Alzheimer’s Disease: Are You, Poor Sleeper, at Risk?

I talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Proteins linked to Alzheimer's a function of insufficient deep sleepI talk quite a bit about dementia and Alzheimer’s disease with family and friends. Our parents are drifting into cognitive impairment, asking the same questions again and again and struggling to find words to express themselves, and we wonder if we’re destined for the same fate.

The concern may be justified in middle-aged adults with chronically poor sleep, according to new research on sleep and two proteins involved in Alzheimer’s disease. Here’s more about the study and its relevance to people with insomnia and other sleep disorders.

Poor Sleep and Cognitive Impairment

Previous research has shown that poor sleep increases the risk of cognitive impairment. And mild cognitive impairment—trouble thinking and memory loss—is one of the first signs of Alzheimer’s disease. The cognitive declines and memory problems gradually worsen as deposits of two proteins—amyloid beta and tau—grow thicker and thicker, causing brain tissue to atrophy and die. To date the disease is irreversible.

But “poor sleep” can take different shapes and forms:

  • Sleep apnea, or pauses in breathing that occur repeatedly throughout the night, leaving sleepers feeling unrested in the morning.
  • Restless legs syndrome, in which sleep is disrupted by involuntary leg movements in the first half of the night.
  • Insomnia, consisting of trouble falling asleep, staying asleep, or waking up early in the morning, and related daytime complaints

Which feature of some or all of these sleep disorders might hasten development of amyloid plaques in the brain? The researchers suspected the problem had to do with deep, or slow wave, sleep, which is associated with feeling rested and restored in the morning. So they set out to see if disrupted slow wave sleep would bring about increased levels of amyloid beta in the brain.

Who They Studied, What They Did

Seventeen healthy adults ages 35 to 65 participated in the study, none with sleep problems or cognitive impairment. Each participant wore a wrist watch-type device to monitor their sleep. After several nights of wearing the device, participants spent a night in a sleep lab. There, they underwent a sleep study that involved wearing headphones.

Half of the participants were allowed to sleep without interruption. The other half experienced sleep disruption. Every time they entered deep sleep, they were subjected to beeps that grew louder and louder until their slow waves disappeared and were replaced by brain waves characteristic of lighter sleep.

The participants subjected to the beeps reported feeling tired and unrefreshed in the morning although they slept as long as usual. Most did not recall awakening during the night. All participants underwent a spinal tap so researchers could test for levels of amyloid beta and tau in the spinal fluid.

The procedure was repeated a month later, when the participants originally allowed to sleep uninterruptedly were subjected to the beeps and the others were allowed to sleep without interruption. Another spinal tap was conducted in the morning to measure protein levels.

Disrupted Deep Sleep and Harmful Proteins in the Brain

The results supported researchers’ contention about the effects of disrupted slow wave sleep:

  1. Participants’ amyloid beta levels were up by 10 percent after a single night of disrupted slow wave sleep
  2. In addition, levels of tau were significantly higher in participants whose wrist monitors showed they’d slept poorly during the week before the spinal tap

So disrupted slow wave sleep increased amyloid beta levels after just one night and tau levels after several days of poor sleep. Evidently, one function of slow wave sleep is to help rid the brain of byproducts that collect there during the day. When deep sleep is compromised, amyloid beta and tau start to accumulate. Development of cognitive impairment and Alzheimer’s is then more likely to occur.

Alzheimer’s and Poor Sleep in Perspective

So does the overall risk of developing Alzheimer’s increase with every poor night’s sleep? Probably not. Lead author Yo-El S. Ju, cited in a Washington University press release, said it’s unlikely that a single night or even a week of poor sleep has much effect on overall risk of developing Alzheimer’s disease. Amyloid beta and tau levels probably go back down the next time the person has a good night’s sleep, she said.

It’s people with chronic, untreated sleep disorders who should be concerned. Here, too, a dose of perspective is in order. Slow wave sleep occurs during the first half of the night. People who suspect they have sleep apnea, which occurs throughout the night, or restless legs syndrome, which occurs during the first half of the night, would be wise to see a sleep specialist for diagnosis and treatment.

People with chronic insomnia may have cause for concern as well—and maybe not so much. These investigators did not find that excess amyloid beta and tau had anything to do with sleep duration or sleep efficiency. Further, it’s never been shown that the main problem for people with insomnia is insufficient slow wave sleep. Some insomniacs experience a reduced percentage of slow wave sleep. Yet in others, slow wave sleep is intact.

The underlying problem in insomnia may instead involve restless REM sleep, which typically occurs in the second half of the night. It may have nothing to do with the development of amyloid plaques in the brain.

In any event, chronic insomnia can be treated (although the causes remain largely unknown). Click on “insomnia treatment” in the tag cloud to the right for more information.

Insomnia or Sleep Apnea, or Both?

Let’s say that after years of experiencing insomnia you go in for a sleep study only to find out you have obstructive sleep apnea. Who knew? You’re outfitted with a breathing mask, you wear it as prescribed, and your sleep improves . . . somewhat.

But your insomnia symptoms are persistent, and you don’t have the kind of stamina you’d like during the day. What then?

Insomnia may persist even after successful sleep apnea treatmentLet’s say that after years of experiencing insomnia you go in for a sleep study only to find out you have obstructive sleep apnea. Who knew? You’re outfitted with a breathing mask, you wear it as prescribed, and your sleep improves . . . somewhat.

But your insomnia symptoms are persistent, and you don’t have the kind of stamina you’d like during the day. What then?

Insomnia and Sleep Apnea

Insomnia and obstructive sleep apnea (complete or partial reduction of breathing during sleep) are the two most common sleep disorders. Many people have one or the other, and some people have both. According to a new paper published in Sleep Medicine Reviews, 39% to 58% of people diagnosed with sleep apnea also report symptoms of insomnia.

The name for this problem is comorbid insomnia and sleep apnea, or COMISA. Having one of these disorders is bad enough: apnea often results in broken sleep and daytime sleepiness. Insomnia, beyond its negative impact on sleep, can sap your energy and dampen your mood. But the effects of COMISA on sleep quality and daytime functioning are worse.

Two acquaintances of mine—Matt and James—were initially diagnosed with sleep apnea. Their experiences were similar to the one described above: a sleep study, an unexpected diagnosis of sleep apnea, and nightly use of a CPAP machine (the machine with the pressurized breathing mask). But despite receiving treatment for sleep apnea, their trouble falling asleep and lack of daytime stamina persisted. Neither one was satisfied that his sleep problem had been fully addressed.

A Complicated Affair

The relationship between sleep apnea and insomnia is not simple, according to a summary of research presented at the 23rd Congress of the European Sleep Research Society last fall. Some studies suggest that insomnia should be thought of as secondary to sleep apnea. Frequent awakenings in the middle of the night (also called middle insomnia) are often prompted by interruptions in breathing. In such cases treatment for the apnea—with an appropriate CPAP device—can correct both the breathing problem and the nighttime awakenings, resulting in continuous breathing and consolidated sleep. Voilà, the two problems are solved.

In other instances, co-occurring insomnia and sleep apnea appear to be distinct disorders requiring separate interventions to turn the situation around.

A Study Involving Insomnia Subtypes

Erla Bjornsdottir and colleagues conducted a 2-year prospective study in which they followed over 700 sleep apnea patients undergoing CPAP treatment to assess how their insomnia symptoms changed over time. Changes in participants’ insomnia symptoms varied according to the subtype of insomnia they had:

  • In participants with middle insomnia, CPAP treatment significantly decreased their middle-of-the-night awakenings. This is further evidence that in people with COMISA, symptoms of middle insomnia are probably a consequence of sleep disordered breathing. Treatment with CPAP alone may alleviate both problems.
  • In participants with initial insomnia (trouble getting to sleep at the beginning of the night), CPAP treatment did nothing to relieve their insomnia symptoms. This suggests that disordered breathing is not the cause of the initial insomnia, and that people who have it should also be treated for insomnia (with cognitive behavioral therapy for insomnia—CBT-I—for instance).
  • In participants with late insomnia (early morning awakenings), CPAP treatment did not lessen their early awakenings. This suggests that late insomnia in people with COMISA is not due to disordered breathing and should be addressed separately.

Now back to Matt and James: Matt, while using his CPAP machine, went through CBT-I hoping to overcome his residual insomnia. Overall he was satisfied with the result. Read more about his story in chapter 8 of The Savvy Insomniac: A Personal Journey through Science to Better Sleep.

As for James, the last I knew of him, he was sliding a bit in his use of the CPAP. But he was talking about returning to a sleep specialist to get more help. I hope he made that appointment.

If you have a CPAP machine, how has your sleep and quality of life changed since you started using it?

It Might Not Be Insomnia After All

People come here looking for solutions to sleep problems. Some read about sleep restriction, a drug-free insomnia treatment, and decide to try it on their own. It’s not rocket science: insomnia sufferers who follow the guidelines often improve their sleep. It’s empowering to succeed.

But self-treatment is not the right approach for everyone. Sometimes insomnia is complicated by another disorder, or what looks like insomnia is actually something else. In both cases, the best thing to do is to have yourself evaluated by a sleep specialist ASAP.

Self-help treatments for insomnia will not work for other sleep disordersI’m a take-charge person when it comes to managing chronic health problems, especially when solutions proposed by doctors are unsatisfactory. I hunt for solutions myself, reading a lot and sometimes coming up with a fix.

People come to my blog looking for solutions to their sleep problems. Some read about sleep restriction, a drug-free insomnia treatment, and decide to try it on their own. It’s not rocket science: insomnia sufferers who follow the guidelines often improve their sleep. It’s empowering to succeed.

But self-treatment is not the right approach for everyone. Sometimes insomnia is complicated by another disorder, or what looks like insomnia is actually something else. In both cases, the best thing to do is to have yourself evaluated by a sleep specialist ASAP.

Up Late at Night

Chris wrote in with questions about sleep restriction several months ago:

I recently started sleep restriction therapy about 3 days ago, and I’m not too tired during the day even though I barely slept the last two nights. Is this normal? I set my bed time at 3:30 a.m. and force myself to get up at 9:30 a.m. even if I haven’t slept too well. Should I restrict my time even more if I’m not too tired? Additionally, I find that I have anxiety when I am in bed sometimes. Do you think I should get out of bed if I am anxious?

Chris knows he experiences insomnia, but the symptoms he reports aren’t the classic symptoms of people with insomnia disorder.

  • He’s “not too tired during the day” even though he “barely slept the last two nights”; many insomniacs during the first week of sleep restriction report feeling tired and out of sorts.
  • He’s set his sleep window at 3:30 to 9:30; a more normal sleep window would be from 12 to 6. Maybe Chris works the evening shift and can’t get to bed until 3:30. But if this is his sleep window of choice, then maybe he has a circadian rhythm disorder—in which case sleep restriction would not be an appropriate treatment.
  • He’s anxious when he’s awake in bed; many insomniacs are, too. But Chris’s anxiety could also be an indication of something else.

Chris’s situation sounds complicated and as though in starting sleep restriction he may be on the wrong track. My response to Chris and others like him is to suggest seeing a sleep specialist for an accurate diagnosis and guidance in managing the problem.

Sleepy in the Afternoon

Shelley contacted me via Ask The Savvy Insomniac. “Could sleep restriction help me?” was the subject line of her email.

I’ve had insomnia for 5 years now. Getting to sleep is no problem. But I wake up several times at night. It’s a drag. The alarm rings in the morning and it never feels like the night was long enough. I manage OK in the morning but after lunch I’m like the walking dead. Coffee doesn’t help. I fall asleep during meetings all the time and people notice. It’s embarrassing.

Nighttime wake-ups are a common symptom of chronic insomnia. But Shelley’s inability to stay awake during afternoon meetings gives pause.

It might seem logical that a person with insomnia would feel sleepy during the daytime, and some insomniacs report that they do. Other words that describe the feeling are tired, fatigued, and exhausted.

But the actual inclination to nod off involuntarily during the daytime is not as common in people with insomnia as it is in people with other sleep problems: sleep apnea, for example, and narcolepsy. It might sound counterintuitive, but a majority of insomniacs given opportunities to sleep during the day are no more likely to do so, say sleep experts, than people who sleep well at night. In fact, some studies show it takes insomniacs longer than normal sleepers to fall asleep during the daytime.

If Shelley has sleep apnea or narcolepsy, sleep restriction will do more harm than good. She needs to consult a sleep specialist and get a diagnosis before starting any type of treatment.

The Take-Away

What looks like insomnia may not actually be insomnia disorder. Before you plunge into sleep restriction or any other insomnia treatment, see a doctor for a diagnosis or do lots of reading to make sure that what you’ve got is insomnia and not something else.

Snoring Keeps You Awake? Oral Appliance Offers Relief

Insomnia is a pain to have to deal with, but it’s worse when someone is snoring. Just as you’re sliding into dreamland, your husband lets loose with a snort that queers the deal. Or your wife starts up with her throaty rattling again. Or—more maddening still—the snore that jolts you awake comes out of your own mouth.

All it may take to stop snoring is a dental device worn at night. Insomniacs with snoring partners and people with mild to moderate sleep apnea: listen up.

Insomnia suffers do not need to put up with snoring any longerInsomnia is a pain to have to deal with, but it’s worse when someone is snoring. Just as you’re sliding into dreamland, your husband lets loose with a snort that queers the deal. Or your wife starts up with her throaty rattling again. Or—more maddening still—the snore that jolts you awake comes out of your own mouth.

All it may take to stop snoring is a dental device worn at night. This month, the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine (AADSM) updated their clinical practice guidelines for the use of oral appliances to relieve snoring.

Insomniacs with snoring partners and people with mild to moderate sleep apnea: listen up.

How the Devices Work

Oral appliance to relieve snoring
Oral appliance to relieve snoring

Snoring occurs when the area at the back of the mouth and nose collapses during sleep. The tongue and upper throat then come to rest against the soft palate and the uvula, striking each other repeatedly during breathing. This restricts the flow of air and causes the sound of snoring.

Oral appliances stop snoring by preventing the collapse of the tongue and soft tissues at the back of the throat. In so doing, they

 

  • Keep the airway open during sleep and allow for adequate air intake
  • Reduce the frequency and intensity of snoring
  • Improve sleep quality and quality of life in both the snorer and the snorer’s partner.

You’ll know what it feels like to wear an oral appliance if you’ve ever worn a retainer or a mouth guard for sports. Made of plastic, it’s fitted by a dentist and molded to the shape of your mouth.

It may take a few weeks to adjust to sleeping with the device, according to the AADSM. But once you get used to it, it’s easy to wear. And unlike CPAP machines, oral appliances are small and portable.

Who Qualifies for Oral Appliance Therapy (OAT)

The new guidelines suggest that physicians should consider prescribing oral appliances for 2 types of patients:

  1. Adults who request treatment for primary snoring (without sleep apnea)
  2. Adults with mild to moderate sleep apnea who cannot tolerate CPAP therapy or prefer an alternative therapy.

The guidelines also recommend that custom, titratable oral appliances (rather than non-custom oral devices) be prescribed for adults with sleep apnea, and that follow-up treatment be provided to all patients to ensure that the devices are working as they should.

Covered by Insurance

All dentists may not know this, but OAT is virtually always covered by medical insurance, according to the National Sleep Foundation. Whether private or public, insurers use the same criteria for OAT as they use for continuous positive airway pressure (CPAP) therapy. Most insurance companies do not require a trial or failure of CPAP therapy before allowing coverage of OAT. But in order for the appliance and fitting to qualify for coverage, a dentist must receive a written prescription from a primary care physician or a sleep specialist.

So whether your partner’s snoring is fueling your insomnia or the culprit is you yourself, check into getting an oral appliance. This is a painless, non-invasive fix for a problem no one needs.

Snoring Partner? Get Help Now

Can this marriage be saved?

You: prone to insomnia and sensitive to noise. Cat fights and flushing toilets wake you up at night. Thunder jolts you awake to a pounding heart.

Your mate: considerate, generous, perfect in every way except one: snoring.

snoring mate | vocal exercises reduce snoringCan this marriage be saved?

You: prone to insomnia and sensitive to noise. Cat fights and flushing toilets wake you up at night. Thunder jolts you awake to a pounding heart.

Your mate: considerate, generous, perfect in every way except one: snoring.

No, it’s not sleep apnea. You lie awake with insomnia so you know exactly what your partner sounds like: it’s a steady breathing in and out without pauses or gasps for air. But every intake of breath is a throaty juddering so loud your silicone earplugs may as well be made of gauze.

Eventually the snoring drives you out of the bedroom and onto the living room couch, and you’re fed up. A more permanent solution has begun to feel inevitable: separate bedrooms or, if your bedroom big enough, separate beds (and who knows where that will lead?).

But wait. Oropharyngeal exercises may turn your snoring partner into the quiet sleeper of your dreams.

Oropharyngeal Exercises?!

“Oro” means mouth, and “pharyngeal” refers to the region of the pharynx, where the nasal passages join the mouth and throat. The exercises mainly involve manipulating the mouth and tongue. They’re definitely worth trying, results of a new clinical trial suggest. Wearing snore strips at night and doing oropharyngeal exercises for 3 months significantly reduced the frequency of snoring in study subjects by 36 percent and the total power of snoring by 59 percent.

The exercises are easy and can be done while driving to and from work. Here they are:

  1. With mouth open, place the tip of the tongue on the roof of the mouth and slide it backward. Repeat 20 times.
  2. Suck the tongue upward so that the entire tongue lies against the roof of the mouth. Repeat 20 times.
  3. Keeping the tongue in contact with the bottom front teeth, force the back of the tongue to lie against the floor of the mouth. Repeat 20 times.
  4. Elevate the back of the roof of the mouth while saying the vowel “A”. Repeat 20 times.
  5. Place a finger in the mouth and press outward on the wall of the cheek. Do this 10 times on each side.
  6. When eating, alternate chewing and swallowing from one side of the mouth to the other.

Would pictures make these instructions easier to follow? Visit ScienceDaily and click on the images to enlarge them.

If your partner is as considerate and generous as we assumed in the beginning, all it should take is a request and some instruction on your part to motivate them to get down to business. If your partner balks, float the idea of separate bedrooms or separate beds. See if the prospect of reduced intimacy brings them to their senses. If not (or if doing the exercises doesn’t help), well, maybe it’s time to invest in another bed.

No matter how good the marriage, a sleeping arrangement that interferes with one partner getting a good night’s rest is ultimately unsustainable. Face the music now.

Q & A: When Sleep Apnea Looks Like Insomnia

Keisha was wondering whether to have a sleep study.

“I asked my doctor to give me something for my insomnia,” she wrote, “but he wants me to have a sleep study first. He thinks I might have sleep apnea. I don’t think I do. I don’t snore (as far as I know). I wake up a lot at night but I’m not short of breath or gasping for air.

“Besides, how could I get any sleep at all with those wires attached to my head! You say sleep studies aren’t helpful for people with insomnia. So what’s your opinion here? Should I have a sleep study or will it just be a waste of my time?”

insomnia and daytime sleepiness may actually be sleep apneaKeisha, a 37-year-old graphic designer, wrote to Ask The Savvy Insomniac recently with a question about having a sleep study.

I asked my doctor to give me something for my insomnia, she wrote, but he wants me to have a sleep study first. He thinks I might have sleep apnea. I don’t think I do. I don’t snore (as far as I know). I wake up a lot at night but I’m not short of breath or gasping for air.

Besides, how could I get any sleep at all with those wires attached to my head! You say sleep studies aren’t helpful for people with insomnia. So what’s your opinion here? Should I have a sleep study or will it just be a waste of my time?

When Is a Sleep Study Useful?

Keisha is right: I’ve blogged about sleep studies before because I’m skeptical about their value for people with simple insomnia. As conducted and scored today, they do very little to help insomniacs other than rule sleep apnea and other sleep disorders out.

But if a doctor suspects you have sleep apnea, it’s important to verify that objectively. A sleep study is then in order, at a sleep clinic or with one of the newer devices for use at home.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a serious problem. During sleep, the tongue falls back against the throat, collapsing the upper airway. This keeps you from breathing, deprives you of oxygen, and increases your level of carbon dioxide until you wake up enough to start breathing again.

OSA compromises the sleep you get, leaving you sleepy and prone to mistakes and accidents. It also leads to serious health problems. Repeated episodes of apnea stress the heart, increasing your susceptibility to hypertension, heart attacks, and other cardiovascular diseases. It’s also associated with weight gain, type 2 diabetes, inflammation, asthma, and acid reflux.

In short, it’s nothing to fool around with.

Often Looks Like Insomnia

But here’s the problem: In most cases, people with OSA are not aware of these repeated awakenings because they occur beneath the level of consciousness. Convincing support for this assertion came in a review of medical records published in the December 2014 issue of Mayo Clinic Proceedings. Take a look at some numbers here:

  • Of 1210 insomnia patients presenting at a sleep clinic in Albuquerque, New Mexico over a period of 8 years, about three-quarters (899) were using sleep aids regularly or occasionally. The majority of these—710—were using prescription sleeping pills. The rest were using over-the-counter sleep aids.
  • None of the 899 medication users reported improved sleep. So they, as well as the others, whose sleep had failed to improve following drug-free insomnia treatments, were seeking further assistance.
  • All of the patients were verbally screened for OSA. Then 942 underwent sleep studies.
  • About 91 percent tested positive for moderate to severe OSA. Yet a screening tool used by many primary care physicians to ascertain the likelihood of sleep-disordered breathing failed to detect it in 32 percent.
  • What’s more, the patients taking prescription sleeping pills were least likely to report symptoms of apnea and the most likely to report severe insomnia and other health problems.

In other words, it’s easy to mistake OSA for insomnia, and primary care physicians may do the same. You’re then treated for insomnia when you should be treated for apnea, compromising your quality of life and increasing your vulnerability to heart and other serious health problems down the line.

The Take-Away

Occasionally I hear from people like Keisha who doubt that a sleep study could tell them anything they don’t already know. There’s a chance they could be right. On the other hand, this is one instance when what you don’t know could end up hurting you a lot. And now, with much less expensive home testing devices available, there’s less reason for concern about cost.

If your insomnia takes the form of waking up several times at night and if, after being interviewed by your doctor, he or she suspects you might have OSA, bite the bullet and have the test. Insomnia is no picnic, but untreated apnea is worse.

Sleep Studies: Do You Really Need One?

If you haven’t had a sleep study, you may wonder if spending the night at a sleep clinic might help the doctor understand your problem and how to fix it. Polysomnography, or PSG, is the test conducted at the clinic. New guidelines from the American Board of Internal Medicine (ABIM) clarify when PSG is useful in cases of chronic insomnia and when it isn’t. Here’s a summary and explanation of the guidelines.

Sleep studies are useful when insomnia is complicated by another disorderWhen I ask people with persistent insomnia if they’ve had a sleep study, the common responses I get are these:

  • “I had one and all I learned from it was that I don’t have sleep apnea.”
  • “I want one, but my doctor won’t write the prescription.”

If you haven’t had a sleep study, you may wonder if spending the night at a sleep clinic might help the doctor understand your problem and how to fix it. Polysomnography, or PSG, is the test conducted at the clinic. New guidelines from the American Board of Internal Medicine (ABIM) clarify when PSG is useful in cases of chronic insomnia and when it isn’t. Here’s a summary and explanation of the guidelines.

When a Sleep Study Is in Order

PSG is good at detecting sleep apnea, sleep-related movement disorders, and violent or harmful behavior that might be occurring at night. If a doctor suspects that your insomnia is associated with any of these disorders, you’ll likely be going in for a sleep study.

Occasionally a person with insomnia reports such an unusual assortment of symptoms that, even after taking an extensive patient history, the doctor can’t figure out what’s going on. Here, too, PSG may help. The doctor may also prescribe a sleep study if you’ve undergone treatment for insomnia (with or without drugs) but your sleep has failed to improve.

When Sleep Studies Won’t Help

But neither the ABIM nor the American Academy of Sleep Medicine recommends sleep studies for other insomnia patients. Here are some of the reasons.

1.  PSG cannot do much except confirm the symptoms you report to the doctor during a clinical interview.

  • Let’s say you wake up several times at night and have trouble falling back to sleep. PSG may confirm that you experience these wake-ups but will not shed light on why.
  • Or maybe your problem is that it usually takes you a long time to fall asleep. Upwards of $2,000 is a lot to spend on a procedure that merely corroborates what you already know.

2.  PSG does a poor job of discriminating between normal sleepers and people with insomnia. In fact, up to 50 percent of the time, the brain activity of insomniacs looks identical to that of normal sleepers.

3.  In some insomniacs, there is abnormal brain activity occurring at night—activity typically associated with being awake. But standard PSG will not show evidence of this wake-like activity. As a measure of what’s going on in the brain at night, PSG is not finely tuned.

4.  Finally and importantly, in most cases of persistent insomnia, PSG will not suggest a course of treatment that differs from treatment that would be prescribed based on a thorough clinical interview.

  • If your complaint is that you’re a light sleeper and wake up frequently at night, the doctor will probably prescribe cognitive-behavioral therapy for insomnia (CBT-I) or some other behavioral treatment before considering medication. PSG might corroborate your symptoms but would not alter the diagnosis or the treatment.
  • Or let’s say your main complaint is that your thoughts keep you too wound up at night to fall asleep easily. The doctor isn’t going to need for you to undergo a sleep study in order to diagnose and treat the problem.

The Bottom Line

Sleep studies are an indispensable tool for people suspected of having sleep apnea and many other sleep disorders. But as conducted now, they’re of no help to insomnia sufferers unless your insomnia is related to another health problem.

If you’ve had a sleep study, what did you learn from it?

 

A Light Sleeper’s Take on Snoring

I see a lot of complaints in insomnia forums about snoring husbands and wives: “At night my wife morphs into a Mack truck!” “My husband’s snoring can shake the paint off the walls!”

Here’s how to contend with a snoring mate so that you, too, get a good night’s sleep.

I see a lot of complaints in insomnia forums about snoring husbands and wives: “At night my wife morphs into a Mack truck!” “My husband’s snoring can shake the paint off the walls!”

snoring-partner-e1366889187717

Maybe these snorers have sleep apnea and should go to the doctor to see if it can be corrected. Then again, maybe they don’t have sleep apnea, and maybe snoring is part of the package we sign for when we pledge to stay together for better and for worse.

The problem can be infuriating, especially if you’re prone to insomnia anyway. Just as you’re drifting into slumber, being wrested out of the arms of Morpheus by the snort that shook the world can make you mad enough to want to punch your partner out! But there is a simple solution: sleep in separate beds.

A Lucy and Ricky Arrangement

I know, I know: where’s the appeal in that? Separate beds are way uncool, what your parents turned to in old age, what you saw in 1950s sitcoms, or for kings and queens who slept in separate bedrooms so consorts could visit in the night. “Sleeping together” is an expression for one of the deepest forms of human intimacy. Why would anyone want to forgo that?

I spent years fighting the idea of separate beds myself. I love my husband dearly, but in matters of sleep we’re completely mismatched. I’m a light sleeper who awakens at the slightest noise or movement, and my husband is a snorer and a thrasher. How could two people so different in their behavior hope to pass the night harmoniously in the same bed?

But oh, how we tried. My first line of defense was my Mack’s earplugs, which muffled some of the noise. But they didn’t block it out completely. Many were the nights when I slipped under the covers wondering if a loud snort or jiggling of the mattress would hijack my sleep. The anticipation alone kept me tense and wakeful.

Sleeping Solo

Then I started keeping a foam futon under the bed for times when the snoring or thrashing began. I could pull it out at night and push it out of sight in the daytime, and still maintain an image of myself and my husband as a typical couple sleeping side by side. A few years later my husband built a platform for the futon (a permanent fixture, but still not a bona fide bed). Finally we faced the music: not only were we a two-car family, but we were also a two-bed family. We bought the extra bed, and we’ve never looked back.

Sleeping together in the same bed is highly overrated, if you ask me. Yes, that skin-against-skin feeling is warm and comforting. You can preserve it by spending part of the night together, as we often do. But apart from sex, why really do you need a bed other than to sleep? And when you’re sleeping, just how aware are you of your partner’s whereabouts? She could be asleep beside you, but she could also be on the living room sofa or partying down in Atlantic City for all you know.

The point of sleep is to disengage from consciousness and stay there, and awaken feeling refreshed and ready for the day. If sleeping in separate beds can make it happen, why hold out?

What sleeping arrangements do you have that help you sleep? What works and what doesn’t?