Archive for the ‘insomnia’ Category

Sleep Hygiene-How to Get a Good Night of Z’s

November 11, 2011

More than half of men and women over the age of 65 years complain of a sleep problem. Many middle age and older people sleep less, wake up multiple times a night, and end up not feeling rested in the morning. This article will discuss the common causes of sleep disorders and how to restore a good nights sleep by practicing good sleep hygiene.

Causes Sleep Problems
Several factors may contribute to the inability to sleep well as we get older. Some common causes include:
Probably the most common cause of sleep disorders is poor sleep habits which is often referred to as poor sleep hygeine. Examples include the consumption of alcohol and caffeine shortly before bedtime, increased wakeful time in bed, or late afternoon napping, can also affect a person’s ability to sleep. One of the causes that so many of us don’t recognize as a factor includes overstimulation with late-night activities such as television. The evening news is not meant to put you to sleep but to stimulate you and as a result you may experience insomnia.
There are medications, such as the use of diuretics or water pills that may impair a person’s ability to fall asleep or stay asleep and may even stimulate wakefulness at night. There are also medical conditions such as hypertension, diabetes, and depression that are frequently accompanied by difficulty with sleep. Finally there are sleep disorders such as obstructive sleep apnea and restless leg syndromes causing sleep problems.

Restoring Good Sleep Hygiene
Begin by having a fixed bedtime and an awakening time. The body “gets used” to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleep habits.


Avoid napping during the day. It is natural to feel sleepy at the end of the afternoon. Avoid the temptation to take a nap at this time as you will certainly have a problem getting to sleep at night. If you do take a late afternoon nap, limit the nap to 30-45 minutes or avoid going into a deep sleep where you start dreaming as this will certainly impair your ability to fall asleep a few hours after your nap.

Avoid alcohol and caffeine 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.


Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.


Block out all distracting noise, and eliminate as much light as possible.
 Use blackout curtains to keep the room dark and avoid sunlight entering the room early in the morning.

The bed should be only for sex and sleep. Don’t use the bed as an office, workroom or recreation room. Let your body associate the bed with sleeping and not working.

Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.


If possible, don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed.

Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
 Avoid thrillers or reading that may stimulate your brain making it difficult to get to sleep.

When all else fails, if you don’t fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy. Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed “trying hard” to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later.

Bottom Line: Good sleep is part of leading a healthy lifestyle. Practicing good hygiene is part of being able to get to sleep and staying asleep. If these simple measures don’t work, consider speaking to your doctor.

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Want to Improve Your ZZZZZZZZs? Take Vitamin D and Snooze

February 5, 2011

I love it when a medical mystery is revealed, or at least partially explained.

A case study in the Journal of Clinical Sleep Medicine and it helped confirm about the importance of vitamins to your sleep.

But a recent case study has shown that a patient with severe sleepiness and a vitamin D deficiency, vitamin D supplementation improved daytime sleepiness dramatically. The patient was a 28 year old female. She was suffering for about four months with excessive sleepiness. Her symptoms started slowly and continued to progress. She kept a standard bedtime between 10 and 11 pm, and she reported falling asleep within minutes. She would wake at 7:30 am and reported that she did not think that she was sleeping poorly. She would get her kids ready for school and then be back in bed by 8am until noon. She would then nap from 4 pm to 7 pm. She reported about 14 hours of sleep per day.

Her sleep study showed no signs of sleep apnea or other sleep disorder. During her clinic visit she showed no signs of narcolepsy, depression or anxiety. Her next day nap study was unremarkable. She reported muscle fatigue and pain, as well as headaches. Her lab work showed a thyroid in the low but normal range and she had low levels of vitamin D.

She was started on a vitamin D supplementation at 50,000 units once per week (IV) and within 2 weeks she started to see a decrease in her sleepiness and fatigue.

Vitamin D is actually considered a fat soluble hormone that can be received in foods (dietary sources and fish) or is self-manufactured by the skin after exposure to UVB light. A vitamin D deficiency has been noticed as a global issue and recently found in underserved populations, patients in northern latitudes, people with darker skin tones, the elderly, obese and pregnant or lactating women. Also very common in areas with a high degree of sunshine (this seems counter-intuitive, but think about all that sunblock!). Recent studies have linked vitamin D deficiency to metabolic syndrome, muscle pain, and even type 2 diabetes.

So why do we think it helped her sleepiness? It is really hard to say, but I have seen this in some of my patients. It could be linked to a decrease in sleep disturbing pain. Or vitamin D may be something that will help decrease a person’s drive for sleep. Only more research in this exciting new area can tell us.

Check with your doctor about vitamin supplementation. We all work hard, and eating right isn’t always easy – and even when we do, we may not get what we need from the food we eat. Our bodies actually make vitamin D, but we have to get enough sunlight to make that happen effectively.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

http://biUy/g006uz