Published: April 10, 2007 12:12 pm         

Advice: Good 'sleep hygiene' can benefit all

FAIRMONT, W.V. — When insomnia hit Kim Sargo, she used to lie in bed awake.

“I’d stare at the ceiling, I’d stare at the clock,” Sargo said.

Since seeking treatment for her inability to sleep, Sargo now knows that is not the best way to cope with insomnia.

“Sometimes we tell people to tape over the time on their alarm clocks,” said Brad Weaver, director of the Fairmont Regional Sleep Disorders Laboratory. “If your alarm clock is set for 6 a.m., and it’s 5:15, for the next 45 minutes, you’re looking at the alarm clock because you have a fear of sleeping over.

“So many people have that problem with the clock in the bedroom. I’ll bet if you interviewed 10 people, nine will tell you that if they wake up and look at the clock, they will then look every 10 minutes to see what it is.”

Sargo also learned that surfing the Internet — something she did during the long, dark hours when she could not sleep — did not help, after consulting with Dr. Mouhannad Azzouz, a neurologist and the director of the sleep lab at Fairmont General Hospital.

“He said the computer wasn’t a good thing because of the bright lights,” Sargo said.

When someone comes to Azzouz complaining of insomnia, he first looks for underlying causes, whether mental or physical. Those could include anxiety, depression, stress, chronic pain or certain medications that people take for conditions such as hypertension, Parkinson’s disease or lung disease.

In Sargo’s case, the doctor administered tests to rule out a physical cause before determining that her 12-hour night shifts as a nurse had prompted her sleep schedule to become completely out of whack.

But in addition to treating the underlying causes of insomnia, doctors and sleep lab officials also recommend good “sleep hygiene,” or habits that will be beneficial to anyone’s sleep schedule.

“The biggest thing in the whole sleep arena is sleep hygiene,” Weaver said. “We feel very strongly about sleep hygiene. If someone has insomnia, and if you look at their sleep hygiene, it’s usually terrible. They don’t prepare themselves for sleep. They don’t eat right and they smoke.”

In addition to avoiding exercise, large meals, caffeine, cigarettes and alcohol close to bedtime, good sleep hygiene also includes going to bed and getting up around the same times every night and morning, even on weekends.

“It can require lifestyle changes,” Weaver said.

That includes not watching television in bed, which provides too much stimulus and keeps bed from being a place dedicated for certain activities, namely, sleep, sickness and intimacy.

“Those really are the only three things,” Weaver said. “We don’t support TVs and all these things in the bedroom.”

Ironically, the two “bedrooms” in Fairmont General Hospital’s sleep labs both feature television sets, even though Azzouz and sleep lab director Rickie Harper do not advocate them.

“We had so many people who watched TV in bed,” Harper said. “We had so many complaints. They were used to falling asleep to TV. It’s cut down on the complaints. We try to make this as much like home as possible.”

Not everyone who has insomnia and comes to the hospital’s sleep lab undergoes a sleep test — a night spent slumbering while technicians monitor breathing, heartbeat and brain waves to look for physical causes of sleep problems.

Someone who snores and has sleep apnea — when breathing actually stops for a moment — is more likely to spend the night at the lab.

“People with insomnia do not necessarily need a polysomnogram,” Azzouz said. “However, in some patients, we have to look at their history, and people with sleep-related breathing disorders, like sleep apnea with excessive leg movement, may have insomnia as a presenting complaint. So in that case, we should rule that out.”

Once doctors determine that a physical problem has not caused the insomnia, they can start helping the person through a variety of measures, including getting insomniacs to change their habits.

If the patient is on medication for another condition that is causing insomnia, Azzouz tries to adjust the timing first.

“Sometimes we can eliminate the problem,” Azzouz said. “If this doesn’t help, sometimes we change the medication that may not have insomnia as a side effect. That does help sometimes.”

Also, medications to help people sleep have gotten more sophisticated and less addictive.

“Medications are much safer,” Weaver said. “So the medication option is better, especially for folks who have more short-term insomnia.”

Most people with a normal circadian rhythm go to bed around 10, 11 or 12 at night, Azzouz noted, and wake up around 7 or 8 a.m.

“That’s the way the mind is set,” Azzouz said.

However, some people have a need to go to bed earlier or later, which is called advanced or delayed sleep syndrome.

“Some of them don’t have any complaints,” Azzouz said. “They feel refreshed, and they develop this as a habit.”

But sleeping is only part of the equation. Sleeping is cyclical, divided between what is called rapid-eye movement sleep and non rapid-eye movement sleep. The non-REM sleep is deeper, and even that is divided among four stages.

“Getting refreshing sleep is when people get into the deep sleep, which is stage three and stage four.”

Following good sleep hygiene can be one way to get the deep sleep. For instance, while a glass of wine before bed might help someone fall asleep, it also can act as a stimulant a few hours later and prompt the person to wake up early, thereby avoiding quality non-REM sleep.

“To have a good sleep, patients should follow very good and regular sleep hygiene measures,” Azzouz said. “Sleep hygiene is very essential to follow.”



Mary Wade Burnside writes for Times West Virginian in Fairmont, W.V.