Dr. Naik’s Recommendations for Good Sleep Hygiene Include: z z z z z z z z
Avoid caffeine (including energy drinks) and alcohol after 3 pm. As a depressant, alcohol helps people fall asleep but then disrupts sleep Avoid smoking, as nicotine is a stimulant Exercise regularly but not close to bedtime Don’t go to bed stuffed or starving – instead, have a light snack Avoid napping Don’t spend more than 20 minutes wide-awake in bed 20 minutes before sleep, avoid light exposure from smart phones or any backlit device Don’t fall asleep to the television
Anita Naik, D.O., medical director of the Sleep Disorders Center, Harford Memorial Hospital and Northern Maryland Sleep Center
other possible causes in the older patient population, e.g. in those over the age of 50. If there is no identifiable cause, treat symptomatically. The most common medications are the dopamine agonists like Mirapex and Requip, which increase dopamine transmission between the neurons.” For patients who do require treatment, the next step may involve anti-seizure medications such as Gabapentin (neurontin) or Lyrica (pregabalin), and for those who don’t respond to this therapy, narcotics may be a last resort. Dr. Naik notes, “Recent data suggests that those with PLM alone should not usually be put on benzodiazepines unless they are injuring their partner or significantly disrupting their sleep continuity.”
Circadian Rhythm Disturbances Night owls, or those with circadian rhythm disturbances, have sleep schedules out of synch with societal norms. Dr. Klein comments, “Delayed Sleep Phase Syndrome, where the person falls asleep at 2 or 3 am, is more common than Advanced Sleep, where
they fall asleep too early in the evening. It commonly starts in adolescents and manifests itself in poor academic performance or being habitually late for school or work in the morning. Primary care physicians should be attuned to this problem because, while common, it’s often overlooked. Symptoms include having difficulty falling asleep at 10 or 11 pm, feeling most awake in the late evening, and feeling extremely sleepy or groggy, especially in the morning. It’s common for patients to sleep through their alarm five to six times.” The treatment is not highly technical, but may be hard to implement except during a long vacation period. “We train the brain through regular exposures to bright light,” notes Dr. Klein. “When the patient naturally wakes up, say at 1 pm, they sit in front of a light box with 10,000 LUX for 30 minutes for three to four days. Then we continue the light box therapy while having them get up a half hour earlier every three to four days until they return to a more normal waking time. If done correctly, the treatment is about 80% effective.” Sleep is so critical to well being that sleep disruption, not incontinence or
memory issues, is the reason many caregivers finally refer loved ones with dementia to a residential facility. Dr. Weinstein concludes, “The deal breaker is often when the person with dementia gets up at night and has their sense of day and night disrupted. It becomes intolerable for the caretaker to get up at night/worry about them.”
Jason Marx, M.D., chief of Pulmonary, Critical Care, and Sleep Medicine, University of Maryland St. Joseph Medical Center Ira Weinstein, M.D., FCCP, Annapolis Asthma, Pulmonary and Sleep Specialists and medical director of Anne Arundel Medical Center’s Sleep Disorders Center Pavel Klein, M.D., director, MidAtlantic Epilepsy & Sleep Center, LLC Anita Naik, D.O., medical director, Sleep Disorders Center, Harford Memorial Hospital and Northern Maryland Sleep Center
JULY/AUGUST 2013
| 19