Tired all the time? Insomnia may be the cause.
By Roberta Cannon, RN
Are you lying awake at night, sleeping for short periods, or feeling as if you haven’t slept at all when you get up in the morning?
If that’s the case, then you are among the 70 million Americans who experience chronic sleep problems, according to the Centers for Disease Control and Prevention (CDC).
One of those sleeping disorders is insomnia, which can be acute or chronic. Acute insomnia lasts for a short period of time and can be due to stressors such as work, family issues or a traumatic event. It can last from a few days to a few weeks.
“Chronic insomnia is persistent beyond three months,” said Mir Shuttari, MD, a pulmonary and critical care specialist with Falmouth Hospital. “If you are experiencing difficulty falling asleep or maintaining sleep beyond three months, it is falling into the chronic category.”
There are a variety of causes that can contribute to chronic insomnia, according to Dr. Shuttari. They include medical issues, such as pain or chronic disease, and mental health issues, including anxiety and depression. Anxiety prevents the onset of sleep and depression makes your sleep less refreshing. You may be in bed a little longer and wake up still feeling tired and sleepy.
Another reason for insomnia, especially for women, can be hormonal.
A 2020 study from the Women’s Health Initiative published in the American Journal of Clinical Nutrition hypothesized that a high glycemic index and high-glycemic diet could be associated with insomnia in post-menopausal women.
“While this is a very important study and high glycemic index could be a trigger, there are a variety of causes and the number one cause is hormonal changes,” said Dr. Shuttari. “Women who are post-menopausal are not secreting estrogen, which is a very important hormone that has many health benefits. It helps you absorb magnesium from the diet, which is what is needed to make melatonin (a hormone secreted by the pineal gland in the brain that regulates your sleep cycle telling you when to sleep and when to wake up).
Three out of 10 to six out of 10 peri-menopausal and post-menopausal women he sees in his practice complain of insomnia.
“One option for treatment is estrogen hormonal replacement therapy which can be a double-edged sword,” said Dr. Shuttari. “We must balance the benefit of maybe getting a better sleep with a risk of getting some cancers. We always consult their GYN physicians and primary care physicians for their medical history, last PAP smear results, or any tests with atypical cells. It is a team effort.”
Sleep studies
To learn more about what is causing your sleep disturbances, you may want to talk with your primary care physician about having a sleep study done. A sleep study is a test done in the sleep lab at Falmouth Hospital to record how much sleep you are getting at night. Dr. Shuttari explained that a lot of people say they have insomnia, but when tested in the sleep lab, they are getting a good seven hours sleep and yet still feel like they have insomnia.
“It doesn’t totally negate insomnia and there are other tests that can be done,” said Dr. Shuttari. “There is sleep latency testing that measures how quickly you fall asleep for daytime napping and the maintenance wakeful test that measures how alert you are during the day. This information can be very useful.”
When chronic insomnia is not related to pain, anxiety, depression or medication side effects, there is a treatment modality that can be tried called cognitive behavioral therapy (CBTi), said Dr. Shuttari. This has the best track record.
CBTi helps you change actions or thoughts that keep you from sleeping well and develop habits that encourage healthy sleep patterns according to the American Academy of Sleep Medicine (AASM).
Therapy includes:
He also suggests that natural, clean melatonin at bedtime may also be helpful. He cautions that melatonin is not approved by the FDA and there isn’t any rigorous review to make sure that the product has melatonin in the amount it claims to have. Consumer Reports has done actual studies and broken them down to see which brand truly contains melatonin and that can be a resource.
Tips for a better night’s sleep
Dr. Shuttari recommends the following sleep hygiene principles to follow for a better night’s sleep:
Dr. Shuttari noted drinking a glass of wine or cocktail in the evening may not cause insomnia, but it can be one of many triggering factors.
“We spend more than a third of our lives sleeping, so let’s acknowledge that and get a better quality of sleep,” he said. “Don’t ignore insomnia, go to your doctor and get things checked out to rule out any other medical or psychiatric causes. Then you can start utilizing the tips we’ve talked about.”
View Physician Profile
Originally published on Cape Health News March 21, 2023
If that’s the case, then you are among the 70 million Americans who experience chronic sleep problems, according to the Centers for Disease Control and Prevention (CDC).
One of those sleeping disorders is insomnia, which can be acute or chronic. Acute insomnia lasts for a short period of time and can be due to stressors such as work, family issues or a traumatic event. It can last from a few days to a few weeks.
“Chronic insomnia is persistent beyond three months,” said Mir Shuttari, MD, a pulmonary and critical care specialist with Falmouth Hospital. “If you are experiencing difficulty falling asleep or maintaining sleep beyond three months, it is falling into the chronic category.”
There are a variety of causes that can contribute to chronic insomnia, according to Dr. Shuttari. They include medical issues, such as pain or chronic disease, and mental health issues, including anxiety and depression. Anxiety prevents the onset of sleep and depression makes your sleep less refreshing. You may be in bed a little longer and wake up still feeling tired and sleepy.
Another reason for insomnia, especially for women, can be hormonal.
A 2020 study from the Women’s Health Initiative published in the American Journal of Clinical Nutrition hypothesized that a high glycemic index and high-glycemic diet could be associated with insomnia in post-menopausal women.
“While this is a very important study and high glycemic index could be a trigger, there are a variety of causes and the number one cause is hormonal changes,” said Dr. Shuttari. “Women who are post-menopausal are not secreting estrogen, which is a very important hormone that has many health benefits. It helps you absorb magnesium from the diet, which is what is needed to make melatonin (a hormone secreted by the pineal gland in the brain that regulates your sleep cycle telling you when to sleep and when to wake up).
Three out of 10 to six out of 10 peri-menopausal and post-menopausal women he sees in his practice complain of insomnia.
“One option for treatment is estrogen hormonal replacement therapy which can be a double-edged sword,” said Dr. Shuttari. “We must balance the benefit of maybe getting a better sleep with a risk of getting some cancers. We always consult their GYN physicians and primary care physicians for their medical history, last PAP smear results, or any tests with atypical cells. It is a team effort.”
Sleep studies
To learn more about what is causing your sleep disturbances, you may want to talk with your primary care physician about having a sleep study done. A sleep study is a test done in the sleep lab at Falmouth Hospital to record how much sleep you are getting at night. Dr. Shuttari explained that a lot of people say they have insomnia, but when tested in the sleep lab, they are getting a good seven hours sleep and yet still feel like they have insomnia.
“It doesn’t totally negate insomnia and there are other tests that can be done,” said Dr. Shuttari. “There is sleep latency testing that measures how quickly you fall asleep for daytime napping and the maintenance wakeful test that measures how alert you are during the day. This information can be very useful.”
When chronic insomnia is not related to pain, anxiety, depression or medication side effects, there is a treatment modality that can be tried called cognitive behavioral therapy (CBTi), said Dr. Shuttari. This has the best track record.
CBTi helps you change actions or thoughts that keep you from sleeping well and develop habits that encourage healthy sleep patterns according to the American Academy of Sleep Medicine (AASM).
Therapy includes:
- Stimulus control to develop a positive response to going to bed
- Sleep restriction that limits the time you spend in bed
- Relaxation training and bio-feedback teaches you how to relax body and mind
- Cognitive control and psychotherapy helps identify attitudes and beliefs that hinder your sleep.
He also suggests that natural, clean melatonin at bedtime may also be helpful. He cautions that melatonin is not approved by the FDA and there isn’t any rigorous review to make sure that the product has melatonin in the amount it claims to have. Consumer Reports has done actual studies and broken them down to see which brand truly contains melatonin and that can be a resource.
Tips for a better night’s sleep
Dr. Shuttari recommends the following sleep hygiene principles to follow for a better night’s sleep:
- Go to bed at a fixed time each night.
- Have a pre-sleep routine, avoiding exposure to bright lights beginning around 8-9 p.m.
- Avoid watching television or using electronic gadgets such as iPads, computers, and cell phones while in bed.
- Don’t drink any caffeinated beverages for at least six hours prior to scheduled bedtime.
- Avoid alcohol for the same duration. The way alcohol is metabolized in the body, you may fall asleep quicker, but it totally disrupts the sleep maintenance. You may wake up a couple of hours later as the alcohol is metabolized.
- Take a warm shower before bedtime.
- Sleep in a cool bedroom.
- Dim the lights so it is dark in your bedroom
Dr. Shuttari noted drinking a glass of wine or cocktail in the evening may not cause insomnia, but it can be one of many triggering factors.
“We spend more than a third of our lives sleeping, so let’s acknowledge that and get a better quality of sleep,” he said. “Don’t ignore insomnia, go to your doctor and get things checked out to rule out any other medical or psychiatric causes. Then you can start utilizing the tips we’ve talked about.”
View Physician Profile
Originally published on Cape Health News March 21, 2023