Sleep Tight

If you’ve ever had sleep issues, you know how stressful it can be to wake up in the night just to turn over, for example, and pretty soon you realise that you’ve “crossed the line” back to being fully awake, even as you feel like death and want nothing more than to sleep. 
If you’re not already one of its 12,000 patients, you may not be aware that first-rate help is available for you right here in Winnipeg at the Misericordia Hospital Sleep Disorder Centre.

The centre consists of the provincial sleep disorders diagnostic laboratory, a sleep clinic and treatment service. Sleep specialist physicians from the University of Manitoba’s Section of Respirology, Department of Medicine, review over 3,600 overnight sleep studies performed each year in the diagnostic laboratory. Roughly 1,200 home sleep studies are conducted annually as well.

Between 200 and 300 people seek help at the centre each week, where a referral process determines if a clinical appointment will suffice to address the problem, or whether the insomniac needs to undergo a full sleep study, during which a specialist known as a polysomnographer collects data while the patient sleeps–including measurements of heart rate, respiratory effort and oxygen saturation.

Following the study, sleep physician specialists review the data and plan a treatment program, which may include medication or the issue of portable devices for use at home. Many sleep with a ventilator that aids their breathing to allow them to get that desperately-needed sleep.
Now, all of us experience the occasional sleepless night, but are your own issues indicative of a disorder? There are over 100, after all, and they can drastically affect your quality of life, and even your physical health.

Dr. Norah Vincent is a clinical psychologist and associate professor with the program of clinical health psychology under the WRHA in a joint appointment with the University of Manitoba Faculty of Medicine. She says the most common disorder–affecting about 10 per cent of us–is chronic insomnia, defined as difficulty with falling asleep, staying asleep or experiencing non-refreshing sleep that occurs more nights than not, is not associated with a substance use problem or with another kind of medical problem, and also causes daytime impairment, meaning fatigue, difficulty concentrating or with motivation, headaches and a general feeling of malaise.

What causes it? “We think that after a period of reduced sleep,” the doctor explains, “people go into a state of hyper-arousal; their bodies are kind of in over-drive, which is why a person who is very tired can have great difficulty with napping during the day–they might be exhausted, but they just can’t fall asleep because they are in a hyper-aroused state. It’s a vicious circle, and that’s exactly how people experience it.” Chronic insomnia is more prevalent among women.

The second most common is sleep apnea, more common among men, and during which, for one reason or another, the airway is collapsing, causing the sufferer to gasp for breath, or stop breathing entirely for a moment. At its most severe, sleep apnea can seriously impact  the health of the heart, and can actually lead to heart disease.

Number three on the list is Restless Leg Syndrome (RLS) or Periodic Limb Movements, which Dr. Vincent describes as “an irresistible urge to move your legs in the evening, making it difficult for you to fall asleep. Even when you do fall asleep, you might be frequently awakened–often without your knowledge–by the twitching and jerking of your limbs.” Little is known about its cause, but Dr. Vincent says that it seems to be related to an iron deficiency or reduced B12, can have a genetic component, and for some reason, is much more prevalent in the French-Canadian population.

The health effects of sleep disorders can vary from feeling awful during the day to heart disease. “Any time you’re getting less oxygen into the body, the body responds negatively,” explains Dr. Vincent. “The heart enlarges and has to work harder to pump oxygen around the body,” she adds, “and that places a strain on many of the organs, and that tends to increase blood pressure.” 

While your problem might indeed be physiological, you might also benefit from a couple of minor behavioural adjustments. Dr. Vincent has a pair of recommendations. “Try not to go to bed too early. When you do,” she notes, “you can tend to worry about falling asleep, which can become kind of conditioned in, which can lead to a more chronic problem. Just go to bed when you’re sleepy, instead of some pre-conceived time.”

The doctor’s second piece of advice is to try not to force the issue. “If you do wake up in the night and are having trouble falling asleep,” she says, “get out of bed instead of lying there for hours.”

She also recommends avoiding eating food that is hard to digest–meats and cheeses, for example–too late in the evening, because your digestive system can keep you awake as it struggles to deal with the extra work. 

If you do find yourself amoung the unlucky numbers of people with chronic sleep impairment, help is out there. “I think it’s very important that we minimize the impact of sleep problems is our lives,” emphasizes Dr. Vincent. “There is assessment in Winnipeg for this problem, and there is treatment right here at home for it. Too many people just push through it and keep struggling on.” 

By the way, thanks to Dr. Vincent, help for your insomnia could be just a mouse-click away after she came up with the idea of developing a website to help treat people with insomnia to remedy the fact that many of her patients were waiting many weeks to see her. Sensing that many of these patients could be helped if they had access to credible information and treatment options, the doctor developed a six-week online therapy program consisting of audiovisual, MP3 and PDF files.

For more information about the Misericordia Hospital Sleep Disorder Centre or the online program developed by Dr. Vincent, contact the Winnipeg Regional Health Authority (www.wrha.mb.ca). 

You’ll be that much closer to a better night’s sleep.