Good Night's Sleep: Medicine and Simple Routines Help : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 2)

Obstructive sleep apnea is by far the most common type. Breathing is interrupted when air can't flow into or out of the nose or mouth. The reason for the blockage could be an over-relaxation of the throat muscles and tongue, which partially blocks the airway or, in obese people, an excess amount of tissue in the airway. Those with receding chin lines are also at higher risk for developing obstructive sleep apnea.

In the less common form, central sleep apnea, breathing is stopped not because the airway is closed but because the diaphragm and chest muscles stop working.

Mild cases of obstructive sleep apnea can sometimes be treated by making simple behavioral changes, such as avoiding alcohol, tobacco, and sleeping pills; losing weight; and sleeping on one's side. Also, oral devices to prevent obstruction of the airway by holding the tongue or jaw forward may help with mild cases.

The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping. A device supplies pressurized room air through a flexible tube attached to the mask. The pressurized air acts as a splint to prevent the airway from collapsing.

"You have to get used to wearing a mask while you sleep," says Ero, who has been using the CPAP device nightly since 1996. "But you feel so much better, it's worth the hassle. Within two weeks after starting to use it, I felt like a different person. I have so much energy now."

Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases.

The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997.

When to Worry

Just as snoring isn't always a sign of dangerous apnea, neither is a sleepless night or two necessarily a medical emergency. Sometimes sleep patterns differ based on simple factors like age and lifestyle.

Bob Rappaport, M.D., a sleep medicine specialist, neurologist, and FDA drug reviewer, encourages people to consider getting help if their sleeplessness persists and appears to be unrelated to life circumstances.

Wooing Sleep

A jokester's definition of insomnia: When you keep a bunch of innocent sheep jumping over a fence all night just because you can't get to sleep.

Experts agree that the time-honored practice of counting sheep or doing another such monotonous task may help induce sleep. Sleep specialists provide these additional tips to help you reach dreamland.

• Avoid caffeine (including caffeine-containing drugs), nicotine, and alcohol for four to six hours before bedtime. The first two are stimulants that can make it difficult to sleep. And while alcohol may have a sedating effect at first, it tends to disturb sleep after several hours.
• Don't exercise within four to six hours of bedtime. Working out earlier in the day, though, not only doesn't hinder sleep, but can actually improve it.
• Perform relaxing rituals before bed, such as taking a warm bath, listening to relaxing music, or eating a light snack.
• Before going to bed, try as much as possible to put your worries out of your mind and plan to address them another time.
• Reserve your bed for sleeping. To preserve the association between bed and slumber, don't watch television or do work in bed.
• Go to bed only when sleepy. If you can't fall asleep within 15 to 20 minutes, get out of bed and read a book or do another relaxing activity for awhile, rather than trying harder to fall asleep.
• Make sure your bed is comfortable and the bedroom is conducive to restful sleep — quiet and at a comfortable temperature, for example.
• Wake up about the same time every day, even on weekends, to normalize the sleep-wake schedule.
• Don't take naps, or nap during the mid-afternoon for no more than 30 minutes.

Melatonin?

Many Americans in search of more satisfying slumber are buying the hormone melatonin at their local health food stores. Melatonin-containing products are marketed as dietary supplements, which can be sold without FDA's premarket review or approval.

Researchers, including those at a 1996 National Institutes of Health conference about melatonin and sleep, caution melatonin users about the absence of scientific studies to prove that melatonin is safe and helpful in treating insomnia.

"Public fervor for melatonin runs far ahead of the scientific evidence to support it," states an article about the NIH workshop in the Journal of the American Medical Association, referring to the reported $200 million to $350 million U.S. market for the hormone.

"People are taking melatonin and we are trying to figure out what it does," said one researcher who attended the NIH meeting. "We are going about it backward."

NIH sleep expert James Kiley, M.D., agrees that many questions about the supplement remain unanswered: "We need some research to address the concerns about melatonin and its safety and efficacy."

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.