Dear Dr. Pat,
For the past four years I have had an increasing problem with sleep. My husband says that I snore and occasionally appear to stop breathing. Sometimes my snoring must be so loud that I gasp and wake up, and I often have trouble falling back to sleep. I am exhausted all the time. When I wake up, I feel as tired as when I went to bed.
I am 60 years old and had my last period 8 years ago. I had no problem with menopausal symptoms until I began to gain weight. Over the last 6 years, I have gained 40 pounds that I cannot lose, and now weigh 170 lbs. at 5 feet 4 inches tall. I have a thick neck but don’t look unusual in other ways. My thyroid and diabetes tests are all normal, but I have high blood pressure that is not well controlled in spite of three different medications. My doctor just tells me to lose weight, but I don’t seem to have the will to do this. I drink six cups of coffee a day in order to function in my job as an assistant principal. I am often agitated early in the evening, when I get home, due to the stressors of caffeine and daytime fatigue and generally have two glasses of wine with dinner. My husband gets home later than I do, and we spend time cooking and having dinner together.
I begin to get anxious even before I get into the bedroom, because I know that nighttime feels like a battleground to me. In order to relax after getting in bed, I respond to emails, make phone calls, and watch the nightly news. Occasionally, I take Tylenol PM, which seems to help me fall asleep but doesn’t make me feel any better in the morning.
What should I do?
Irene
Dear Irene,
Questions about sleep and daytime energy and wakefulness should be part of all wellness visits to a health practitioner. A few selected questions will direct further evaluation and treatment for a sleep disorder that has an impact on a patient’s ability to function.
You have many of the signs and symptoms of sleep apnea, which include snoring, snore/gasp, witnessed prolonged periods of no breathing, along with your complaints of unrefreshed sleep and daytime sleepiness, exhaustion, and need for stimulants in order to function at work. In addition you are overweight with a larger neck. Obstructive sleep apnea, which your symptoms suggest, is associated with hypertension and other medical problems and is statistically associated with death at an earlier age.
Visit your doctor again and insist on an evaluation for sleep apnea. During episodes of sleep apnea, the airway is temporarily compressed or blocked by the soft tissues around the trachea (windpipe). Obesity, an enlarged neck, and hypertension are all associated with this diagnosis. Your doctor should be willing to refer you to a sleep specialist who may ask you to spend a night in a sleep lab to diagnosis your sleep disorder in order to create a treatment plan.
While you will need this medical evaluation for your sleep dysfunction, there are things that you need to change now if you want to feel better.
Insomnia is a condition in which difficulty sleeping at night disrupts the ability to perform during the day, causing impaired cognitive function, fatigue, mood disorders, and poor performance at work. Insomnia is more common in women of all age groups. About 10 to 13% of adults meet the criteria for insomnia but 30-40% of adults have some form of disturbed sleep during the year
Sleep has been described as the “mysterious one third of our existence.” Many of us are constantly in search of getting enough sleep and feel as though we are frequently not well rested when we get out of bed many days. Sleep hygiene, like all other body maintenance, is essential to improving the quality and quantity of our sleep.
Dr. Pat
Photo by drocpsu via Flickr
After sleeping with me not sleeping for over 30 years, my husband (a pulmonary physician), is convinced my life-long sleep problems are caused by a “delayed phase circadian rhythm disorder”. (My father and one of two sons have the same issue). I can sometimes get myself to a somewhat normal sleep schedule, but I have never been able to sustain that for very long. My drive to sleep occurs between 3:00 a.m. and 11:00 a.m. I now have a life situation where I can indulge that schedule most of the time, but I hate being out of sync with the rest of the world. Any suggestions for dealing with this on sustained basis? The silver lining: I am not very affected by jet lag since my drive to sleep or be awake does not seem to be strongly controlled by light exposure.