing could now be due to sinus congestion, caused by the drying effect of CPAP. This can cause short term mouth breathing. Therefore, if you can’t sleep, and use a nasal mask, mouth breathing might now be some of the cause.

Also, a surgical procedure that removes excess tissue in the back of your mouth lessens snoring and reduces apneas. However, studies have found that people who have had these procedures might still need CPAP. And they are also more likely be mouth breathers because of the lack of tissue support.

The question is, is mouth breathing anything to worry about? And if not, why not just use a full face mask and be done with it. Well, let’s see what happens to you physically when you breathe with your mouth.

Health Effects of Mouth Breathing

When you breathe through your mouth, the air isn’t warmed and moisturized like it is with nasal breathing.  This causes dry mouth, which encourages bacteria growth, leading to cavities. Nasal breathing not only warms and moisturizes the air, it also acts as a filter, reducing dust and allergens.

Also, when you breathe through your nose, Nitric Oxide is produced in small quantities. This gas actually makes you absorb more oxygen, which is even more important while you’re sleeping. This is because your breathing becomes slower and shallower in your sleep.

Keep in mind that many people see their Dentist more than their Doctor. Therefore it’s usually the Dentist that notices mouth breathing issues. Especially important to consider is that mouth breathing in children can actually cause abnormal facial and dental development.

How to Reduce Mouth Breathing

Here are some things you can do to encourage nose breathing:

  • Use a chin strap-These can be fairly effective if you’re not dealing with sinus congestion. Although, even then, they don’t always guarantee you won’t breathe through your mouth at times.
  • Use a mouth guard
  • Elevate your head
  • Eliminate allergens
  • Use decongestants to clear your sinuses.
  • Excercise-Yoga and cardio workouts can improve your breathing
  • Try sleeping on your side instead of your back
  • Tape your mouth shut-I’m not kidding! Use surgical tape. However, this can be uncomfortable, especially at first.

Also, if you use a nasal CPAP mask, simply increasing humidification can help clear your sinuses, and therefore increase nasal breathing.

Conclusion

If you’ve had a sleep study, but you still can’t sleep, there are some things to look at as the cause. Most of these problems can be dealt with fairly easily. But be sure to consult your Doctor with any concerns you might have. You might just need a mask adjustment. But then again, another sleep study may be necessary.

Till next time…Blessings.

Is it Attention Deficit Disorder or Sleep Apnea?

In children, sleep apnea and Attention Deficit Disorder can cause similar Attention Deficit Disorderbehavioral issues. It’s important to know which one you’re dealing with because each requires totally different forms of treatment. Let’s take a look at these; see how they’re similar, and also how they differ. We’ll also explore some treatment options.

We’ll start by defining the two.

Sleep Apnea

As you probably already know, Sleep apnea (OSA) occurs when your airway closes off in your sleep, causing you to stop breathing.

OSA occurs in an estimated 25% of kids ages 2-8. With the most common cause of apnea being due to enlarged tonsils and adenoids. Also, under developed jaw and/or oral structures play a critical role as well.

Sleep apnea in kids can also lead to problems with learning and behavior. They can be hyperactive, have problems adjusting socially, and become anxious and depressed.

Other issues include:

  • Bedwetting
  • Hormonal/metabolic imbalances
  • Stunted growth
  • Irritability/mood swings
  • Tiredness

Also, you can have sleep apnea and not snore.

Now we’ll take a look at ADHD.

ADD 

ADD stands for Attention Deficit Disorder; there are 3 forms of it.

1-Mainly inattentive. This is what think of when we hear the term ADD. Symptoms include:

  • Failure to pay close attention to things
  • Makes careless mistakes
  • Doesn’t seem to listen when spoken to
  • Tends to be unorganized

2-Mainly Hyperactive (ADHD), or ADD with a hyperactive component. Symptoms include:

  • Fidgeting
  • Excessive talking-Including interrupting others when they’re talking.
  • Inpatient

3-Combined-Inattentive, hyperactive and impulsive.

They have trouble focusing and/or paying attention, especially if they’re not interested. On the other hand, they can be super focused. They also tend to be creative, intuitive and full of energy.

ADD/ADHD develops in childhood. In fact, kids as young as 4 years old can be diagnosed. But whats a normal attention span for kids, vs the average attention span of one with ADHD? Also, girls with ADHD are less likely than boys to show cognitive, psychiatric, and functional impairment.

Refer to the following link for more information.

http://www.drhallowell.com/add-adhd/top10questions/

If a kid has sleep apnea but is misdiagnosed with ADHD. Do the meds resolve the behavior issues? Leaving the kid with untreated sleep apnea? And how long will this go on until sleep apnea is suspected?

signs of ADHD–You don’t have to be loud, or bouncing off the walls to have ADHD. Women of all ages sometimes have a form where they are “quiet and spacey”.

Notice the similarities in symptoms. Therefore, if you just focus on the behaviors, and not on their sleep, a misdiagnosis could easily happen.

Is Attention Deficit Disorder Really a Disorder?

There are many theories about the cause of ADD/ADHD. However, the strongest research reveals the following as most likely causes:

  • Brain injury
  • Exposure to environmental (e.g., lead) during pregnancy or at a young age
  • Alcohol and tobacco use during pregnancy
  • Premature delivery
  • Low birth weight

Genetics plays a critical role. Also, brain scans show significant changes in brain structure. Therefore there are physical signs of Attention Deficit disorder; thus qualifying it as a disorder.

But does your child have ADD/ADHD or OSA?  From a behavioral stand point, you can’t be sure. So let’s look at some things that can show us the difference.

Tests

Attention Deficit Disorder

The following link is an interactive self-test for women and girls to determine the likelihood you have ADHD.

https://www.additudemag.com/self-test-adhd-symptoms-women-girls/?src=embed_link

However, there’s not really a test for ADHD. Your Doctor will look at things like your child’s behaviors, comparing them with other kids his/her age. The following criteria are used to determine the possibility of ADD/ADHD:

  • Are in constant motion
  • Squirm and fidget
  • Do not seem to listen
  • Have trouble playing quietly
  • Often talk excessively
  • Interrupt or intrude on others
  • Are easily distracted
  • Do not finish tasks

Additionally, a brain scan might also be ordered.

OSA

The following links will take you to questionnaires you can use to determine the likelihood you have sleep apnea.

Epworth Sleepiness Scale http://www.sleepmed.com.au/epworth-calculator.html

Berlin Sleep Questionnaire:

https://www.britishsnoring.co.uk/berlin_questionnaire.php

STOP-BANG http://www.stopbang.ca/osa/screening.php

Snore score (Not an interactive link) http://sleepapnea.org/wp-content/uploads/2017/02/snore-score.pdf

Upper airway examination.

And of course, the ‘gold standard’ diagnostic tool is an in lab sleep study. However, in some cases, a study can be done right at your home. These tests are called Home Sleep Tests, or HST’s.

The nice thing about home testing is that you can sleep in your own bed in your own home. And they cost much less than an in lab study. However, they tend to under diagnose sleep apnea.

Treatment options

Attention Deficit Disorder

Meds-Ironically, stimulants such as Ritalin or Adderall are commonly prescribed for children with ADHD. However, as many as 30% of children either don’t respond to these meds, or they experience undesirable side effects. There are some non-stimulant medications that work, such as tricyclic antidepressants. But even these may have unwanted side effects.

However, there are complementary treatments that are showing promise. These include…

Biofeedback (Brain Training)-Sensors are attached to the child’s head and monitor brain waves. They’ll then play a computer game they control with their mind. this helps them focus.

Behavioral treatment-Works best when given by the parents and the child is 6 years old or younger.

Meditation, prayer, and Yoga have all shown some positive results.

Even something as simple as being outside in a place where there’s lots of greenery has been helpful to some.

For milder forms of ADHD-Eat healthy. Excercise. Minimize caffeine intake.

Fish Oil (Omega 3 fatty acid) can be ‘moderately effective’.

OSA

Removal of tonsils and adenoids is the most common way to treat pediatric sleep apnea, and can effectively eliminate OSA up to 90% of the time. If that’s not effective, then treatment with either CPAP, an oral appliance should be considered.

Positional therapy-Different methods to keep a person off their backs while they sleep. Weight management might not eliminate OSA, but can at least reduce its severity. And it just may be that using any combination of the above might bring the best results.

Also, OSA in children can resolve on its own. However, don’t rely on that, as the health risks are too great. Sleep apnea stresses your body, which leads to inflammation. And there’s a direct link with inflammation and disease. See http://sleepguyblog.com/__poor-quality-sleep-cause-disease/

Conclusion

Sleep Apnea and Attention Deficit Disorder can be easily confused in kids. This is because both can cause similar behavioral and cognitive issues. It’s absolutely essential that you as a parent know what to look for so that your child can receive proper treatment.

Please leave a comment, as you might have something to say that will help others.

Till next time…Blessings

Are you Concerned About Your Sleep Quality?

If you have concerns about the quality of sleep you’re getting, or just looking for information, here are a few links to help you out.

Blogs

https://www.aastweb.org/blog

http://www.sleepworksinc.com/sleep-study-blog-2016.php

Forums

http://www.healthboards.com/boards/sleep-disorders/

https://patient.info/forums/discuss/browse/sleep-problems-2099

http://talk.sleeptember.org/

Informational

https://sleepfoundation.org/

https://www.somnosure.com/

Here’s some good information on home testing.http://www.sleepworksinc.com/sleep-study-home-sleep-testing.php

This site provides a link to find a sleep professional in your area https://sleepfoundation.org/

If you need a CPAP machine but can’t afford it, the American Sleep Apnea Association may be able to help you. https://www.sleepapnea.org/community/cpap-assistance-program/

Do you have, suspect you have Narcolepsy? Click on this link http://www.narcolepsylink.com/

This sleep center has sleep labs in hospitals throughout several states. Check them out. http://www.pdssleep.com/

Interactive Forms

The following link will bring you to an interactive ESS where you can test yourself http://www.sleepmed.com.au/epworth-calculator.html

This interactive questionnaire will determine the likelihood you have sleep apnea http://www.stopbang.ca/osa/screening.php

This isn’t an interactive link but you can print out a good rating scale for Restless Leg Syndrome http://sleephub.com.au/wp-content/uploads/2015/04/RLSratingscale.pdf

 

This isn’t an exhaustive list by any means, and I might just add links from time to time as well.

If you have any links you’d like added please leave a link in the comments.

Thanks. Till next time…Blessings.