INSOMNIA AND SLEEP APNEA

Apr 30, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Mulder: Come here you big, bald, beautiful man. Skinner: The only thing you're going to be kissing, Mulder, is your sweet ass good-bye! Mulder and Scully are the two main protagonists from the 90's conspiracy theory laden TV show The X-files. FBI Assistant Director Walter Skinner is their cranky boss. I loved the X-files the first time around. I have to admit now that they are talking about reviving the show, the folliclely challenged Skinner appeals to me more than he did a couple decades ago. And, I'm sure that has nothing to do with the secret implant the Cigarette Smoking Man put in the back of my neck to control my thoughts.

Conspiracy theories abound. From the JKF assassination, to 911 cover-ups, to vaccines causing harm to Area 51, no amount of proof can convince disciples that dark forces are secretly out to get us. These beliefs can seem downright silly at 3 pm in a sunlit pharmacy. However, at 3 am, in the dark, when I can't sleep, conspiracy theories can become all too real. Unnecessary fixation on alien abduction is one of the lesser known problems of insomnia.

Insomnia can be having trouble falling asleep, getting enough sleep, but not feeling rested, broken up sleep, or waking up too early. To understand insomnia, 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 your 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.

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. Don't keep your cell phone in the bedroom. 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, iPad, phone or computer as the bright light from the screen 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.

Sometimes 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.

Velcro, stealth technology and Kevlar probably weren't discovered on an alien craft in Roswell. The US government probably didn't intentionally crash planes into the World Trade Towers to start a war. But a 3am.... dark forces seem to be everywhere, and usually smoking a cigarette in a corner. I'm not sure skinny little Mulder is up to the task of saving us all in the new Millennium. Bring on the bald hero Walter Skinner. Mulder might know the Truth is Out There, but Skinner can head butt the monster in the nose and take it down.

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.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.

Huffington Post 31 Tips for Better Sleep - http://www.huffingtonpost.com/2015/04/20/sleep-tips_n_7042124.html?utm_hp_ref=healthy-living

Time's Top Ten Conspiracy Theories - http://content.time.com/time/specials/packages/article/0,28804,1860871_1860876_1861003,00.html

X-files Reboot - http://www.empireonline.com/news/story.asp?NID=44073

Big, Bald Beautiful Man - https://www.youtube.com/watch?v=V6Z1X9apMV8

 


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