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Summit Medical Group of Oak Ridge

Trouble Sleeping? By Dr. Aaron Jones

Trouble sleeping is a complaint I hear at least weekly and usually daily in my practice. It affects the young, the old, male and female. According to the CDC in a 2009 survey about sleep more than 1 in 3 adults reported unintentionally falling asleep during the day at least once in the preceding month, and 1 in 20 reported nodding off or falling asleep while driving at least once in the preceding month. The National Department of Transportation estimates drowsy driving to be responsible for 1,550 fatalities and 40,000 nonfatal injuries annually in the United States.

Many people just want a “pill to fix it” but I find myself telling patient after patient that it is not that easy. While sleep is a very complex issue, I want to give you a brief step by step approach that I use with my patients. The first issue I address is expectations. Many people want to do something to allow them 8-9 hours of uninterrupted sleep every single night. They want to wake up feeling peppy and ready for the day. Honestly, I do too! But this is less likely to happen the older we get. There is no pill that we can take that will give us a good night’s sleep every single night. But there are other things we can do besides medicines that have been proven to improve the chances of a good night’s sleep.

We all learn to take care of our teeth by brushing, and to do basic hygiene (routine healthy things) to stay healthy. In the same way I always address “sleep hygiene” with every patient reporting poor sleep.

  • No naps- daytime naps put us in a cycle of sleepless nights and daytime naps.
  • No caffeine after lunch- there is some evidence that as we age we do not get rid of caffeine in our bodies as quickly. We can also become more sensitive to the effects of caffeine as we age, which could be keeping you up at night if you have an evening soda or coffee.
  • Only use your bed for sleep and sex- no TV, no reading. Train your mind that the bed = sleep
  • Go to bed and wake up at the same time every day- we are creatures of habit and regular sleeping patterns train our bodies to release melatonin (which aids in sleep) at a regular time nightly.
  • No large meals before bed- try to limit your meals to 3-4 hours before bed to limit reflux and allow your body to do the work of digestion before you lie down.
  • No “night caps” or bedtime alcoholic drinks- while this helps some people go to sleep, it puts you in a shallow sleep and most people wake up 1-2 hours later unable to go back to sleep.
  • Avoid stimulants- like nicotine, phentermine, or most ADHD medications.

Another tip is to keep a pen and paper close by your bed. A number of sleepless nights are caused by anxiety and racing thoughts. Often writing things down can help us put our mind at ease.

If you are not already doing these things, this is a good place to start. Then next step in my stepwise approach is over-the-counter melatonin. Studies show 3mg 1 hour before bed is a good dose to start with and you can usually increase up to 10mg if needed. But of course, check with your doctor first before using any over-the-counter herbs, supplements, or medicines! In most people melatonin is a safe supplement to take long term for help with sleeping.

My next step is an occasional Benadryl (diphenhydramine) 25mg. This is the common sleep aid in Unisom as well as other over-the-counter sleep aids. Again check with your doctor before trying any over-the-counter medicines.

If these things do not help, it is usually time to see your doctor. We can evaluate you for other common issues such as sleep apnea, overactive bladder, depression or a number of other health issues that can cause trouble sleeping.

Here at Summit Medical Group of Oak Ridge “We care about your care”! Call today as we are accepting new patients daily.