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HEART Insight:
doi: 10.1097/01.HEARTI.0000407816.52982.05
Features: Related Risk

Can You Buy a Good Night's Sleep? (Online Bonus)

Gupta, Nelly Edmondson

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Abstract

Sleep-aid manufacturers claim that the right pills, pillows and gadgets can help us get the rest we need. Are they right?

When it comes to sleep, two things are clear: First, we're not getting enough of it. And second, it's very big business.

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An estimated 58 percent of Americans experience sleep problems, and as a nation we spend 23.7 billion dollars a year on products designed to help us solve them. These products include prescription and over-the-counter (OTC) medications, high-tech pillows and mattresses, white noise machines, anti-snoring devices, light boxes, throat and pillow sprays and much more.

And yet, too many of us still toss and turn, snore like freight trains and wake up feeling exhausted and out of sorts.

What to do? HEART INSIGHT sought advice from two nationally known sleep experts: Steven Y. Park, M.D., Clinical Assistant Professor of Otolaryngology at New York Medical College in Manhattan, and Sam Sugar, M.D., F.A.C.P., Director of the Sleep Services Program at the Pritikin Longevity Center and Spa in Doral, Fla.

According to Park and Sugar, while some sleep aids may be helpful for some people, simply throwing money at the problem—or under the blanket—isn't the answer. Most of these products are “band-aids,” says Park, author of Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (Jodev Press, 2008). He explains: “You're covering up the problem. But ultimately, you have to get to the root of the problem and allow the wound to heal.”

Effective treatment for sleep disorders, both agree, depends on the underlying cause. Here's their step-by-step plan to help you take control:

Give yourself a sleepiness test. Go online and rate yourself on the Epworth Sleepiness Scale at www.stanford.edu/∼dement/epworth.html. A low score indicates that you're getting enough sleep. A moderate score may mean that you have a minor sleeping problem. In that case, an over-the-counter sleep aid containing natural sleep-inducers such as melatonin, valerian root and/or L-tryptophan may be helpful for a few nights—but first get your doctor's OK, since OTC drugs can interact with other prescription and nonprescription drugs. If your sleepiness score is higher, it's time to visit your doctor.

Talk, really talk, to your doctor. “You've got to help your doctor,” stresses Sugar. “Even admitted insomniacs rarely discuss sleep with their doctors, because they don't feel it's that critical.” But it is critical, so describe your symptoms in detail. “If you just tell your doctor you're tired, alarms may not go off,” adds Sugar. “But if you say you find yourself falling asleep while driving, that will set off some bells.”

“Emphasize you're there for a problem with sleep,” advises Park. “And don't accept a reflex prescription for medication.” Instead, he says, ask whether you should seek more in-depth analysis about what is causing your sleeplessness.

Get tested. The next step may be an in-home sleep-test using a small, portable monitoring device that records airflow and other data as you sleep. If home testing comes up clear, take a closer look at your sleep hygiene and/or consider whether there are emotional issues you need to address. (For more information on sleep hygiene, see: “Could Chronic Sleeplessness Be a Heart-Health Nightmare?”)

If home testing indicates a sleep disorder, you'll probably need a formal sleep study to pin down a diagnosis. Most university hospitals have excellent sleep centers; ask your doctor for a recommendation.

Follow through. Once you have a diagnosis, you and your doctor can determine the best treatment. People who suffer from nasal congestion and snoring may benefit from nasal strips that open up the airways in your nose.

If you have obstructive sleep apnea (OSA), a condition characterized by repeated breathing pauses during sleep caused by an obstructed airway, there are a number of treatment options. These include oral devices that move your jaw and soft tissues slightly forward to keep the airway open; special pillows and/or a body positioning garments that force you to sleep on your side, which prevents excess tissue in the throat from flopping backward and obstructing the airway; and a continuous positive airway pressure (CPAP) mask, which can help you breathe more easily during sleep by keeping the airway open. Some people may benefit from laser or other types of surgery to eliminate excess tissue in the throat and facilitate better breathing.

People with insomnia unrelated to anxiety or depression usually have poor sleep habits, like drinking caffeinated beverages at night or habitually staying up to watch a late movie or finish a chapter in the can't-put-down mystery novel they're reading.

In other cases, poor sleepers may have a medical condition that causes difficulty in falling asleep (restless legs syndrome [RLS], for instance) or staying asleep (acid reflux), or may have trouble breathing because of a deviated septum, nasal congestion due to allergies or repeated sinus infection. Treatment of the underlying medical condition should resolve the insomnia.

Your sleep environment also matters. If your bedroom is too bright or warm, your pillow is too soft or not soft enough, your mattress is too lumpy, your blanket is too heavy or scratchy, or your feet are too cold, you're just not going to fall asleep. Like Goldilocks, everything has to be just right. Your bliss may be a high-tech foam pillow that cradles your head and neck just so, an adjustable bed that elevates your head or feet or lightly starched, crisp sheets perfumed with lavender-scented fabric softener. Whatever works for you is money well spent.

“There's no shame in not sleeping well,” Sugar says. “We just need to be smarter about sleep, and about how important it is.”

© 2011 American Heart Association, Inc.

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