Wednesday 18 September 2019

Sleep-deprived nation: the disorders keeping you awake

From insomnia to snoring and restless leg syndrome, there are many culprits causing disturbed sleep. Here, Chrissie Russell examines the most common sleep disorders

40pc of adult men and 24pc of adult women are habitual snorers
40pc of adult men and 24pc of adult women are habitual snorers
Snoring can be a real problem and a sign of sleep apnoea

How do you feel right now? Full of energy or a little tired? For four out of five of you, the answer will be a drowsy 'yes' to the latter.

 Ireland is a sleep-deprived nation. Surveys show that only 20pc of us reckon we're getting enough sleep and, in a poll of 14 countries, the Irish fell second only to the UK in terms of reporting poor sleep.

But does it really matter? Well, yes. In the short term, poor sleep can have an impact on your mood, productivity and interactions. In the long term, it's been linked to serious medical issues like heart disease, stress, poor memory function, reduced ability to fight infection, weight gain, increased risk of type 2 diabetes and depression. It's also a fact that driver fatigue is a factor in an estimated 20pc of road traffic deaths in Ireland.

The figure often touted as the 'optimum' amount of sleep per night is eight hours. But the reality is more complex - with experts recommending anywhere between six and 10 hours for adults. The question you need to ask yourself is: How do you feel?

"If you are wakening up unrefreshed, feel sleepy during the day, have disturbed sleep, or if you are thinking or worrying about your sleep despite getting enough of it - you have a sleep disorder," says Breege Leddy, Insomnia Specialist and Director of The Insomnia Clinic Ltd.

We often need less sleep as we age, but the incidence of poor sleep also increases. "It's important to remember than this increase is not physiological [a normal part of ageing] but pathological and therefore should be treated," says Dr Kevin O'Boyle of Burlington Dental Clinic.

Disordered sleep can be easily identifiable and simple to fix - like too much screen time or a room that's too hot - or less obvious and potentially a sign of something more serious.

"There are more 80 sleep disorders according to the ICSD [the International Classification of Sleep Disorders] each having different clinical presentations and symptoms," explains Breege. Here are some of the main offenders...

■ Insomnia

"The most common sleep disorder is insomnia and this can be caused by a number of factors including bereavement, financial worries, shift work, pregnancy, menopause, relationship problems, work stresses or poor sleep habits," says Breege. According to a poll, 56pc of poor sleepers in Ireland cite stress as the main culprit in their lack of shut-eye. "Usually there is some stressor or trigger that starts a bout of sleepless nights," explains Breege. "As time goes on, the individual develops bad sleep habits and these keep the problem ongoing. Over time it becomes a learned behaviour, the circadian rhythm is now completely out of sync and it's impossible for the individual to get back into a normal rhythm without clinical intervention."

Short-term intervention is usually medication while cognitive behavioural therapy for insomnia (CBT-I) is the gold standard for long-term treatment of the condition. If you feel a lack of sleep is affecting your quality of life, then always seek medical help.

■ Snoring

Snoring might get laughed off but it's often no joke and can severely impact sleep, with an estimated 40pc of adult men and 24pc of adult women habitual snorers.

Patrick McKeown from the Buteyko Clinic, Co Galway believes many of us simply need to learn to breathe correctly. "The single best practice to improve sleep is to breathe through the nose during sleep. No one should be waking with a dry mouth in the morning." His website has easy to follow videos to nail optimum breathing technique (buteykoclinic.com) but sometimes snoring might need greater intervention, especially if it's a sign of...

■ Sleep apnoea

If your partner has been snoring thunderously, then suddenly stops for a short period of time, they could be experiencing an apnoea, a condition where the sleeper's airway is obstructed and they stop breathing for a short time. It's most common in men aged 50 to 70, with incidence increasing with age, increased weight on the torso and reduced muscle tone in the upper airway muscles.

"Every time there is an apnoeic event, the brain wakes the sleeper up enough to open the airway, heart rate shoots up, adrenaline pumps but often the sleeper is unaware. Their body is not relaxed and rested and therefore they wake feeling tired," explains Dr Kevin O'Boyle, who fits anti-snoring devices like MAA (mandibular advancement appliances) to help. In other instances, a CPAP machine, which increases air pressure in your throat will fix the problem, so don't just put up with it.

■ Restless leg syndrome (rls)

About 10pc of Irish people will experience RLS at some point, with symptoms ranging from discomfort to pain and having to get up multiple times a night to stretch.

There are a number of lifestyle changes that can help manage the condition. "Try sleeping with a pillow between your legs, it may prevent nerves in your legs from compressing," advises Daragh Bogan, chair of the charity RLS-UK.

"Some people find going for a gentle walk early in the evening helps." The RLS-UK website (rls-uk.org) carries a wealth of advice on management such as staying hydrated, avoiding eating late at night and hot-cold shower therapy before bed to increase blood flow to the legs.

Several chronic diseases also have links to RLS - almost half of people with kidney disease will also have RLS and there are also links with Parkinson's disease, fibromyalgia and thyroid disorders, so seek medical help.

■ Orthosomnia

A new condition where the quest for the perfect sleep (and an obsession with sleep trackers) is actually proving detrimental to well-being. "People who use these trackers may try to achieve optimal numbers of sleep and if they don't get it, it can lead to a performance anxiety and an increase in the stress hormone cortisol," explains Breege. "The more we think about sleep and the harder we try to sleep, the less likely it is to happen."

She says it's important to realise that sleep trackers are not a diagnostic tool or validated for measuring sleep.

"People have called the clinic asking to attend because their sleep tracker is telling them they are getting very restless sleep but when I ask what their symptoms are, they don't report any!" says Breege. "My advice to them is to stop looking at the sleep tracker."

 

How to improve your sleep hygiene

■ "Sleep hygiene is simply a series of good sleep habits or behaviours to optimise sleep," explains Breege Leddy of the Insomnia Clinic. "Good sleep hygiene alone won't fix a chronic sleep disorder but it is extremely important not just for poor sleepers but for everyone."

■ Avoid blue light (smartphones, laptops etc) for at least two hours before bed. The blue light suppresses melatonin which relaxes the body and helps us nod off. Ban all tech from the bedroom and make it as dark as possible.

■ Keep bedroom temperature between 16°C-18°C. It's believed that temperatures over 24°C will cause restlessness, while under 12°C makes it tough to drop off.

■ No exercise too close to bedtime.

■ No eating too close to bedtime.

■ No long naps - keep it to 20 minutes maximum and no later than 3pm. A study this month, published in the peer reviewed journal Alzheimer's & Dementia, showed a link between napping and Alzheimer's but don't be alarmed if you're a fan of a post-lunch siesta. The research concluded it was only increased excessive napping and a change to normal napping habits that suggested a correlation.

■ No booze or cigarettes close to bedtime. Researchers from Florida Atlantic University and Harvard Medical School found that having either within four hours of bed resulted in worse sleep continuity than a night without. Maybe have a coffee instead, since the same study found caffeine, instead of being the sleep-reducing demon it's made out to be, instead had no effect.

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