Sleep Problems?
Posted on October 4, 2015 by bob in In Every Life
“Chronic insomnia lasts longer than three weeks,
and can result in a cyclical fear of being unable to sleep, 
that then prevents sleep.”
Each October we change our clocks as Daylight Savings Time ends. This can affect sleep patterns until an adjustment to the day/night (circadian rhythm) cycle is made. Although people have individual biorhythms (early birds or night owls for example), changes in sleep patterns can occur throughout life. The National Sleep Foundation reports that most adults need 7-9 hours of sleep each night to feel fully rested and identifies poor sleep as an indicator of health, and one that requires investigation. The Centers for Disease Control and Prevention detect that between 13 to 19% of adults in Alabama say they are not getting enough sleep or rest. (See http://www.cdc.gov/sleep/data_statistics.html.)
Insomnia is defined as difficulty either going to sleep or staying asleep. Transient insomnia can occur from stress–people may experience situational difficulty sleeping when a disturbing event has occurred, but resume regular sleep patterns after resolution of the stress. Short-term insomnia may occur with prolonged stress, changes in lifestyle, medication, or health conditions. Chronic insomnia lasts longer than three weeks, and can result in a cyclical fear of being unable to sleep, that then prevents sleep. Insomnia can lead to mood changes; memory, concentration, and judgement problems; and even changes in the immune system.
One factor that can alter sleep patterns is sleep apnea, or short periods when breathing stops. Periodic gasping, snorting or 
snoring may be signs of sleep apnea, and may or may not awaken the person. Awakening with a headache or daytime sleepiness are additional symptoms. Risk factors include family history, upper airway obstruction or abnormalities, cardiac disorders, hypertension, obesity, large neck circumference, use of alcohol or medications, as well as other factors. The underlying cause must be identified because treatment depends on the cause(s). A Continuous Positive Airway Pressure (C-PAP) device may be helpful.
Gastroesophageal reflux disease (GERD) may interfere with sleep, as gastric acid secretions flow up into the esophagus and are perceived as a burning sensation. The lining of the esophagus becomes scarred, causing secretions in the back of the throat which result in frequent coughing during sleep. Eating several hours before going to bed, elevating the head of the bed, and avoiding coffee and alcohol may be helpful, or medication to reduce acid may be required.
Restless Leg Syndrome (RLS) is another possible cause of sleep disturbances. The prevalence increases with age, and although the cause may be unknown, there may be a family history or it may be a side effect of caffeine or some medications. Other contributing factors may be anemia, iron or folate deficiency, nerve lesions, Parkinson’s disease, diabetes, chronic obstructive pulmonary disease, arthritis, or other diseases. Avoiding caffeine, nicotine and alcohol may improve RLS, as may stretches or walking, or medication may be needed.
Changes in the kidney or circulatory system can lead to accumulation of body fluids through the day, which are then processed when lying down, causing a need for more frequent nighttime urination.
Changes in schedule for drinking fluids, reduction of salt, and medications for the underlying cause can help.
Pain is another cause of sleep disturbance, for which again the underlying cause must be identified for effective reduction.
A consistent habit before going to bed can be helpful. Changes in sleep need to be discussed with your healthcare provider. Recording when you sleep, and what you have been doing can help healthcare providers identify patterns in order to provide appropriate help. One example of a sleep diary is available at http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf
Arlene H. Morris, EdD, RN, CNE is Professor of Nursing, Auburn Montgomery School of Nursing. Reach her at amorris@aum.edu.
