February 2002
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IMPROVING SLEEP: Reviewed by Lynne Lamberg |
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Surveys suggest that more than half of American
adults sleep poorly, but only 3 percent seek a doctor's help for sleep
problems. This report aims to narrow that gap, stressing that much
can be done to remedy many common sleep disorders. It updates a similar
1999 Harvard report. The need for such a
quick revision highlights important recent advances in the field.
The report cites the recent discovery of hypocretin
(also called orexin), for example. This neurotransmitter helps regulate
sleep and appetite. It's lacking in people who have narcolepsy, a
disorder that involves excessive daytime sleepiness. Modafinil, a
medication approved by the Food and Drug Administration in 1999 to
improve alertness in people with narcolepsy, also holds potential
benefits for people with other disorders that cause fatigue, such
as multiple sclerosis and chronic fatigue syndrome. Elsewhere, the report provides a succinct review
of the stages and states of sleep, and of circadian rhythms of sleeping
and waking. Our bodies are programmed to seek sleep not only at night
but also between about 2 and 3 p.m. In siesta cultures, people who
nap for an hour or two in the day sleep correspondingly less at night.
Light is the key cue for setting body clocks. Up to 90 percent of
totally blind people experience disruptions in their circadian rhythms
and sleep/wake patterns. The report also delves into disturbances of sleep
timing, including jet lag, shift work, and perhaps most common of
all, Sunday night insomnia. Staying up late on weekend nights prompts
the body to stay up late Sunday, too. Attempting to go to bed early
then often ends in frustration. A sleeping pill is not the answer.
Just go to sleep as soon as drowsiness sets in, the report suggests,
and don't sleep late Monday morning. In describing sleep over the lifetime, the report
presents new findings on sleep in women. It includes a section on
getting a good night's sleep in pregnancy. In middle age, nighttime
awakenings become more frequent and last longer. Many readers will
find it comforting to know that it's "normal" for adults
to awaken at least briefly about three hours after falling asleep.
Physically active people sleep more soundly than their sedentary peers. Many medical conditions disrupt sleep. People
with fibromyalgia, for example, often awaken feeling tired, and as
stiff and achy as people with arthritis. Studies show the tricyclic
antidepressant amitriptyline eases pain in about half of those with
fibromyalgia who take it. The report explores the effects of cardiovascular
disease, diabetes, eating disorders, heartburn, kidney disease, menopause,
mental illness, musculoskeletal disorders, neurological problems,
breathing disorders, and thyroid disease. It includes a substantive
review of medications used to treat these illnesses that may disturb
nighttime sleep or cause daytime drowsiness. Nicotine patches, and
theophylline, which is used for asthma, for instance, may trigger
insomnia. More detailed sections examine specific sleep
disorders, including insomnia, breathing disorders, movement disorders,
narcolepsy, and disorders known as parasomnias that include bedwetting
and nighttime eating disorder. Some people gorge themselves only during
their usual hours for sleep, not when they are fully awake. The report includes a comprehensive section on
evaluating sleep disturbances, with a sample sleep history questionnaire,
and self-tests of depression and anxiety. It also includes a sleep
diary. The text tells what's involved in a sleep laboratory evaluation,
describing both nighttime and daytime sleep tests, as well as home-based
tests that include the use of wristworn activity monitors. It also
reviews both over-the counter and prescription sleep medications,
listing usual dosages and providing cautions. This report offers a concise general introduction to sleep and its disorders. It would be a good addition to the bookshelf in a general medical office waiting room. |
Copyright (c) 2002
Websciences |