INSOMNIA AND SLEEP APNEA
Aug 6, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
The two best days in a boat owners life are the day he buys a boat and the day he sells it. Those sage words of advice come from Don who is my neighbor at the Lake and my neighbor in town. The more I think about it, Don might not be wrong. We have a little 12 foot boat with a little 9 horse two stroke motor on it. It is not fast, but it is perfect for taking the kids out on short little fishing trips. This summer the motor was actually running really well. It started right away, but it would stall out every 20 minutes or so. I wasnt blaming the motor for this. I was using old gas because I was too cheap and lazy to get new gas. The second last time I took the kids out the motor stalled every 5 minutes. It stalled so much another neighbor at the lake, Kevin, asked if Id like to buy a boat that actually works. The last time I took the boat out, I put in new gas. However, I guess since Id been pull starting it so often I wore out the cord. Because the last time I took the boat out the cord broke on the first pull. Eric and I then just went fishing in the canoe.
Running an engine on old gas is like running your body on not enough sleep. You can do it, but you will stall out a lot and it may lead to other problems like broken pull cords. So first lets talk about normal sleep. Normal sleep involves four to six cycles divided between rapid eye movement (REM) and non-REM sleep. Non-REM sleep consists of four stages. Stage 1 is a transition from wakefulness to sleep and lasts 30 seconds to 7 minutes. Stage 2 is a light sleep and we are in stage 2 about half the time we are sleeping. Stages 3 and 4 (sometimes called delta sleep) are deep sleep stages and these stages make you feel rested the next morning. If something disturbs your delta sleep, you will wake up in the morning not feeling rested. REM sleep is when you eyes move back and forth under your lids very quickly, but the rest of your body remains very still. REM is when you do your dreaming.
Insomnia can be having trouble falling asleep, getting enough sleep, but not feeling rested, broken up sleep, or waking up too early. There are some general rules you should follow to help get a good nights sleep. Go to sleep and get up at the same time every day. Use the bedroom only for sleep and sex. Dont read, knit, work, or watch TV in the bedroom. Do not drink coffee, tea or cola 4-6 hours before sleep, and try to drink as little of these caffeinated beverages as possible during the day. If you cannot sleep after 15 to 20 minutes, get out of bed and go to another room and read in a dimly lit area. Avoid watching TV as the bright light may wake you up more. Go back to bed only when feeling sleepy again. Avoid watching the clock. Some people even turn the clock face away them. Finally, avoid daytime naps.
Sometime your insomnia isnt your fault. Sometimes the person sleeping next to you snores so loudly you cant sleep. This can be a problem for both of you. Loud snoring can be a symptom of sleep apnea. Sleep apnea is when you actually stop breathing many times during the night. This can both make the sleep apnea sufferer very tired during the day and cause insomnia for their bed partner. Sleep apnea may also put a person at risk of high blood pressure, heart attacks, abnormal heart beat, stroke and diabetes. The following is a sleep apnea checklist: Do you snore? Are you tired during the day? Has a bed partner observed you stop breathing while asleep? Do you have high blood pressure? Are you overweight? Are you over 50 years old? Is your neck circumference greater than 40 cm? Are you male? If you answer yes to 3 or more of these questions, you are at high risk of sleep apnea. Sleep apnea has to be diagnosed with a sleep study. A few years ago I had a sleep study done. I had to take a day off of work, drive into Winnipeg, sleep there and take another half a day off work and drive back. The whole experience was a bit of a pain. Now, with a prescription from your doctor, you can get a sleep study kit from the Dauphin Clinic Pharmacy! We will show you how to set up and use the equipment yourself. There is a charge of about $200 but you get to do the sleep study in your own home instead of going to Winnipeg or Brandon.
If you still arent sleeping well after adopting good sleep habits, and the problem isnt the snoring person beside you, you might need a medication. If that is the case, talk to your doctor. First your doctor will check you for any underlying health problems. For example, insomnia can be a symptom of another condition like painful arthritis. If we treat the arthritis pain, sometimes the insomnia will go away on its own.
If your doctor decides you need a sleep medication, there are several to choose from. Many over the counter sleep medications contain diphenhydramine. It is safe in many patients, but it doesnt work as well as the prescription sleep aids. It starts working in 30-60 minutes, but probably shouldnt be used more than 3 nights in a row or the patient will become tolerant to the effects. One of the common prescription medications for sleep problems are the benzodiazepines. A common benzodiazepine used for sleep is temazepam. Temazepam takes 1-2 hours to kick in and lasts 6-10 hours. Benzodiazepines work well for sleeping, but can become habit forming. Because temazepam can last for 10 hours in some people, morning drowsiness can be a problem. A different prescription sleep aid is zopiclone. Zopiclone starts working in 15-30 minutes and lasts 8 hours or longer. Because it is not a benzodiazepine, it is less likely to be habit forming. It has the interesting side effect of leaving a bitter, metallic taste in the mouth. If you drink something acidic like orange juice in the morning, that usually washes the taste away. If you drink something plain like water it can make it worse.
A general warning with all the sleeping medications, is dont mix your sleeping medication with alcohol. Alcohol can prolong the effects of a sleeping medication, effect your breathing , and mixing alcohol and sleeping medications have lead to very dangerous things like driving and having no memory of doing so.
So Ive got new gas in my boat motor. Despite being the least mechanically inclined person I know, Ive fixed the pull cord. Now all I need is a good night sleep before a nice day of boating and fishing. Or maybe Don is right and I should just put the boat on The Bargain Bin.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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As always if you have any questions or concerns about these or other products, ask your pharmacist.