Waking up to sleep disorders

Trouble sleeping? You're not alone. In fact, about 25 per cent of Canadians will have a significant sleep disorder in their lifetime, estimates Dr. Adam Moscovitch, a.k.a. The Sleep Doctor.

"We have about 85 different sleep disorders that we can now recognize and treat," said Moscovitch, an internationally-recognized expert on sleep and fatigue disorders.

"Sleep deprivation as a result of not sleeping as much as we need, or because of an underlying sleep disorder, is becoming quite an epidemic. And we are paying a very heavy price for it-both individually and as a society."

A sleep disorder should not be confused with an occasional sleep disturbance, Moscovitch emphasized.

Everyone has an occasional sleep disturbance, he said. It may be in relation to a stressful period or worrying about something.

A sleep disorder, on the other hand, is already chronic, Moscovitch explained.

"It has lasted at least for weeks if not months and in most cases for years. And it has a significant impact -in a lot of cases a measurable impact on the individual's physiological, psychological, educational or occupational functioning."

Insomnia, for example, is a sleep disorder. It includes: problems falling asleep, staying asleep, waking up too early, or waking up not feeling refreshed.

"Frequently, people that have that will report that when they wake up in the morning, they feel like they have been run over by a truck," Moscovitch said. "They frequently have a multitude of aches and pains upon waking up-from back aches to jaw aches to headaches-that either interfere with their ability to fall asleep, or their ability to stay asleep, or they wake up with it in the middle of the night for a variety of reasons."

Chronic insomnia is not a diagnosis, Moscovitch emphasized. He compared it to chest pain.

The key is to find the underlying condition-whether it's medical, neurological, hormonal, environmental, psychiatric, psychological -and then tailor the treatment to that, he said.

The consequences of sleep disturbance or sleep deprivation, can include: fatigue; increased likelihood of sleepiness; increased likelihood of accidents at work and at home; increased irritability; higher risk of developing a major psychiatric condition-in particular depression and anxiety disorders; problems with memory, concentration, difficulties with decision-making, and difficulty learning new things which may eventually affect the immune system.

Treatment options for those with sleep issues are as varied as the causes of the problem, Moscovitch pointed out. Mechanical devices, for example, can be used to treat snoring and breathing problems. Light treatment offers a way of shifting back and forth the biological clock. Medications, whether over-the-counter or prescription, can be used. Cognitive therapy is an option. Relaxation techniques may help. Sometimes it's a matter of addressing what's happening with your bed partner, or how much light is coming into your bedroom at 5 a.m., or whether your bedroom faces a busy roadway.

Pain is a major contributor to sleep problems, Moscovitch said.

"Almost every individual that has a problem with pain, whether acute or chronic, will have a significant problem with sleep," he said. "And intuitively, we know that."

Short-term solutions can include the use of a sleep aid, or a prescription drug if the problem is more significant he said.

A new over-the-counter medication, Advil Nighttime, was recently released in Canada, to treat the combination of pain and sleep difficulty.

"It's intended for short-term use. But what is hoped by that short-term use is that it will help stop it from developing into a vicious cycle," Moscovitch explained.

The newest prescription sleeping pill on the Canadian market is over 20 years old, he said.

"We did not have anything new released on the Canadian market as a way of helping pharmacologically individuals that have a sleep problem for a very long time," he pointed out.

Besides pain, some common causes of chronic insomnia include:


Those are people, for example, who fall asleep on the sofa watching TV, but the second they try to sleep in bed it's like their mind is going 200 miles an hour. "The bedroom literally gets conditioned, for a variety of reasons, as a place of struggles instead of a place for sleep," Moscovitch said;


That can be due to restless leg syndrome or sleep apnea,


In particular depression, anxiety, panic attacks, and schizophrenia may lead to problems with insomnia;


These include diabetes and bladder problems, for example. Mismatch between body clock and scheduled sleep time.

"We have about 50 million shift workers in North America now. We are moving more and more into 24/7 types of operations, practically in every industry," Moscovitch pointed out, adding that shift workers may have difficulty falling asleep during daylight hours.

Teenagers and frequent business travellers are also prone to sleeping disturbances caused by their body clock and scheduled sleep time not being in sync.


"Alcohol in particular is notorious for causing long-term sleep problems, and taking away the refreshing quality of it," Moscovitch said.


For example, what kind of person you are sleeping next to. Is it a loud, disruptive snorer? Do they move around a lot?

Also, take into consideration the quality of the mattress you're sleeping on.

- Moscovitch is the founder and former medical director of the Canadian Sleep Institute. You can follow The Sleep Doctor on Twitter at @thesleepdoc.

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