THE MYSTERY. Restful sleep is something that everyone needs and seeks. It is essential to health and and helps us lead happy and productive lives. A good night’s sleep is as important as the air we breathe and the water we drink.
If you are reading this book in bed, I hope you’ll be able to close it at the end of this chapter and feel reassured that the solution to your sleep disorder will soon be within your grasp.
Sleep disorders and lack of sleep seriously affect many people’s lives. When someone cannot sleep properly at night, he or she feels sleepy throughout the day, has no energy to get important tasks done, and is at risk for a number of health problems. Sleep problems can affect us all, but they do not affect us all in the same way. Women, men, and children have different sleep issues.
Females differ from males in many aspects of life, and sleep is no exception. Women’s sleep can be negatively affected by hormones, pregnancy, menopause, and juggling outside work with the job of being primary caregiver at home (men who are the primary caregivers face the same challenges). For women of childbearing age, each month brings hormonal changes that can cause sleep disturbances. A common problem in hormone secretion, polycystic ovarian syndrome, can lead to a dangerous problem, sleep apnea. And when a woman becomes pregnant, a dramatic change occurs in her physiology and anatomy to prepare for the miracle of birth. The mother pays a price for this miracle. About 80 percent of pregnant women have disturbed sleep, and some develop sleep apnea and movement disorders. Making sure that the mother-to-be does not become deficient in folic acid and iron might improve her sleep and protect the developing baby from a permanent neurological condition.
Another big change in hormone levels occurs during menopause, which affects a woman in many ways. The reduction in the normal levels in female hormones increases a woman’s risk of developing sleep-breathing problems and heart disease. It also causes severe menopausal symptoms, such as hot flashes, which can seriously disrupt sleep. More than half of menopausal and postmenopausal women have insomnia. Though there are treatments, the best way to treat sleep problems during menopause remains unclear. If you are a woman with one or more of the sleep problems described in this book, you should be able to find here the information you need to seek medical help specifically directed to your needs.
For men, sleep problems can come from stresses related to work and their lifestyle. Because they tend to snore more than women, they are considered at special risk for sleep apnea. (It can also make life miserable for their bed partner, putting a strain on the relationship.) As they age they can develop sleep problems related to heart disease and stroke.
Children are not merely small adults. They need more sleep than adults. They can also get sleep apnea related to enlarged tonsils, a small jaw, or obesity. As they age they are prone to develop problems with their body clocks, and the mid-teenage years is the period when narcolepsy usually manifests. Sleep problems in children can lead to academic failure, which can affect or even ruin their entire life.
One of the most potentially dangerous—and common—sleep disorders is sleep apnea. We now know that sleep apnea affects about 4 percent of all adults. What is less well known is that in many cases a cure can be simple, as was illustrated by the case of the farmer’s fourteen-year-old daughter whose life was almost ruined by her big tonsils. Women’s sleep apnea symptoms sometimes differ from those of men; consequently, women suffering from sleep apnea are often misdiagnosed and treated for depression. As we saw, sleep apnea is considered by many doctors, as well as the general population, to be a disorder of overweight men; however, many women and children have sleep apnea, and they might not be obese. The information in this book can help you recognize when you or a family member should seek professional help and suggest treatments that have been proven to work.
Sleep apnea is often suspected because the patient snores. As we have seen, snoring can not only alert patients to a potential danger to themselves; it can cause serious secondhand sleep problems for bed partners. The strategies I have suggested for dealing with snoring can help both bed partners have healthier and more restful sleep.
The amount of sleep your body needs is as individual as your hair color. Different amounts of sleep are normal for different people. Additionally, the “clock” in the brain that controls sleepiness and alertness can run on a different time from the clocks of those around you. When your clock is different from that of the general population, you may either have trouble staying asleep all night or be unable to fall asleep. Travel across time zones can seriously confuse this clock. Information in this book can alert you to what can go wrong with your body clock and how you can reset it.
The most common sleep problem for both men and women is insomnia, though it is much more common among women than among men. We have seen that insomnia is not just a disease; it is a symptom of something else that has gone wrong in the body—a medical, psychological, or psychiatric condition, or a reaction to stress. Medical diseases ranging from heart failure to diabetes, acid reflux, ulcer disease, arthritis, and many other painful conditions, including cancer, can lead to severe insomnia. We have seen how these conditions can cause insomnia and what means are available to help with insomnia. If you have persistent insomnia, you need to consult your doctor so that he or she can recommend a specific treatment for the medical or psychiatric condition causing it.
Restless legs syndrome and other movement disorders affect up to 15 percent of the adult population worldwide. In many cases, the underlying cause of RLS is iron deficiency. Women are much more likely to become iron deficient in their lifetime than men because of their menstrual cycles, and RLS frequently starts during pregnancy. Information in this book can help you recognize this condition in yourself and family members. Fortunately, we now know that certain simple treatments can often cure this miserable disorder.
I have written repeatedly in this book about the great power the brain and nervous system wield over the quality and quantity of our sleep. Nearly all psychiatric disorders have disturbed sleep as a characteristic feature. The most common of these disorders is depression, which affects about 5 to 10 percent of adults worldwide. Women are more likely than men to be treated for depression, are therefore more likely to have sleep problems related to depression, and are more likely to be on antidepressant medications, many of which can cause disturbed sleep. Along with antidepressants, the effect of drugs on sleep can be either good or bad. Many sleep remedies, such as prescription drugs, over-the-counter medications, and products obtained in health food stores, have potentially negative effects on sleep. Many medications, both prescribed and not prescribed, can worsen an already existing sleep problem and can even cause sleep problems. Because North American women statistically take almost twice as many drugs as men, they are more likely to suffer from these unwanted effects.
Other brain-controlled sleep problems can disturb a person’s sleep and result in a fear of going to sleep. This can occur in combat veterans and others suffering from posttraumatic stress disorder. These sleep problems include sleepwalking, sleep talking, sleep paralysis, hallucinations, and even violent physical behavior. In one disorder, the sleeper reacts to dream content and might injure the bed partner. Though this disorder is much more common among males, it is the bed partner—often a woman—who can suffer the physical consequences. This problem too can usually be treated quite easily. The information in this book should help you distinguish between sleep behaviors that are risky (to yourself or others) and those that are relatively harmless.
Even serious conditions like narcolepsy can often be treated, allowing the sufferers to live normal lives. The hardest thing for many narcolepsy patients is to receive a correct diagnosis. The symptoms described in this book should help you recognize this devastating disorder in yourself or a family member and get the help you need.
From the extreme of narcolepsy to something as simple as drinking too much coffee, I’ve tried to catalogue the many problems that can disrupt your sleep. If after reading this book you realize you have a sleep problem, the good news is that there is help available. There are clinics with doctors devoted to people with sleep problems all over the world.
Armed with the knowledge gleaned from this book and a precise description of your symptoms, you will be able to help your doctor help you.
There are still many mysteries about sleep, but we now understand a lot of them. I wrote this book to give you the information and the tools you need to awaken every morning feeling rested, wide awake, and ready to tackle the world.
I wish you sweet dreams.