With an estimated 50 million to 70 million Americans suffering from some
kind of sleep disorder, we’re clearly a country in trouble. Researchers
have found chronic sleep deprivation can be as bad for our health as smoking,
and driving while sleep-deprived is as dangerous as driving drunk.
Yes, an occasional sleepless night might just render you tired the next
day. But chronic sleep deprivation and insomnia can cause long-term health
problems like type 2 diabetes, hypertension, heart attack, stroke and
depression, and make it nearly impossible to maintain a healthy weight.
Guidelines from the National Sleep Foundation suggest adults need a minimum
of seven hours of sleep.
“Sleep problems are very common and very prominent,” says Torrance
Memorial Physician Network internist Khalid Eltawil, MD, who is board-certified
in pulmonary critical care and sleep disorders. “So many people
don’t realize they have a sleep issue and/or are embarrassed to
mention sleepiness to their doctors. They think it’s just laziness
or age-related. But without good sleep, their overall health is being
Many who have sleep issues might be surprised to find they are referred
to a pulmonary specialist. “Several specialties deal with sleep:
neurologists, psychiatrists, even dentists,” Dr. Eltawil explains.
“But the most common cause of sleep deprivation is sleep apnea,
which is a pulmonary issue. Men are especially vulnerable. About 50% of
men over 50 have some degree of sleep apnea.”
Indeed you might have sleep apnea without even knowing it. “Sleep
apnea involves an episode during sleep when the air flow stops or decreases,
and you wake up because you can’t breathe—often due to a throat
airway obstruction,” says Dr. Eltawil. “It happens repeatedly
over the night, and therefore your sleep is constantly disrupted. You
might not be aware of it, but often a partner will hear a pause in your
breathing, then a snort, and you’re back to sleep.
“So even though you have been asleep for eight hours, you wake up
feeling tired and not rested. If you live alone, you might not even realize
it’s happening—although you feel tired. Some might think it’s
normal, and it’s just what happens as you get into your 60s, for
instance. But sleep apnea has a very negative effect and can raise blood
pressure and lead to atherosclerotic tract problems such as heart attack.
“The warning signs are simple: If you are getting a full night’s
sleep and still need a nap, or doze off reading or watching TV, you should
see a specialist.”
Treatment will depend on what your particular problems are, according to
Dr. Eltawil. “There might be other reasons a patient can’t
sleep. They might have insomnia or abnormal leg or body movements that
keep them awake. We go over medical history and medications and look for
red flags. We examine them and see if we can get a diagnosis. They might
get set up for a sleep study.”
If that notion conjures up a scary lab experiment scenario, rest easy.
There are two kinds of sleep studies, and most are done at home. “The
patient brings home a small recording device and wears it for one night,
then brings it back and we see what’s on it,” says Dr. Eltawil.
“It will show us patterns of sleep apnea, if they are occurring.
“For the second type of sleep study, we bring them into the sleep
lab to spend the night. It’s not bad—it’s a simulated
bedroom or hotel room, made as comfortable as we can make it feel. The
patient is hooked up to wires that monitor different systems. The majority
of people have no trouble with it.
“If we determine it is sleep apnea, we often prescribe a feedback
machine, which is a small device called a CPAP (Continuous Positive Airway
Pressure)—a mask worn over the face that provides a puff of air
down the throat, just enough pressure that when the patient breathes,
they breathe more comfortably without the airways collapsing. It really
is the easiest and most effective treatment. The mask is worn during sleep
and only until there has been a change. People often get better. A big
change people can make on their own is weight loss. Mild to moderate sleep
apnea often subsides with just a few pounds of weight loss. If these measures
are not successful, we discuss surgery, which will depend on the facial
If the patient is diagnosed with insomnia, it can be much more challenging.
“So many things can lead to insomnia,” Dr. Eltawil cautions.
“You have to look at all the lifestyle issues, such as watching
TV or using your iPad in bed. Medications or chemicals can disrupt sleep—the
most common being caffeine in coffee and soda. Next we look at alcohol.
People end up becoming dependent on it to fall asleep, and in turn alcohol
can hinder sleep.”
Anxiety, stress and depression are factors in about 35% of insomnia cases,
according to Dr. Eltawil. “And many seniors have chronic pain issues,
so you have to address all of those possibilities. We start with lifestyle,
sleep hygiene, and medical and chemical issues, and start to manipulate
sleep times and habits. Sometimes we might have to use sleep aids, but
I prefer to start with good hygiene and avoiding caffeine and alcohol
first.” (See “Good Night,” Dr. Eltawil’s sleep
tips, on page 2.)
Some people find relief using melatonin and valerian root. “Melatonin
is an interesting chemical. Its main goal is to tell your body what time
it is. When melatonin levels are high, it’s time to go to bed. Not
being a drug or medicine, it’s not very well regulated, so doses
can vary from 1 mg to 10 mg, and there’s no exact absorption from
one person to another. You just have to go with trial and error. It does
have a sedating effect, so that is a positive. But some of it might be
a placebo effect, so taking more is not necessarily better. Another natural
agent is valerian root, which seems to help people sleep. The root is
made up of so many components, we are unsure which is working …
but it can be sleep-promoting.”
The first step in solving our nationwide sleep crisis, believes pulmonary
physician Khalid Eltawil, MD, is recognizing the importance of a good
night's sleep and vowing to make it part of your overall healthy lifestyle.
Here are some tips from him and other experts:
Establish a sleep routine
“This means going to bed at the same time every night,” Dr.
Eltawil explains. “Also getting up at the same time and creating
rituals, such as meditating, deep breathing, reading, taking a bath or
shower.” A pre-sleep routine lets the body know what’s coming.
And that in turn regulates your circadian rhythms—key to healthy,
Clean sleep hygiene
Make sure your room is completely dark (not even a speck of light, according
to Andrew Weil, MD), quiet and cool. Turn all electronic devices off.
In fact, the UCLA Sleep Disorders Center suggests not even looking at
a screen for two hours prior to bedtime. Open the windows. And do everything
to make your bed comfortable to you, whatever that means: featherbeds,
waterbeds, down comforters and pillows. Just get cozy.
Avoid sleep saboteurs
Alcohol, tobacco, caffeine, and recreational and prescription drugs all
can disrupt your somnolent efforts. “Alcohol becomes a problem because
people get dependent on it. It does make you sleepy,” says Dr. Eltawil,
“but then as it wears off, that disruption can keep you awake. Don’t
ingest caffeine (coffee, tea, soda) after 2 p.m. It’s also best
to avoid large meals just before bedtime, but have a light snack so hunger
doesn’t rouse you in the middle of the night.”
And the jury is out on marijuana—research in the U.S. has not been
allowed over the past few decades. It does seem to change the stages of
sleep, but it’s too early to say whether it helps or hurts.
Finally, try not to worry about not getting enough sleep. “Anxiety
and stress are some of the biggest issues causing insomnia,” says
Dr. Etawil, adding if these tips don’t work, you should seek professional
help. There are behavioral techniques such as relaxation and breathing
exercises that a pro can teach you. It’s all about controlling your
environment and setting the stage for a good night’s sleep.
Khalid Eltawil, MD, is a pulmonary specialist with the Torrance Memorial
Physician Network. He practices at 2841 Lomita Blvd. in Torrance and can
be reached at 310-517-8950.