Lifelong Health by Dr. David Lipschitz

What I would not do for a good night's sleep.

For many years I felt perpetually fatigued, and as I reached my 60s, I never felt refreshed upon wakening. After progressively developing a middle-age spread, it dawned on me, one day, that perhaps I had sleep apnea.

I saw my doctor and arranged to have my oxygen level measured during sleep. Called an "overnight pulse ox," this simple screening test involves no more than placing a sensor on a finger that identifies reduction in blood oxygen levels caused when breathing ceases during sleep. Stopping breathing during sleep sets off alarm bells in the brain that cause partial awakening as your brain directs you to resume breathing. This greatly impairs the quality of sleep and leads to daytime drowsiness and fatigue.

I was diagnosed with sleep apnea, which is treated by sleeping while using a continuous positive airway pressure (CPAP) machine, which helps maintain normal breathing patterns. Untreated, sleep apnea contributes to a higher risk of heart disease, stroke, atrial fibrillation, difficult-to-treat high blood pressure, diabetes, depression and even memory loss.

Two other common conditions affecting sleep are restless leg syndrome and periodic limb movement disorder.

Restless leg syndrome presents with abnormal sensations in the legs and body when you lie down to sleep. Whether asleep or not, a strong urge to move occurs because of sensations that can feel like pins and needles, burning or snakes crawling up the legs. The cause is not clear; it is more common in patients with inadequate iron stores and can run in families.

The diagnosis is suspected if the patient volunteers the rather typical symptoms. Therapy involves the use of medications that soothe and suppress sensory nerves; the most common brand names are Neurontin and Requip.

Periodic limb movement disorder is a condition in which the legs and occasionally the arms move and jerk frequently during sleep. Unlike restless leg, there are no sensory changes, and because the movements occur only while sleeping, the disorder can go unrecognized for years. Occasionally a spouse will recognize leg movement during sleep.

Daytime fatigue and sleepiness suggest the problem, which is definitively diagnosed by performing an overnight sleep study.

Once the disorder is diagnosed, treatment involves the use of medications that are also used to treat Parkinson's disease, including Sinemet and levodopa.

Drugs including alcohol, over-the-counter medications and many prescription medications can affect sleep. Antidepressants cause insomnia, as do drugs used to treat Alzheimer's disease. Paradoxically, many sedatives, while putting you to sleep, may reduce sleep quality, resulting in a "hangover" headache and fatigue during the day. In older people, the use of Benadryl (the antihistaminic diphenhydramine) in combination with over-the-counter analgesics (Tylenol PM or Advil PM) can cause depression, severe fatigue and reduced reaction times, which increases the risk of falls and car wrecks.

The most common cause of sleep problems, by far, is burning the candle at both ends, high levels of stress and too much caffeine.

The best approach to management is not to combine stimulants with sleep aids but to practice good sleep hygiene. Working extra-long hours, a rite of passage for most professions, can be dangerous, leading to mistakes, injuries and even death. We all must learn to work sensibly, to control stress, to avoid caffeine after noon and to understand that a good night's rest boosts productivity, health and quality of life.

Ideally, go to bed at the same time each night, avoid alarm clocks, spend sufficient time outdoors in sunlight (essential for normal body rhythms) and exercise in the morning instead of the night. Go for a stroll when arriving home. This raises body temperature somewhat so that it can fall as the evening progresses, leading to drowsiness and a better night's sleep.

Do not watch TV or read in bed, and if you awaken, leave the room and do something mindless until you feel tired. And consider a light snack and a warm drink an hour before bedtime. This has been shown to improve sleep patterns.

Many conditions affect the quality and the quantity of sleep. Whether caused by an illness or poor sleep habits, the long-term effects are serious. Not only is the quality of life impaired, life expectancy is shortened because of the increased risk of life-threatening diseases.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at:

www.drdavidhealth.com

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