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Following on from another thread, I'm a GP who has an interest in sleep.
I'm going to stick around for the next hour or two and try and answer any questions that you may have, so fire away.
Light-hearted one to kick off. I've just been out for my slightly boozy Christmas lunch with my other half and have been sleeping it off on the sofa since 2pm while trying to watch the Chicken Run sequel on Netflix. Are afternoon naps a good idea in the binge-drinking elderly, or should we power through to bedtime?
I have been suffering with what I think is a form of central sleep apnoea. its not all the time but as I'm going to sleep I can occasionally feel myself stop breathing.
It's bloody terrifying and once aware of it I often end up getting up and missing a whole nights sleep.
Other nights I can sleep like a log for 9hrs, sadly that seems to coincide with having a bit more alcohol than I should?
I sometimes have dreams about being an apex predator, preying on cats, living as a wild man clothed only in cat skins.
Or, at other times, being a cannibal, but then I wake up with anxiety problems when I realize that I'm going to starve when I've finished eating all the other passengers.
Sorry missed the question bit off! Do you know what causes this, have been treated in the last year for an over active thyroid which was over treated and went under active?
Hi,
do you happen to know anything about periodic limb movement disorder and help that doesn't include clonazepam ( or similar drugs). It been a long time since I was diagnosed with it in a different part of the country so I have no access to the specialists I saw them and I stopped the medication on another GPs advice due to issues they were causing with long-term use
I'm on the waiting list for a sleep clinic where I am, but have been told the waiting list is a year so any advice would be useful.
On a related note to the sleep clinic. I've suspected OSA, I certainly snore a lot and have had episodes where I've woke up choking, but may not hit the threshold for OSA treatment. .. I E been looking at private OSA assessment and treatment. They say they use the same monitors as NHS , and give the same depth if detail. I'm tempted for a couple of hundred quid to do this to save the length wait. Any idea on the validity of these? They're not in the same camp as the blood testing companies they?
Despite employing all the sleep hygiene I'm aware of my sleep and general energy is terrible with the above. Are day time naps worth a try? I just worry it might make my night time sleep worse.
I appreciate these are very specific questions and you are not my GP, but appreciate any thoughts you might have, and thanks for doing this.
Some evenings I can feel absoluetly exhauseted*, like not even wanting to sit on the sofa, feel myself drifting off watching TV levels of tired... So I'll go up to bed and either spend hours tossing and turning and not getting to sleep, or pre-empting this and reading until 1am.
Why can I not keep the tiredness through the strenuous process of walking upstairs, undressing and brushing my teeth?
*not worried about the actual tiredness, I can always identify the cause as either being a long strenuous day, or a big bike ride
Are afternoon naps a good idea in the binge-drinking elderly, or should we power through to bedtime?
It depends on how well you sleep at night. If you don't sleep well, then daytime napping will probably make the problem worse. If you sleep like a log then a daytime nap (as long as you aren't driving) is unlikely to be a problem.
However sleep that is aided/induced by alcohol is rarely replenishing, because it interrupts the natural cycles of deep and REM sleep followed by brief wakening periods and replaces them with uninterrupted deep sleep. Current thinking in neuroscience is that REM sleep and brief wakening periods are needed to process emotion and move memories from short term to long term storage in the brain.
+1 about daytime naps/siestas. Good/bad/irrelevant? edit: answered.
Related, is a 'full' night's sleep important, or is 4+4 with (say) 1-2 hrs awake in the middle fine too?
Is 8hrs (or any other number I guess) sleep a night necessary/good? I usually target 8, but realistically it's more like 6-7 as I can't get to sleep early enough usually.
Before I got a cpap machine, sometime when I stopped breathing due to sleep apnoea I could sense I was not breathing but not wake myself up (I think term is sleep paralysis, where you are aware but not awake) it seemed to go on for ages and was absolutely terrifying.
Restless or achy leg syndrome.
Years ago I suffered from this then for some reason it completely disappeared. In the last year it has started to return. At places like cinemas I always wear shorts which appears to control it.
But 30 minutes after going to sleep the only curry I have is to get up, may be eat something, watch crap and go back to bed an hour later. Typically then all is fine.
Any better ideas other than nasty drugs please. I don't drink caffeine after 1pm and little anyway.
Thanks
Let me be weak, let me sleep and dream of sheep
Other nights I can sleep like a log for 9hrs, sadly that seems to coincide with having a bit more alcohol than I should?
Please see my previous answer about alcohol induced sleep being too deep and so probably less effective hence you're needing to sleep for a longer time. However because it is so deep, it can feel like it's been more effective because your perception is of uninterrupted sleep. This effect is more intense if you have disordered sleep, such as central sleep apnoea, because your normal sleep pattern is likely to include repeated episodes of full consciousness.
2 questions from me -
how much sleep do we really need a night and are the (scare) stories that people that sleep less / have affected sleep are more prone to health issues. Is that lack of sleep or more due to (leads on to Q2)
I can't switch my brain off at night. I'm regularly absolutely bushed - fall asleep in the chair in the evening and rarely have problem getting off to sleep in bed. But then often wake with a thought in my head that won't go away (so back to Q1) - is it actually lack of sleep that is a health hazard or the negative indicators of stress, etc., that manifest as bad sleep that create those outcomes.
Because I get stressed both by work / life / family, and then stressed again because that stress stops me sleeping which is also apparently bad for me.
Sorry, meant to add I don't drink alcohol and I'm on decaf tea and coffee.
Nowadays I wake up a lot at 3-4am I am still tired and still need to sleep but often really struggle to get back to sleep. Usually I lie in bed awake for 2-3 hours and feel I am not getting enough sleep. I would love to hear some tips or solutions for this problem.
Separate question to RLS.
I never have an issue actually going to sleep. It's pretty well instant. But I do generally wake up too early, far too early . Often from 5am. My brain then instantly goes in to overdrive
I appear unable to turn it off and go back to sleep so end up getting up so not to disturb mrsMcMad.
I have tried breathing exercises but no luck. Any ideas please.
Do you know what causes this, have been treated in the last year for an over active thyroid which was over treated and went under active?
Diagnosis and treatment of central sleep apnoea is a specialised area, and not something that we do routinely as GPs. In most cases of disordered sleep, IME it's usually a case of optimising multiple factors rather than a single cause. Usually this is related to medication, alcohol use, smoking, upper airway congestion, and fat deposition around the windpipe. Often there's a family history too.
Sorry that I can't be more specific.
I would love to hear some tips or solutions for this problem.
similar question to mine - I have an answer (sort of) which is to count sheep - ie find something occupying enough to take your mind off whatever's keeping you awake, but not interesting enough to entertain you. I find counting upwards in prime numbers works, can you list them all from 1-100 and beyond. Or imagine a journey or bike ride, in detail, at every junction how many left, right or straight aheads are there and keep count of all of them in your head.
They work for me, I'd dearly love to find out how to stay asleep in the first place though, and as said whether having broken sleep is actually that bad for you.
Let me be weak, let me sleep and dream of sheep
Best song about imminent death by drowning ever.
Hi @Kramer,
I struggle to get to sleep. I stay up until I'm tired but as soon as my head hits the pillow my brain starts whirring away. Not so much worries, just thought after trivial thought. I wake up during the night needing the toilet* and then can't get back to sleep again! Very annoying. I do try and get up at the same time but will sometimes have a lie in if I'm really tired. I'm tired almost all of the time (see below) but feel that I would have a bit more energy if only I could get a good night's sleep!
To explain a little further; I'm 54 years old, reasonably fit, eat a healthy diet and I'm about the right weight, BUT, I also have stage 4 prostate cancer (spread to lymph nodes). I was diagnosed 18 months ago (PSA 374). I have had chemotherapy and radiotherapy (12 months a go and 9 months ago), and have a 12-weekly Zoladex injection. I also have paroxetine and Tamsulosin. I do understand that my condition and the hormone therapy affect my energy levels, but I'm sure they could be a bit better! PSA now 1.46 btw.
Any tips to help me sleep a little better most nights?
Thanks in advance,
Andy
ive tried everything to sleep, for over 20 years.One thing Im really bad at, is getting out of bed after 20mins if im still awake.
Z drugs work mostly, if I can get them, but I rarely can. alcohol keeps me up,even just 2 pints at6pm.
I dont know what else to try.
Could i be particularly sensitive to coffee and/or alcohol, so it would affect me for 2 or 3 days?
I can have exercised very hard all day, then I cant sleep.
Is it some kind of chemical imbalance?
I dont stress about it anymore, I have to live with it, but it makes many things so difficult,like long drives, and precision work, and of course my riding. I really want 7+ hours sleep everynight.
Could it be a side effect from psychotropic drugs i was put on many many years ago?
My GP cant help more
I average 4hrs sleep, 3nights very little sleep then one good night
Hi @Kramer
I take Tegretol (200mg prolonged release, twice a day) for temporal lobe epilepsy:
Am I correct in my perception that the medication puts me into an immediate deep sleep for 2 - 4 hrs, (as in shut my eyes and I'm off) followed by waking and fitful dream sleep for a further 3 - 4hrs?
Only occasionally do I sleep through, and would like to sleep better - should I change the timing of the medication so that i'm not taking my second dose at bedtime - would that help?
Alcohol is awful for my sleep, any more than 4 units and i'll not sleep well, if at all. So I generally avoid it.
I’d dearly love to find out how to stay asleep in the first place though.
I read somewhere it affects quite a lot of people as we age, and it is because the natural melatonin our bodies produce to get us to sleep is fading as the night progresses. For me I think that as the melatonin wears off, then the mask and pipe from my cpap machine is more likely to wake me.
For others also minimising wake triggers would probably be a good idea, usual sleep hygiene, blackout blinds, cool room, no led's etc Maybe also separate beds or mattresses so your partners sleeping movements don't disturb you.
Very specific but I'm struggling with post concussion syndrome at the moment. It led to me having depression in October but I feel like I've moved past that.
However, I'm still sleeping ten hours a night and need a nap in the afternoon. If I sleep less then I feel absolutely knackered all day - like fall asleep where I stand knackered. Even if I've had a good solid eight hours.
Is this something I'm perpetuating by letting myself sleep so long and napping? If I force myself to sleep less will it get me out of the habit or will I just make it worse? The knock on the head was back in September and I'd like to move on with my life.
do you happen to know anything about periodic limb movement disorder and help that doesn’t include clonazepam ( or similar drugs).
A little.
Commonly known as restless legs syndrome. It's worth measuring your serum ferritin (an iron transporting protein) and taking iron supplements if it's below (I think) 80 as that can improve restless legs syndrome. If that doesn't help, then I think that there are some anti-Parkinson's disease drugs that can be used, but in our area they're specialise initiation only.
They say they use the same monitors as NHS , and give the same depth if detail. I’m tempted for a couple of hundred quid to do this to save the length wait. Any idea on the validity of these?
Unsure. As a rule of thumb, if you're staying the night in hospital and are hooked up to monitors then it's very likely to be valid. I believe (but am not sure) that in some areas the NHS may be moving towards home monitoring for diagnosis, but not in our area so I've no direct experience myself.
One slight problem with all private providers is that when you're the paying customer, they've got a financial incentive to find something wrong and thus give you actionable information. IME that does sometimes bias the advice that they give. At least on the NHS, you've got someone who's hopefully impartial making the diagnosis.
Despite employing all the sleep hygiene I’m aware of my sleep and general energy is terrible with the above. Are day time naps worth a try? I just worry it might make my night time sleep worse.
I'll refer you to my previous answer about napping. If you're sleeping through the night, and find a nap in the daytime helpful then it's likely to be beneficial. If you're not sleeping at night, then catching up in the day is likely to lead to a disordered sleep cycle.
Sometimes when I go to bed, I can feel and hear a pounding or beating in my head. If I put my ear on the pillow it's worse, but it won't go until I eventually give in and get up, do something else like watch tv for a bit, then try again. Drives me demented.
Thanks Kramer,
my GP said the NHS do do at home overnight monitoring now (atleast here in Angus). My previous sleep clinic it was the full on night in hospital all wired up like a puppet. I also did a daytime sleepiness test where you had to sit in a dull room 45mins at a time (i think 5 sesssions through the day) with headphones on an press a button when a little light came on. That was fun 😁
So I’ll go up to bed and either spend hours tossing and turning and not getting to sleep, or pre-empting this and reading until 1am.
Why can I not keep the tiredness through the strenuous process of walking upstairs, undressing and brushing my teeth?
Because, unfortunately, you've trained your brain that bed is a place to toss and turn or read rather than sleep.
If you have problems getting to sleep, then bed should be for two things and two things only. Sleeping and shagging. Avoid doing anything else in bed, including reading.
In your case, I'd suggest that you move your bedtime later. You're not sleeping for the first few hours anyway, so don't spend them in bed. Set yourself a later time, and only go to bed after this time when you feel tired. If you don't feel tired after brushing your teeth, then don't go to bed, do something else instead.
When in bed, give yourself 20 perceived minutes to fall asleep. Don't clock watch, just go by your estimate. If you've not fallen asleep after what you think is twenty minutes, get up again and do something else instead until you feel tired and then repeat the process. This way you're starting to break the cycle of endless hours in bed trying to get to sleep. This is the basis of CBTi.
Something worth looking at in your case would also be cutting caffeine consumption completely after lunchtime, and also avoiding exercising in the evening.
Why do I wake up feeling tired, regardless of how much sleep I've had! I never, ever, wake up feeling refreshed and ready to go. Every day I have to drag myself out of bed 😞
On a serious note though, I have pretty bad tinnitus and whilst I've learnt to ignore it mostly and I can get to sleep, I'm convinced it affects my sleep quality WHILST I'm sleeping. Any thoughts on that Dr K?
Following thread with interest. Would give anything for a decent night's sleep and to lose the bags under my eyes.
After night shift I literally fall asleep in seconds. I usually wake after 4-5 hrs, any suggestions to help me sleep a bit longer? Or is that just the way it is?
Usually once I've had my initial sleep I'll get up, have a bite to eat and try and get another 2 or 3 hours.
Related, is a ‘full’ night’s sleep important, or is 4+4 with (say) 1-2 hrs awake in the middle fine too? Is 8hrs (or any other number I guess) sleep a night necessary/good? I usually target 8, but realistically it’s more like 6-7 as I can’t get to sleep early enough usually.
Great question.
There's two answers to this. The first is how effective sleep is for our bodies, and for that it doesn't matter whether it's broken or in one go. However people's perception, is important, and indeed, many people perceive themselves to sleep less than they actually do. Coupled with this, as mentioned in a previous answer about normal sleep cycles, it's absolutely to have brief waking periods in the night, although most people do not remember them.
If people perceive that they've had a good night's sleep, then they function as if they had. If they perceive that they haven't then that can effect them too, although it's more likely to be a mood related thing than a pure neurological phenomenon.
One last point, there is variety in how much sleep we need. It can vary between 4-5 and 11-12 hours a night, although the vast majority of people are between 7-8 hours. It also varies as we age, generally decreasing.
The way to find out how much time we need to sleep for is to get up at the same time every day, and then gradually move our threshold time (not bedtime!) backwards and forwards so that we go to bed, and ideally wake up just before our getting up time without an alarm.
The reason I highlight threshold time, is that's the time that we go to bed after when we feel tired. Trying to force ourself to go to bed when we don't feel tired is training ourselves not to be able to sleep in bed as mentioned in a previous answer.
Am I correct in my perception that the medication puts me into an immediate deep sleep for 2 – 4 hrs, (as in shut my eyes and I’m off) followed by waking and fitful dream sleep for a further 3 – 4hrs?
Only occasionally do I sleep through, and would like to sleep better – should I change the timing of the medication so that i’m not taking my second dose at bedtime – would that help?
I was on the same type of Tegretol at around that dose for a prolonged period. I noticed that intially it made me woozy and sleepy post-medication, but that wore off pretty quickly and it had no effects on sleep after that (I didn't take it at bedtime). So it may well be the timing of the doses that is key.
Dr Kramer may have some views on that, but speaking to your own GP is a good idea.
I wake up, a lot. I've been bad at sleeping since my early 20s, and am from a long line of bad sleepers. I have conquered the problem of not being able to get back to sleep by putting on podcasts - if it's interesting I'll almost almost always be back asleep within 10min. If I'm not, I don't mind because I'm listening to something interesting, and usually will be back asleep within the hour. But, I'll wake up probably 12.30, 1.30, 4.30, and 6.00 before eventually getting up at 7am (usually reluctantly, I could sleep until 8.30 comfortably). I am very rarely aware of having had any dreams at all. On the rare occasions I do sleep through the night, I feel much more refreshed in the morning.
Should I just accept that this is what my body does, or should I be trying to fight it/retrain myself?
My old A-level English teacher once claimed that despite the fact dreams can seem like they last ages, they actually in reality never last longer than about 7 seconds...do you reckon that's true or was he talking utter bull**it?
Any better ideas other than nasty drugs please. I don’t drink caffeine after 1pm and little anyway.
It's worth getting your ferritin levels checked as per my previous answer and having some iron supplements if it's below 80 (I think!).
One other thing to look at is that you may be going to bed a bit too early when you're not quite tired enough. It may be worth moving your threshold time (see previous answer for explanation) back a little so that you're falling asleep more quickly and so not having time for restless legs to kick in?
I wonder if you're going to regret offering this AMA but here's another one...if I smash out a load of V02 max intervals on the turbo trainer and then can't sleep all night afterwards, how annoyed should I be?
Like have I just cancelled out all my hard-worked for fitness gains from that session or is it merely the case that I will have benefitted slightly less than if I'd slept really well?
Interesting @martinhutch , sort of concurs, but I don't notice getting woozy after the dose I take in the morning.
Yeah, I asked the GP at some point when I was discussing reducing the dose a few years ago, but they weren't aware of any similar links with sleep quality.
Before I got a cpap machine, sometime when I stopped breathing due to sleep apnoea I could sense I was not breathing but not wake myself up (I think term is sleep paralysis, where you are aware but not awake) it seemed to go on for ages and was absolutely terrifying.
I know exactly what you mean about it being terrifying! You dread having to go to bed and are also hyper aware of any breathing issues.
I have had a full at home sleep test machine, but typically by the time I got the machine the issue had passed. I think its related to my thyroid treatment as my GP did say an under active thyroid can cause it?
@Kramer thanks for the replies I realise its a whole other specialism with regard to central sleep apnoea. Your info about restless leg is interesting as my girlfriend suffers with that and is suffering with low serum ferritin IIRC
how much sleep do we really need a night and are the (scare) stories that people that sleep less / have affected sleep are more prone to health issues. Is that lack of sleep or more due to (leads on to Q2)
Great question. Please see my previous answer about how much sleep we need and our perceptions of sleep. But I'll go into more details about the health issues here.
There are loads of studies that show significant impairment in function in sleep deprived people. However, sleep deprived people are not the same as people who have insomnia, or just tend to naturally sleep less. In fact there's very little evidence that insomnia causes much harm at all, as people tend to become accommodated to it and function very well.
The lesson from this is not to intentionally sleep deprive ourselves by burning the candle at both ends. If we naturally need 7-8 hours sleep, trying to pretend that we can survive on 5 is not good for our health.
However if our natural undisturbed sleep pattern is to have 5 hours of broken sleep and then wake, then that's not nearly so harmful.
I can’t switch my brain off at night. I’m regularly absolutely bushed – fall asleep in the chair in the evening and rarely have problem getting off to sleep in bed. But then often wake with a thought in my head that won’t go away (so back to Q1) – is it actually lack of sleep that is a health hazard or the negative indicators of stress, etc., that manifest as bad sleep that create those outcomes.
As mentioned before, it's entirely normal to have brief waking periods in the night, usually 4 or 5, when we wake up, may talk nonsense about a dream that we've had and then go back to sleep. Although we're conscious at the time, we don't wake to the point of making memories so in the morning we don't remember it. This is the scenario when, in the morning our bed partner asks us who "Jill" is, and why we were asking her not to boil the onions...
However, if our general levels of stress (specifically cortisol) are high, when we have these brief waking periods, we're much likely to rouse to the point of making memories, and that's when we can start ruminating on the thoughts that we had before we went to bed.
One way to deal with this is if you're having thoughts about something before you go to bed is to make a list briefly outlining the worry, and what action you're going to take about it. Keep it by the bed, and if you wake with something new to add to it, write it down. Then you can be reassured that you'll remember it in the morning and that can stop the rumination.
Nowadays I wake up a lot at 3-4am I am still tired and still need to sleep but often really struggle to get back to sleep. Usually I lie in bed awake for 2-3 hours and feel I am not getting enough sleep. I would love to hear some tips or solutions for this problem.
I refer you to a previous answer about training yourself to be awake in bed.
Try going to bed a little later, and look at the previous answer about 20 minutes perceived time lying awake in bed, and then getting up and doing something until you feel tired again.
This is covered in more detail in CBTi.
but I don’t notice getting woozy after the dose I take in the morning.
That stopped after a few weeks for me. But absence of feeling sleepy during the day doesn't mean it's not responsible for disrupting your sleep quality though.
Good control of your TLE is the prime concern - have a chat with a GP who knows your history.
I don’t have any answers to any of this but it feels nice to know I’m not the only one who is a bad sleeper. <br /><br />
Currently having problems with a deep humming tinnitus which is hard to ignore. Pink noise on a loop seems to help. (Means sleeping in a different room from my wife)<br /><br />
I also can’t breathe through my nose when I lay down so I have been referred to an ENT specialist.
Last time I slept all the way through the night was the night my son was born and he and my wife were still in hospital- 21 years ago