Sleep is essential to our physical and mental health.
Adequate sleep may play a role in helping our bodies recover from illness or injury. Studies have shown that sleep deprivation results in a loss of strength, an impaired immune system and an increase in blood pressure.
In general, most healthy adults need an average of seven to nine hours of sleep a night, although individual sleep requirements vary. The need for sleep does not decline with age, although the ability to maintain it may be reduced. To get an idea of whether you are getting enough sleep, take the sleep quotient quiz below.
Causes of Sleep Deprivation
Sleep is also important for emotional and mental functions. Sleep loss can affect concentration and impair the ability to perform tasks involving memory, learning, logical reasoning and mathematical calculations. A recent study reported in The New York Times suggests that chronic lack of sleep may even make the aging process more difficult.
For people living with HIV, sleep disturbances may result in potential decline in quality of life. For example, sleep disturbances may cause daytime fatigue and affect functional status and quality of life. Many HIV-positive individuals with daytime fatigue also have medical sleep disorders. Thus, proper diagnosis and medical treatment of the sleep disorder may produce significant improvement in quality of life. Complaints of sleep disturbance have also been associated with depression and pain, both of which may also make it harder to fall asleep or lead to nighttime or early morning awakenings. Insomnia, which is difficulty falling asleep or staying asleep, is also widespread and underdiagnosed in HIV-positive individuals.
Although most of the FDA-approved HIV antiretrovirals can cause fatigue, it is interesting to note that most of them have been shown to cause some type of sleep disturbance as well. In clinical studies, many of the available drugs caused insomnia less than 1 percent of the time.
One major exception, however, is Sustiva (efavirenz), which lists some type of sleep disturbance as a more common side effect, especially during the initiation period for the drug. Regardless of which drug may be causing a sleep disorder, a change in dose scheduling, nutrition or exercise may alleviate this side effect. Check with a healthcare professional, treatment advocate or nutrition advocate before making changes to your medication regimen.
According to a report in the November issue of Pediatrics, HIV-infected children appear to have a higher than normal rate of sleep disturbance than children who are not HIV-infected. HIV-infected children participating in the study woke up more frequently, stayed awake longer, and reported a greater level of tiredness.
Prompt diagnosis and interventions to promote sleep may improve the quality of life and prevent additional compromise of immune function in people living with HIV.
Healthcare providers who treat HIV-positive individuals need to be aware of medical sleep disorders as treatable causes of daytime fatigue and insomnia. Often, they pay attention only to measurable physical symptoms such as fever or weight loss, granting more attention as measurable symptoms change and the individual becomes sicker.
Types of Sleep Disorders
What are some common sleep problems?
Insomnia -- difficulty falling asleep or staying asleep -- affects one in every three people.
Insomnia may be caused by stress, medications, pain, illness, noisy surroundings, even sleeping pills. Short-term insomnia, lasting up to three weeks, may result from anxiety, nervousness and physical and mental tension. Long-term insomnia stems from health conditions such as depression, and can also be brought on by chronic drug or alcohol use, excessive use of beverages containing caffeine and abuse of sleeping pills.
Sleep Apnea -- or trouble breathing during sleep -- affects more than 12 million people in the United States. Loud snoring, daytime sleepiness, and tiredness are the most common signs. Most people are not aware of having any problem.
Treatment of Sleep Apnea may involve a change in sleep position, weight loss, or other non-invasive interventions.
Narcolepsy is a neurological sleep disorder that affects one in 2,000 people. Symptoms can include chronic daytime sleepiness, spells of muscle weakness, lifelike hallucinations and paralysis while falling asleep or awakening. Medications and lifestyle changes can help manage symptoms.
Shift Work Problems are caused by working non-traditional hours and affect one in five people in the United States. Shift work interferes with sleep, workplace performance, health and home life. Sleep specialists can help shift workers to solve sleep problems and schedule activities to minimize disruption of daily life.
Seasonal Affective Disorder (SAD) is a type of depression that reappears at the same time each year (usually fall). SAD is associated with an abnormal response to environmental cycles such as seasonal changes in day length or temperature. SAD is effectively treated with high intensity light.
Jet Lag is the inability to sleep after having traveled across several time zones and your biological rhythms become "out of sync." (See "Sleep and the Traveler" below.)
Environmental Interferences may also play a role in your sleeplessness. A distracting sleeping environment such as a room that's too hot or cold, too noisy or too brightly lit can be a barrier to sound sleep. Other influences to pay attention to are the comfort and size of your bed and the habits of your sleep partner. If you have to lie beside someone who snores, can't fall or stay sleep, or has other sleep difficulties, it often becomes your problem, too. Help your partner get the professional advice he or she needs.
Psychological factors, particularly stress, are considered by most sleep experts to be the leading cause of short-term sleeping difficulties. Usually the sleep problem disappears when the stressful situation passes. However, if short-term sleep problems are not managed properly from the beginning, they can persist long after the original stress has passed.
Insomnia can be brought on when depression is suspected. Many depressed people complain of insomnia without recognizing that they are depressed. If you have lost interest in activities you used to enjoy or if you have feelings of hopelessness or suicide, your sleep problems may be a result of depression. Talk to your healthcare provider about any sleeping problem that recurs or persists for longer than one week. When the depression is treated, the accompanying sleep problems usually disappear.
Give Yourself Time
Changing your sleep patterns cannot be done overnight, but changes can be made in a relatively short period of time. If you're plagued by serious fatigue or more than transient insomnia, don't delay in seeing your doctor.
Most of us, however, simply need to be a little more aware of the fact that a good night's sleep is just as important to our health as exercise and good nutrition. Make a few small changes and you'll soon find yourself feeling better.
Many sleep problems can be improved by changing your sleep habits, reducing stress, improving your diet or exercising. If problems persist, it may be time to seek professional help.
- Consume less or no caffeine, nicotine and alcohol. Watch out for the caffeine in soft drinks and chocolate as well as in coffee. Nicotine can inhibit sleep as well. Although alcohol may initially cause sleepiness, it can interrupt your sleep later in the night because alcohol becomes a stimulant when the body metabolizes it.
- Exercise regularly, but do so in the daytime. Exercising regularly can greatly improve the quality of your sleep and increase the amount of deep sleep, but do it at least three hours before bedtime. Some people may need to exercise up to six hours before bedtime in order to allow themselves enough time to unwind. The best time to exercise to benefit sleep is in the afternoon.
- Don't stay in bed tossing and turning. If you can't go to sleep after 30 minutes, get up and involve yourself in a relaxing activity until you feel sleepy. Remember, try to clear your mind; don't use the time to solve your daily problems.
- Go to bed at the same time every night and get up the same time every morning. This is one area where the body craves consistency. Don't sleep in on the weekends to make up for lost sleep. If you do end up suffering from sleep deprivation during the week, go to bed earlier but get up at the same time on Saturday and Sunday.
- Establish a regular bedtime routine, such as walking the dog, taking a bath, and reading a book. It doesn't matter what you do. Just be consistent and your routine will signal your brain that it's time to snooze.
- Use the bedroom for sleeping or sex only. Leave TV-watching, bill-paying and other activities to another part of your home so that your brain associates the bed and bedroom with sleep.
- Try a relaxing routine before bedtime, like soaking in hot water (a hot tub or bath), reading a book, listening to relaxing music, or practicing deep breathing. You can also try drinking a glass of warm milk, which is high in L-tryptophan (a natural sedative).
- Drink less fluids before going to sleep.
- Avoid heavy meals and foods and drinks high in sugar close to bedtime.
- Use sleeping pills sparingly or not at all. Although sleeping pills are temporarily helpful for addressing sleep disorders, they should be used for the shortest possible time, and in the smallest effective dose. Sleep-promoting medications can eventually cause sleep disturbance, side effects, a sleep "hangover" during the day, and dependency on the drug.
Read the statements below and choose each one that has applied to you in the past year. If you choose one or more statements, discuss your sleep with your health care provider.
- Falling asleep is hard for me.
- I have too much on my mind to go to sleep.
- When I wake up during the night, I can't go back to sleep.
- I can't relax because I have too many worries.
- Even when I sleep all night, I feel tired in the morning.
- Sometimes I am afraid to close my eyes and go to sleep.
- I wake up too early.
- It takes me more than 30 minutes to fall asleep.
- I am stiff and sore in the morning.
- I feel irritable when I can't sleep.
- I feel that I am dreaming all night long.
Every day, millions of travelers struggle against one of the most common sleep disorders: jet lag.
Jet lag results from an imbalance in our body's natural "biological clock" caused by traveling to different time zones. When traveling to a new time zone, our circadian rhythms (24-hour cycle) are slow to adjust and remain on their original biological schedule for several days.
Some of you will be traveling for the holidays and may find the following tips useful in minimizing some of the side effects of jet lag.
- Select a flight that allows early evening arrival and stay up until 10 p.m. local time. (If you must sleep during the day, take a short nap in the early afternoon, but no longer than two hours. Set an alarm to be sure not to oversleep.)
- Anticipate the time change for trips by getting up and going to bed earlier several days prior to an eastward trip and later for a westward trip.
- Upon boarding the plane, change your watch to the destination time.
- Avoid alcohol or caffeine at least three to four hours before bedtime. Both act as stimulants and prevent sleep.
- Upon arrival at a destination, avoid heavy meals (a snack is OK).
- Avoid any heavy exercise close to bedtime. (Light exercise earlier in the day is fine).
- Bring earplugs and blindfolds to help dampen noise and block out unwanted light while sleeping.
- Try to get outside in the sunlight whenever possible. Daylight is a powerful stimulant for regulating the biological clock. (Staying indoors worsens jet lag).
- Bring elements or objects from home like a picture of a friend or loved one, favorite pillow, blanket or even a coffee mug to ease the feeling of being in a new environment.
- Check with the hotel to see if voice mail services are available to guests. Then, whenever possible, have your calls handled by the service.
- Check your room for potential sleep disturbances that may be avoided, such as light shining through the drapes, unwanted in-room noise, etc.
- Request two wake-up calls in case you miss the first one.
Nancy Wongvipat, M.P.H., is a health education specialist in AIDS Project Los Angeles' Education Division. She can be reached by calling (323) 993-1511 or by e-mail at nwongvipat@APLA.org.