Episode 8 - Sleep Insomnia = Sleep difficulties Multiple causes of sleep disruption: Obstructive sleep apnea, the need to urinate, medication side effects, restless leg syndrome, heart burn, worry, mood disorders (anxiety, depression), uncontrolled asthma Caffeine can disrupt sleep. If having difficulties would limit intake to before noon. Alcohol- poor sleep quality even if you feel helps you get to sleep Medications that can disrupt sleep: decongestants, antihistamines (allergy and cold meds), nicotine replacement, inhalers, stimulants, some antidepressants Obstructive Sleep Apnea: pause in breathing, snoring, morning headaches, awaken feeling unrefreshed, fall asleep easily if driving, reading, watching tv. Underdiagnosed so bring attention to symptoms of concern. Untreated leads to uncontrolled hypertension, heart failure, weight gain, atrial fibrillation, etc Restless leg syndrome can lead to poor sleep - discuss symptoms with your PCP Lack of sleep leads to poor decision making, poor concentration, increased accidents, poor ability to deal with life stressors 7.5-9 hours sleep is considered adequate Sleep Hygiene: Exercise daily but not within 2 hours of scheduled bedtime Consistency in bedtime and wake time. Prebedtime routine: quite time away from lights (screens included) Limit total time in bed to 9 hours no matter if you have slept or not Reserve bed for sleeping only – read, tv should be done elsewhere If not asleep in 30 minutes or not feeling sleepy leave bed and do something quiet. Return when tired Limit daytime naps to 30 minutes or less Cooler temperature Dark room Quiet environment or white noise Cognitive Behavior Techniques Squeeze muscle groups from head to toe 30 sec and relax Imagery Meditation- new apps like Calm or CBT-i coach Set aside worry time or worry journal Work with cognitive behavioral therapist Other things to try Sleepy time tea Melatonin 3-6mg Blue lights during day time Usually recommend avoidance of over the counter PM meds that contain Benadryl or diphenhydramine because of side effect profile- if use do so for short term/limited basis Prescription options: never intended for chronic daily use Mirtazapine: especially in older adult with low appetite, and low mood Ramelteon: works on melatonin receptors, cost has been prohibitive Trazodone low dose often helpful We are often avoiding medications like Ambien and Lunesta because of side effects- reasonable if using short term for certain conditions. Can be habit forming. Also avoiding benzodiazepines like clonazepam and lorazepam except for short term/intermittent use in certain conditions. Would avoid long term nightly use as linked to dementia etc. www.deprescribing.org Health Pearl: check out The Blue Zones www.bluezones.com Follow us on Facebook and Twitter: www.facebook.com/everythingdoc www.twitter.com/everythingdoc1