Seven signs of poor sleep

Alabama is one of 10 U.S. states with the highest rates of short sleep duration.

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Written by: UAB MedicineMedia Contact: Adam Pope

Alabama is one of 10 U.S. states with the highest rates of short sleep duration.Most people have trouble sleeping from time to time, but it can cause serious health problems when it happens almost every night.

According to the Centers for Disease Control and Prevention, adults need at least seven hours of sleep per night, and anything less is considered “short sleep duration.” Alabama is one of 10 U.S. states with the highest rates of short sleep duration; between 38 and 44 percent of its adult population are not getting the recommended seven-plus hours of slumber.

“The health consequences of chronic sleep deprivation are severe,” said Patricia Patterson, M.D., medical director of the UAB Medicine Sleep/Wake Disorders Center. “There is an increased risk of diabetes, obesity, depression and anxiety, as well as the possibility of worsened memory and decreased immune function.”

Signs of Poor Sleep

Patterson points to seven signs that you may not be getting enough sleep or that you may have a sleep disorder:

1. Daytime sleepiness, which can be caused by a sleep disorder or nighttime behaviors that reduce your sleep duration.
2. General fatigue, which may occur for months or years but does not include daytime sleepiness.
3. Increased appetite, which may be caused by hormone imbalances that can lead you to feel hungrier than usual and then less satisfied when you do eat.
4. Inability to fall asleep, which in many cases is caused by digital devices. Melatonin is a hormone crucial to the sleep-wake cycle, and the blue light from smartphones and tablets reduces melatonin production.
5. Frequent trips to the bathroom during the night, a condition known as nocturia, may be caused by sleep apnea, certain medications or caffeine.
6. Nighttime awakenings, which are a common result of alcohol. Although alcohol may help you get to sleep, your body’s overnight processing of the alcohol sugars can lead to waking up, increased snoring, sleep apnea and nocturia.
7. Waking up gasping or choking, which may be symptom of sleep apnea, a condition in which the airway becomes blocked during sleep.

Better Sleep Behaviors

When a patient is first seen at the Sleep/Wake Disorders Center, Patterson and her colleagues ask a series of questions and take an inventory of the person’s bedtime habits. The first line of treatment is encouraging patients to adopt sleep-promoting behaviors, such as:

• No electronics one to three hours before bedtime. Electronics interrupt physiological sleep mechanisms and stimulate the brain. If you have to be on your computer or phone at night, wear glasses that block blue light.
• A more sleep-friendly environment that may include dimmer lights, a cooler temperature and no television. Patterson says it is best to have a comfortable mattress and pillow, with no dogs, cats or children in the bed.
• Avoid heavy meals late in the evening. Indigestion and heartburn can keep you up.
• Avoid caffeine three to four hours before turning out the lights, and no alcohol, nicotine or marijuana one to three hours before sleep. Insomnia is a primary sleep disorder in the United States, and these stimulants can prevent people from falling asleep.
• Daytime exercise. Even a small amount of daily aerobic exercise can improve sleep quality.
• A consistent bedtime: Shift workers have an especially hard time with this, but those on routine nights do better than those who do rotating shifts.

According to Patterson, cognitive behavioral therapy can be an effective treatment for insomnia.

“Our sleep lab has one of only two sleep psychologists in Alabama,” she said.

While not a substitute for a sleep psychologist, there are mobile apps that offer cognitive behavioral therapy for insomnia (CBTI) and work for some people.

Patricia Patterson, M.D., medical director of the UAB Medicine Sleep/Wake Disorders Center

While adopting sleep-promoting behaviors can help many who suffer from periodic daytime sleepiness and fatigue, the CDC estimates that 50 million to 70 million Americans live with a chronic sleep or wakefulness disorder. That is where the UAB Sleep/Wake Disorders Center steps in to help. Sleep apnea is the most common disorder it treats.

“Patients often come to us because their significant other complains about their snoring or notices that their breathing pauses during sleep,” Patterson said. “Based on their symptoms and our examination, we may recommend a sleep study.”

A sleep study monitors several physiologic parameters, including respiratory effort, airflow and blood oxygen levels. It may be done in the center’s sleep lab or at the patient’s home. The number of pauses in breathing or episodes of shallow breathing per hour is evaluated, and if sleep apnea is diagnosed, then the patient is prescribed treatment.

“The gold standard of treatment is CPAP,” Patterson said. A CPAP, or continuous positive airway pressure device, consists of a mask connected by a tube to a small machine that increases air pressure to help ensure that the airway does not collapse when the sleeper inhales. “Other options include positional therapy, which prevents patients from rolling on their back during sleep, and an oral appliance that resembles a mouth guard.”

The Sleep/Wake Disorders Center also treats patients with other sleep disorders, such as restless leg syndrome, narcolepsy or idiopathic hypersomnia.

Getting to the bottom of poor sleep — whether caused by routinely binge-watching Netflix or a sleep disorder — is critical.

“Sleep affects everything we do — our family responsibilities, our ability to socialize, our work and our medical conditions,” Patterson said. “Good-quality sleep is the key to being fully present in our lives.”

Click here to learn more about UAB Medicine’s Sleep/Wake Disorders Center.