Sleep Disorders (cont.)

belsnickle_WebMD I have been an insomniac since I was a child. I just do not need 8 hours of sleep. But society deems the 8 hour cycle gives you the best rest. How can I increase the number of hours I sleep without simply lying in my bed with nothing to do, waiting for the world to wake up?
Dr. Wooten If you are tired, you may want to find a sleep center with an insomnia program. If you can sleep less than 8 hours and feel rested, try shortening your bedtime to the amount you need.

abstrack_WebMD Do you lend much credence to the idea of "sleep debt"?
Dr. Wooten Depends on the definition. If we do not get enough sleep, we get progressively more sleep over several days. We must oversleep at some point to bring us back to equilibrium. But chronically undersleeping for a year doesn't mean that we have to oversleep for the exact amount of time we under slept. The brain is nice enough to recover on just a few nights of recovery sleep

moderator So, you can't put sleep in the bank to be used later?
Dr. Wooten I wish.

We cannot sleep more than we need indefinitely, either. Insomniacs find this out the hard way -- they spend more and more time in bed trying to catch up or capture more sleep.

Unfortunately, it works against them. They become frustrated because they are just spending more time in bed not sleeping. The one situation in which trying to "store up" sleep is helpful is in the case of heading into a jetlag or shift-work situation. By getting a couple of good nights of sleep before traveling to a new time zone or going on a graveyard shift, a person can feel better and perform better on the new schedule.

moderator that actually bring up this next question....
smersh_WebMD What kind of advice do you give to workers who work odd hours?
Dr. Wooten I wish it were practical to tell them to get a day job.

Unfortunately, 25 percent of the workforce does shiftwork, and that may get worse. It is a tough area to give generic advice for, because there are so many different shift schedules. If a person works a graveyard shift, they should try the following:

  • Dont drink caffeine within 4 hours of going to bed
  • Allow a couple of hours to unwind before going to bed
  • Darken the bedroom completely
  • Wear eyemasks, earplugs and use sound generators to help sleep in the day
  • Avoid exposure to daylight or exercise in the morning before going to bed
  • Try to sleep part of the time in the mid afternoon to take advantage of a biological tendency to sleep at that time of day
  • Don't answer the phone, the doorbell or run errands during you scheduled bedtime, after all you wouldn't do it if you were trying to sleep at night
  • Set a schedule to go to bed and get up. Stick with it , even on your days off if possible.

bill31_WebMD I only get about 5 hours of sleep a night and it is not usually continuous. Is there a good non-prescription medication that may help?
Dr. Wooten There are no good non prescription medications. Most of the over the counter stuff is weak, short lived, or has more side effects than I like to see. For insomnia, I recommend learning relaxation techniques, good sleep habits, and as a last resort, prescription sedatives.

The prescription sedatives are only to be used when physical sleep disorders have been assessed by history or sleep testing. Some people need chronic sedatives and it is ok, in my opinion if all else has failed. However, I have found that some people do better with behavioral techniques and medications specific to their CAUSE of insomnia.

For example, if a person has restless legs syndrome, there are several effective medicines. If a person is obsessive/perfectionistic/Type A, selective serotonin reuptake inhibitor might be better to reduce their underlying tendency to think and worry too much.

Of course, if the person has full blown anxiety or panic attacks the drugs I just mentioned can help. And, if depression is present these drugs and other types of antidepressants should be used.

joyhope_WebMD Does a sleep pattern, like sleeping in the day time and work in night hours, affect the brain functioning in other ways?
Dr. Wooten Typically, shiftworkers don't sleep as much or as well during the day as do night sleepers. The symptoms of inadequate sleep are memory impairment, inability to process complex information, reduced reaction time, irritability and moodiness. As far as any permanent impairment there is no firm supporting evidence for that.

abstrack_WebMD Are persistent nightmares considered a sleep disorder?
Dr. Wooten Yes. I usually see that in people who have been abused or traumatic situations (like combat, rape, etc). Also in people who grew up in families with a lot parental fighting...

As far as treatment, most of the time that is best addressed through psychotherapy and medications, not by most sleep centers. There are some specific techniques applied to recurrent nightmares that specially trained psychologists use. The one situation in which a sleep center might help is in REM sleep behavior disorder. This is a situation in which an individual can actually act out their dreams. It can cause injury to self and others.

moderator Well, Sir... I just wanted to thank you for coming by today to do this. Do you have any closing thoughts?

Dr. Wooten Thank you very much. This has been very enjoyable, and I hope that it has been useful for you and your participants.

moderator It certainly has been a pleasure having you by... and thanks everyone for your great questions.
Your guest today has been Virgil D. Wooten, MD.

Dr. Wooten Thanks, you did a great job. Signing off.

moderator Have yourself a good Holiday season!

Dr. Wooten You too.

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