Sleep Disorders in Adults (cont.)

KRYGER:
There are many possible explanations for this sleeping pattern, including this is the way your body clock is. Some people's body clocks seem to function in such a way that the person falls asleep late and wakes up late, and in such people we often hear the term "night owl." The problem with night owls, of course, and this is something we've found in the NSF poll, is that some groups of night owls -- in order to function in the daytime on reduced sleep because they have to get up before their body wants them to get up -- is that they overuse caffeine.

Now, having a body clock out of sync with the rest of the world is not really a disease. That is the way the person is. Most of the time the best approach for someone to take when they have such a body clock, is for them to choose a career that is more in line with their own biology.

I have had many patients over the years that have ended up in the hospitality or entertainment industry because they are able to stay up late and be in sync with their body clocks.

The other side of the coin who is the person who is often called a lark. Such people go to bed very early and wake up early. Often, such people gravitate into jobs that start very early in the morning.

Many teenagers start to have features of being a night owl, and it is amazing that within the U.S. there are many school systems that force high school students to start their school before they are really awake. Interestingly, in the past few years, the National Sleep Foundation has tried to educate school systems and the public in dealing with this important issue. This year, the National Sleep Foundation, for example, presented the Wilton Connecticut Board of Education and League foundation an award because they changed the start time for middle and high schools, which is much more reasonable and in sync with students' biology. As an example, if someone has a school starting time at 9:00 versus 7:00 to 7:30 am., that could have an extremely beneficial effect on the students' ability to learn, and overall mood since they are less likely to be in a state of chronic sleep deprivation.

MEMBER QUESTION:
If I am sleepy all day and even minutes before I go to bed, why is it that as soon as I lie down I can't sleep?

KRYGER:
There are some people that develop a condition that is called psychophysiologic insomnia. This type of sleep problem is quite common, and very often the symptoms that have just been described is what we hear in the clinical assessment. The person is sleepy, gets into bed, and instantly feels wired and alert, their mind races and they can't turn it off.

Very often, this response is "learned" in the same way that Pavlov's dogs learned to salivate when they heard a bell. In such people, it is the sleep environment that they are in that is the culprit. Such people need to learn very often how to fall asleep again and a commonly used treatment that's been studied more in the past few years is called cognitive behavioral therapy, which is a treatment that doesn't involve pills. There is a chapter in my book, A Women's Guide to Sleep Disorders, that is called "Treating Insomnia without Pills" that covers this topic. Such treatment is often administered by a clinical psychologist and can be quite effective.

Very often, such a problem arises as a response to something else that has caused insomnia and the problem may persist even though the original cause is long gone. For example, a person might develop trouble sleeping during a very stressful time in their life, perhaps a divorce, death in the family, and so forth. They may start to develop the behavior of expecting to sleep poorly every time they go to bed. Often long after the initial stress is over the behavior that is perpetuating this insomnia continues and the person starts to expect a bad night every night. Very often such people need to learn how to fall sleep again.

"If your sleep is poor and you're not functioning well during the day, you should do something about it."

MEMBER QUESTION:
What would you say is the best way to get a good night's sleep?

KRYGER:
The best way to get a good night's sleep is to make sleep a priority, to find out why you are not getting a good night's sleep, and then to treat that cause. Sometimes the problem may be with you, in that you may have a sleep disorder, or the problem may be that your bed partner is keeping you awake.

If your sleep is poor and you're not functioning well during the day, you should do something about it. One of the things you should consider is to go onto the web site of the National Sleep Foundation which has a great deal of educational material about sleep that pertains to people of all ages, sleep disorders, shift work, etc. The more you know about sleep the more you'll realize how important it is and how important it is to achieve it.

The National Sleep Awareness week is a time when people hear a lot about sleep. There are many diverse partners that play a role in disseminating this information, including over 100 federal and state agencies, nonprofit organizations and associations including the National Center on Sleep Disorders research, and this year the National Association of Elementary School Principals, the Asthma and Allergy Foundation, the U.S. Coast Guard and the AAA Foundation for Traffic Safety among others.

MODERATOR:
Our thanks to Dr. Kryger for joining us today. And thank you, members, for your great questions. For more information, please visit the National Sleep Foundation on line at www.sleepfoundation.org.



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