Dental Associates of North Virginia

Northern Virginia Health & Life Magazine: October 2009
"Dream a Little Dream"

Most of us don't realize how important sleep is until we don't get enough. Here's how to improve both the quantity and quality of your time in dreamland.

It’s 2 o’clock in the morning and instead of sleeping, you’rewide awake working on a crucial report. Or it’s 3 a.m. andyou’ve been lying in bed for hours but sleep still eludes you, and now you’re stressed out over the fact that you have to be up in a just few hours. Or maybe the clock reads 4 a.m. and you’re already awake for the day, unable to stay asleep. It’s frustrating, sure—but it’s also unhealthy.

For most people, the occasional bout of sleep deprivation is nothing new. In fact, according to recent studies, nearly 70 percent of adults don’t get enough sleep. But chronic deprivation can cause a laundry list of woes that range from merely irritating to life-threatening. To get the rest you need and crave, read on.

Sleep Facts

Although the hours you spend in dreamland may seem like downtime, they’re actually one of the most active parts of your day. As we slumber, we engage in a five-stage sleep cycle (each lasting from 90 to 100 minutes) that repeats itself throughout the night. In the first and lightest stage of sleep, muscle activity slows and you easily can be awakened. At stage two, eye movements stop, brain waves slow, and you drift into a deeper sleep. Stages three and four are the most restorative states of sleep and also the most difficult from which to be awakened; brain waves slow to a crawl, there is no eye movement or muscle activity, and your body is completely at rest. Finally, in the REM (or rapid eye movement) stage, breathing becomes rapid and shallow, your heart rate drops and your blood pressure rises, and your eyes move quickly in different directions. This is when you dream, and if you are awakened during this period it is often easy to recall your dreams.

Sleep Better Tonight!

While it’s easy to track how many hours of sleep you’re getting each night, gauging your sleep hygiene—the quality of your sleep—is more difficult, but no less important. For example, getting nine hours of sleep isn’t much of a consolation when you wake up two or three times during the night and never go through those restorative sleep stages. But the good news is that many sleep issues (like trouble falling or staying asleep) are temporary and can be solved with a few easy lifestyle changes. To improve your own sleep hygiene, consider these strategies from sleep specialists.

Create a bedtime ritual, which means keeping sleeping andwaking times consistent.

Don’t smoke. Smokers tend to sleep very lightly, have reduced amounts of REM sleep, and wake after just three or four hours because of nicotine withdrawal.

Caffeine stimulates the brain and will keep you awake, so avoid coffee, tea, soda, chocolate, and even some over-the-counter pain relievers and decongestants (check the label) at least two hours before bedtime.

Skip the nightcap. Drinking alcohol close to bedtime may make you feel sleepy, but it will actually prevent you from falling into a deep, restful sleep and cause you to be awakened more easily.

While it’s wise avoid heavy meals right before bed, you also shouldn’t go to bed hungry. Have a light snack like crackers before hitting the sheets. You can also sip some chamomile tea, which is naturally decaffeinated.

A good exercise routine will help you sleep better, but don’t work out close to bedtime; the adrenaline rush will keep you awake.

Wear loose cotton clothes to bed. When it comes to sleep, comfort is key.

Keep your bedroom cool. Start at 70 degrees, then raise or lower the temperature to your liking.

Keep your bedroom dark and quiet. That means nodding off with the television on is a no-no. TV frequencies are stimulating to the brain and will cause you to sleep restlessly. If you need a little noise to keep your mind from wandering, try a white noise machine or a fan. And if you often get up to go to the bathroom during the night, use as little light as possible.

If you have trouble falling asleep, get out of bed, leave the bedroom, and sit in the dark while you read or watch television until you feel sleepy again. Anxiety over not being able to sleep often contributes to insomnia.

Relax and clear your mind before bed. Read for 15 minutes, do a crossword puzzle, or take a warm bath. Getting into bed right after dealing with a pile of laundry or dirty dishes is not conducive to quality sleep.

Certain scents (try lavender or chamomile) can be sleep-inducing, so try placing a sachet or reed diffuser (but never a burning candle) next your bed.

So You're A Little Tired. Why All The Fuss?

Aside from not feeling (or looking) your best when you’re tired, prolonged sleep deprivation can cause health problems. While we rest, our bodies recharge their vital systems, which keep us functioning at full speed. When that renewal is disrupted, the consequences can be dire, causing …

Memory loss. According to Harvard Women’s Health Watch, the REM stage of sleep helps the brain log new information, so not getting enough sleep or getting poor-quality rest can lead to forgetfulness and even trouble conquering new tasks.

Bad moods. Sleep deprivation can leave you irritable and impatient and may even result in or exacerbate depression.Premature aging. While we sleep, our bodies secrete growth and repair hormones that aid in cell renewal and keep skin bright and firm. Poor-quality shut-eye or lack of sleep causes a decrease in these hormones.

More colds. Sleep helps the body stockpile energy and boosts the immune system. When you’re wiped out, your body is less able to fend off colds and even less able to heal from more serious illnesses.

Safety concerns. When you’re not sleeping properly your concentration, judgment, and reaction time are impaired and you’re also more likely to doze off while performing simple tasks, like driving. In fact, research shows that losing just one hour of sleep can affect your alertness the next day by up to 25 percent. In fact, the National Highway Traffic Safety Administration has estimated that a staggering 100,000 car accidents—and 1,500 fatalities—can be linked to driver fatigue every year.

Poor heart health. Recent studies have begun to show a connection between poor sleep habits and hypertension and irregular heartbeats.

Weight gain. It’s true: Sleep deprivation can make you fat. Not only do you not have the energy to exercise, but your body also naturally craves more carbohydrates when you’re tired. In addition, levels of the hormone ghrelin (which triggers appetite) rise and levels of the hormone leptin (which controls appetite and aids in the processing of carbs) drop when we’re exhausted. So prolonged sleep loss will actually make you hungrier and less able to burn calories.

When It's Time to Get Help

Turning off the television and turning down the heat can’t solve every sleep issue. Some problems require medical intervention, but how can you tell for sure? If your sleep issues have been going on for several months and can’t be linked to one traumatic event, like a death in the family or losing your job, you should seek treatment. Other signs that you may need medical help include constantly waking up during the night, going to the bathroom every night, or sleeping restlessly for a prolonged period of time. If you have high blood pressure and begin to snore regularly, if you’re always tired, can’t concentrate, or are forgetful, or if you’re waking up with headaches, start by discussing the problem with your general practitioner or dentist. You can also go directly to a sleep specialist who will take a detailed history of your lifestyle and sleep habits, and may recommend that you participate in a sleep study. Be aware, however, that while sleep studies can be very useful tools, they’re not indicated for every type of problem. Chronic insomniacs, for example, are not good candidates for sleep studies because their problems don’t occur during slumber. But if your doctor suspects a condition like sleep apnea (a chronic disorder in which you repeatedly stop breathing during the night), restless leg syndrome (abnormal sensations in the legs like aches, burning, or tingling that lead to erratic kicking or other leg movements), narcolepsy (falling asleep at inappropriate times), or seizures, a sleep study will most likely be indicated.

Now What?

Once a sleep disorder has been diagnosed, it’s time to begin treatment.

If snoring is a problem for you, the solution could be as simple as getting a sleep positioner to keep you off your back at night. If that doesn’t do the trick, pay a visit to your dentist. “A simple dental device can be designed in just one office visit that positions the lower jaw so that your airway is maintained and you don’t snore,” explains Michael Rotter, DDS, of Dental Associates of

Northern Virginia in Fair Oaks.

Teeth grinding is another very common problem (especially in these stressful economic times) that your dentist can address. “If a patient knows they’re grinding at night but there’s no sign of damage,” says Rotter, “we can design a mouth guard, like many athletes use, to protect the teeth during sleep. But if I notice damage during a routine exam or a patient tells me they often wake up with headaches—a common sign of teeth grinding—an NTI [nociception trigeminal inhibitor] appliance can be prescribed to actually stop the grinding.”

For patients suffering from insomnia, temporary medications are often used in conjunction with cognitive therapies to find out why you can’t sleep and to help you learn to fall asleep. If restless legs are disrupting your slumber, your doctor will most likely use information gleaned from a sleep study to determine what’s causing the movements and then use medications to stop the twitching.

For sufferers of sleep apnea, probably the most common and serious sleep disorder, there are several treatments and lifestyle changes your doctor can suggest. You’ll be asked to avoid sedatives like alcoholic beverages, and since obesity has been linked to sleep apnea you may be asked to shed some weight. Your doctor also may refer you to a dentist who can create a device that will maintain your airway while you sleep. “These devices work similarly to the way we perform CPR, by pulling a patient’s lower jaw forward to open their airway,” Rotter explains.

There are two kinds of devices your dentist can offer. The first starts as a standard form that can then be molded to fit your jaw. The second is a more sophisticated model made with dental impressions and meticulously fitted to your jaw. “These devices work very well for people with mild to moderate sleep apnea,” says Rotter, “but for more severe cases a C-PAP machine may be needed.” A C-PAP (continuous positive airway pressure) machine increases air pressure in your throat so that your airway does not collapse when you inhale. Fortunately, these devices work for nearly 99 percent of apnea patients. But for the most stubborn 1 percent of cases, treatment can include surgically removing the tonsils or adenoids, or inserting upper palate implants to prevent the upper palate tissue from collapsing and obstructing your breathing. Most important, your doctor may recommend a thorough cardiac evaluation, since recent studies have shown that developing sleep apnea may be a warning sign for cardiac diseas