When insomnia becomes persistent and negatively impacts your health

Sleep is a fundamental aspect of human existence, crucial to physical and mental well-being. However, when sleep becomes disrupted, it will have profound, adverse effects on our overall health and quality of life. To better understand the prevalence and consequences of sleep disorders, we spoke with Dr Jirayos Chintanadilok, a sleep medicine specialist with decades of experience treating various sleep issues.

Sleep disorders affect people of all ages.

Sleeping issues can affect individuals of any gender and age. Children, for instance, may wake up in the middle of the night and experience parasomnia or confusional arousal. Another demographic prone to sleep disorders is students. Often, they adopt late-night bedtime habits and early wake-up schedules, contributing to sleep deprivation.

“Seniors are at a higher risk of experiencing insomnia, characterized by challenges in falling asleep or experiencing disrupted and restless sleep, resulting in daytime sleepiness and a lack of feeling refreshed. Furthermore, the prevalence of associated health conditions that come with aging increases the likelihood of developing sleep apnea. This condition, affecting as many as 1 in 5 seniors today, not only impacts their health but also has implications for their families.”

“Compared to Thailand's GDP, the expenses associated with managing sleep apnea are considerable.”

Individuals with sleep apnea and those who snore during sleep face an elevated risk of developing sleep apnea. This risk increases with age and weight, with individuals who have a narrow lower jaw also being more susceptible. If left untreated, sleep apnea can contribute to various health conditions, including hypertension, stroke, coronary artery disease, and depression. Additionally, untreated sleep apnea can lead to decreased work efficiency. Early diagnosis and intervention are crucial to mitigate these potential health impacts.

The dangers of sleep deprivation are often underestimated.

Achieving good sleep involves 6-8 hours of uninterrupted rest without awakening or experiencing muscle jerking during the night. Disrupted sleep is often linked to specific factors such as nocturia in seniors, heart disease in some individuals, and sleep apnea.

In cases of sleep apnea, where breathing interruptions occur, the heart is compelled to work harder, signaling the kidneys to excrete more urine, which can contribute to nocturia. Addressing sleep apnea through treatment is crucial to alleviate issues like nocturia.

Insomnia, when it strikes, can have a spectrum of health impacts, ranging from mild to severe. Individuals with sleep apnea, especially if coupled with underlying heart disease, face potential risks such as sudden death. The interruption of breathing in sleep apnea leads to a drop in oxygen levels, triggering cardiac arrhythmia and sudden arrhythmic death syndrome (SADS).

Sleep deprivation or poor-quality sleep also carries significant health risks. These include inadequate cellular repair, a weakened heart, and an increased susceptibility to conditions such as hypertension, diabetes, atherosclerosis (hardening of arteries in the heart and brain), brain fog, and fatigue. 

Signs indicating you do not get enough sleep.

• Fatigue
• Dozing off during the day
• Mood changes

Experiencing one or all these symptoms may indicate sleep deprivation, which can have long-term effects on your health.

“Sleep deprivation significantly heightens the likelihood of making mistakes, particularly in individuals working shifts, those with roles involving responsibility for others' lives, or jobs demanding intense focus and concentration. The potential negative impacts of sleep deprivation can range from minor to catastrophic.”

While a healthy individual can usually compensate for insufficient sleep by catching up the following day, disruptions may occur if the body is not in a normal state or influenced by substances that alter the sleep mechanism. For instance, elements in coffee can hinder the functions of certain brain chemicals, making it challenging to initiate sleep. The effects of one cup of coffee can last from 30 minutes to 6 hours but typically not more than 10 hours. Understanding these dynamics is crucial for managing sleep patterns and ensuring overall well-being.

Coffee and sleeping pills come with their downsides.

“Many people have the misconception that coffee helps them stay alert and perform their tasks as well as people who do not have sleep deprivation or feeling drowsy. Although coffee does help us stay awake, it does not help us perform our work as efficiently as others. In addition, coffee has its disadvantages. Its long-lasting effects lead to going to bed late and frequent awakenings.”

Apart from coffee, there are details that you should learn and consider before using ‘melatonin’ to promote sleep due to its many indications. Some studies found that seniors had more side effects from melatonin than younger users. Although melatonin can hasten the sleep phase, it does not increase sleep efficiency or duration. Plus, melatonin can cause hangovers when you wake up.

As for sleeping pills, the types of medications used worldwide include diazepam or valium and alprazolam. These medications stimulate “GABA” neurotransmitter secretion, which has sleep-enhancing effects. The advantage of sleeping pills is the rapid onset of action. However, they can affect sleep quality and cause dizziness after waking up.

Another common sleeping pill is zolpidem. The recommended dose of zolpidem should not exceed 5 mg; a higher dose leads to higher adverse effects. One of the side effects of zolpidem is a condition where an individual wakes up to eat in their sleep, known as sleep eating.

“The last one is food supplements; there is not enough research to support their benefits. In addition, certain herbs may not contain enough substances to impart their beneficial impacts. Patients should know about the placebo effect, which can improve their symptoms with or without the active ingredients.”

It is essential not to ignore chronic sleep issues.

“Good sleep is not merely a matter of duration but also its quality.”

Dr Jirayos noted that individuals with sleep disorders span all age groups, from children to older adults. However, the most prevalent demographic affected is the middle age group. Frequently, individuals in this age bracket seek the expertise of specialists, inquiring about potential conditions such as sleep apnea or narcolepsy. The impact of these sleep disorders significantly disrupts their daily lives. Moreover, individuals grappling with demanding jobs or substantial family issues often experience heightened anxiety, contributing to the development of sleeping disorders.

“A study suggests that women are increasingly more prone to insomnia as they age compared to men. Hence, gender appears to be a contributing factor in sleep-related issues.”

If left untreated, sleeping problems can lead to long-term adverse health effects. Beyond impacting one's own health, these issues can have detrimental effects on the lives of others, particularly those in roles responsible for the well-being of others. Reduced work performance and an increased likelihood of making mistakes can stem from sleeping problems, potentially causing harm in various contexts.

Unraveling Sleep Disorders: The Role of Sleep Studies in Diagnosis and Treatment

The Sleep Medicine Center at MedPark Hospital offers a comprehensive sleep study service conducted by experienced sleep medicine specialists. Our specialists utilize advanced diagnostic technology and equipment to monitor key physiological indicators such as the electrical activities of the brain and heart, breathing patterns, blood oxygen levels, and muscle movements.

Analysis of the sleep study data is instrumental in accurately diagnosing various sleep problems or disorders. To undergo a sleep study, individuals can schedule a consultation with a sleep medicine specialist who will supervise the testing process. The study involves spending a night in a well-equipped sleep lab to ensure a thorough and precise evaluation of sleep patterns and potential issues.

“If you are wondering whether patients can fall asleep during a sleep study and if the medical team can capture all necessary data, it is common for patients to naturally fall asleep during the test, in sync with their circadian rhythm. However, some patients may become aware or awake during the study, possibly due to the presence of wires or cables attached to the monitoring machines. If a patient finds it challenging to initiate sleep, a doctor may consider prescribing short-acting sleeping pills.”

In addition to nocturnal sleep tests, the Sleep Medicine Center at MedPark Hospital also offers a daytime assessment known as the Multiple Sleep Latency Test (MSLT). This test is designed to evaluate a patient's ability to resist falling asleep, particularly in cases of suspected narcolepsy.

Similarly, the Maintenance of Wakefulness Test (MWT) is conducted during the day to assess individuals, such as airline pilots, for their capacity to stay awake. This daytime test is valuable in determining if an individual has the requisite alertness for their profession or if they are susceptible to fatigue. Given the increased risk of sleep disorders in certain professions, the MWT is particularly relevant for individuals like pilots, airline staff, air traffic controllers, truck drivers, public transportation operators, and shift workers.

“During a sleep study, the doctor will typically gather comprehensive information by inquiring about the patient's medical history. Patients may be asked to complete a questionnaire that delves into their sleep patterns, including bedtime and wake-up times, and any specific sleep-related challenges they may be experiencing. The doctor may also explore details regarding the patient's activities and diet on both restful and troubled sleep days. This supplementary information is usually sufficient to aid in the diagnostic process, providing the doctor with valuable insights into the individual's overall sleep health and potential contributing factors to any sleep-related issues.”

Positive outcomes give rise to an improved quality of life. 

“Sleep disorders impact not only physical but also mental health. Individuals dealing with mental health issues, anxiety, or depression should receive psychological intervention. Our sleep center recognizes the importance of this holistic approach and may involve a psychiatrist or psychotherapist in the treatment process.”

For patients with sleep apnea, the center provides Continuous Positive Airway Pressure (CPAP) and Automatic Positive Airway Pressure (APAP) machines. These devices help maintain an open airway during sleep studies.

Additionally, collaboration is key in addressing diverse sleep issues. The Center work closely with the Dental Center if oral anatomical structures contribute to sleep problems. In such cases, a doctor may recommend an oral appliance to reposition the mandible, widening the airway and enhancing airflow. For patients with sinusitis, Ear, Nose, and Throat (ENT) specialists may also engage in the treatment process.

“Patients typically experience improvement within 1-2 months after undergoing procedures at our Sleep Medicine Center, especially when they adhere to instructions and receive accurate treatment for coexisting health conditions.”
 
“Recognizing that sleep problems are unique to each individual and arise from various factors, our approach involves collaboration among specialists from different fields. This collective effort aims to restore an excellent quality of life by helping patients regain quality sleep.”

Dr Jirayos advises individuals who consistently get 6-8 hours of sleep per night but still encounter unusual sleep-related symptoms, such as morning fatigue, afternoon drowsiness, or mood changes, to consult a sleep medicine specialist. Such symptoms may indicate an underlying sleep disorder. Patients with sleep disorders often lack awareness of their condition, and by the time of the diagnosis, their health may have already been compromised.