May 4, 2023: Difficulty initiating and maintaining sleep is a common problem for many patients. Over-the-counter sleeping aids are used by many and we commonly get asked for prescription medications to help with their sleep.
Unfortunately, the ideal sleeping medication doesn’t exist and many have potentially worrisome adverse effects, some produce daytime somnolence and others may have the potential to produce dependence.
Cognitive behavioral therapy is an alternative treatment option to pharmacologic therapy and is safe, can be easily taught, and offers an alternative to the many with chronic insomnia. In this podcast, we’ll discuss this innovative treatment option with sleep expert, Michael H. Silber, M.B.Ch.B., a neurologist at the Mayo Clinic.
Sleep has many functions, among which are clearing the body of toxins and consolidating memory. The exact amount we need is determined by age, and genetics among another things. From what I’ve read, eight hours is required, plus or minus an hour.
That being said, there are a few among us who are super sleepers. Going back in history this probably included Mozart and Thomas Edison: They could live healthy, productive lives with as few as three or four hours of sleep. Genetic mutations, including changes to the Orexin Gene receptor account for true super-sleepers.
Familial fatal insomnia is a genetic disease operating through prion proteins, and does not illuminate the problem of insomnia. In most people there are two major forces which determine the onset of sleep, the circadian rhythm, and sleep pressure.
The TIMING of the sleep varies from morning larks to night owls. These shifts in the circadian rhythm is also genetic, involving many genes, including PER and CRY. Diurnal rhythm can apparently be changed, But with difficulty.
The sleep pressure is caused by the gradual daily accumulation of adenosine in the system, apparently resulting from the stripping away of the phosphate groups from the energy currency, ATP. This can be assuaged by caffeine containing drinks, such as tea or coffee. Caffeine temporally blocks the effect of adenosine, but when it wears off, you usually go right back to your fatigue state.
INSOMNIA occurs when you do not get as much sleep as you need, and are tired in the daytime. This is a major problem for a lot of people.
Insomnia has many causes. Stress will cause an increase in Cortisone in the bloodstream which interferes with sleep. Caffeinated drinks nicotine and other stimulants can cause you to have difficulty falling asleep, and alcohol will help you fall asleep but will often result in awakening in the middle of the night when the alcohol is metabolized.
Depression, Parkinson’s, chronic pain, gastroesophageal reflux and any other medical conditions can interfere with sleep. Sleep apnea, often associated with overweight and heavy snoring, is a special problem that sometimes needs the help of a sleep specialist.
Some poor habits such as reading in bed, doing work in bed, eating at bedtime, and heavy exercise just before bed can also be a problem. A regular routine of Preparing for sleep, such as brushing and flossing and taking a warm shower are also helpful; you can get more details by looking up “sleep hygiene”.
A lot of people take a nap, but this can cause some difficulty in going to sleep. Among things you can do to prevent insomnia include living an active life, making your bedroom comfortable for sleep, and using your bedroom ONLY for sex and sleep.
Please refer to the accompanying Mayo clinic article for more organized information.
Diabetologia (Sept 8, 2020) – Insomnia with objective short sleep duration has been associated with an increased risk of type 2 diabetes in observational studies [27, 28]. The present MR study found strong and suggestive evidence of a causal association of insomnia and short sleep duration, respectively, with increased risk of type 2 diabetes.
Conclusions/interpretation
The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.
This was a laborious and apparently objective study.
The discovery of insomnia as a unique risk factor is no surprise, and reinforces the restorative IMPORTANCE of SLEEP.
I was surprised to see docosohexanoic and Eicosapentanoic acids in the risk column and LDL in the good column. However they were studying type 2 diabetes, and not vascular health. I will continue to take my fish oil, and enjoy my HDL, which is in the good column.
—Dr. C.
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