The sleep cure
Obesity, diabetes, even heart disease—you can fight them all with a good night’s sleep

BY MARY TERESA BITTI

When Snoring is Serious Roger Currie quit smoking 11 years ago. Then his weight ballooned and his blood pressure soared. Along with the weight gain, Currie, a 56-year-old radio announcer from Winnipeg, developed a snoring problem. Worse, he routinely stopped breathing. Tests at a sleep clinic yielded a quick diagnosis: sleep apnea. In obstructive sleep apnea, tissue in the throat relaxes during sleep, closing off the airway. Excess weight can narrow the passage, but you don’t have to be overweight to have the disorder. Most apneacs aren’t aware they’re reaching consciousness—possibly every 30 seconds—overnight. The arousals necessary to restart breathing, however, prevent them from getting enough restorative deep sleep. Perhaps as a result, apnea is associated with hypertension, stroke and heart disease. In Canada, 29 percent of insomniacs are diagnosed with obstructive sleep apnea. It may strike as many as 730,000 adults: up to five percent of men, two percent of women and about four percent of the elderly. For five years Currie slept wearing the continuous positive airway pressure mask, which forces air through the nostrils and mouth to maintain open airways. But after diet and exercise trimmed 100 pounds from his frame, he felt good enough to try going to bed one night unmasked. Next morning, he felt sufficiently rested and has been mask-free ever since. Even better, his longtime hypertension has disappeared. M.T.B.

By day, Pascale Rigaud seemed to have it all. An occupational therapist at a Quebec City hospital, she was happily married with two young children, a cosy home and no financial worries. But one thing prevented the 34-year-old from fully enjoying her life: lack of sleep. Exhausted after a full day of work and children, she’d fall into bed at 8:30 but wouldn’t get to sleep until about 10 p.m.

Two hours later she’d be awake again, and she might then nod off periodically, but by 4:30 a.m. any chance of sleep was over. She kept a book by her reading lamp to get her through most nights.

Rigaud knows what triggered her four-year battle with insomnia. A personal relationship had become strained, and this preoccupied her thoughts. So, after a lifetime of clocking eight to nine hours a night, Rigaud couldn’t stay asleep for more than five—even after she resolved the conflict. She found herself despairing whether she’d ever sleep again: Why is this happening? What if it goes on for the rest of my life?

Rigaud’s insomnia granted her membership in a huge club. One in every four Canadian adults has trouble going to sleep or staying asleep. And almost half feel that they can cheat on sleep to accommodate family or job demands.

The result: an epidemic of fatigue that’s ratcheting up stress at work and road rage on the highways, and is literally aging us before our time. It’s a shame, since scientists have made great strides in treating sleep disorders—often without medication. While some of us may need professional attention, for others it may be simply a matter of making more time for sleep.

Either way, quality shut-eye should be a priority. There are epidemic levels of heart disease, obesity and diabetes in this country, and sleep may be the missing link.

Sleeping Sicknesses
Less Z’s, More Weight
People who don’t get enough sleep risk getting fat. In a University of Chicago study, men who were limited to four hours of nightly sleep had decreased levels of leptin, a hormone that signals the body you’re full. “Not getting enough sleep leads to increased appetite and a craving for carbohydrate-based foods,” says Dr. James MacFarlane, assistant professor of psychiatry at the University of Toronto and lab director of the Centre for Sleep and Chronobiology. “This pushes many people towards weight gain.”

Heart Matters
In a recent study by Dr. Najib Ayas, assistant professor of medicine at the University of British Columbia, women who slept less than six hours a night had a 39 percent higher risk of heart attack than those who slept eight hours. Previous studies have linked sleep deprivation to heart problems in men, says Ayas. One culprit may be inflammation of the arteries, a condition that has been linked to even mild sleep loss.

Studies have shown that one of the immediate effects of sleep loss is increased activity in cytokines—immune-system molecules secreted to fight disease. When elevated, they indicate there is something wrong, as if the body is being attacked. “This immediately causes increased blood pressure and inflamed arteries,” says Ayas. “If you suffer from chronic sleep loss, you are at higher risk for stroke and heart disease.”

Sleep loss seems to target the human heart in particular. Even the newest star on the heart-disease front, C-reactive protein—perhaps the body’s best predictor of heart attack and stroke—is elevated in sleep-deprived lab volunteers. C-reactive protein is produced by the liver as part of the body’s immune response and can indicate damage to arterial walls.

The Diabetes Link
Sleep scientist Eve Van Cauter at the University of Chicago recently monitored 27 sleepers aged 23 to 42 in their homes. One group slept just over five hours on weeknights; the other, eight. Van Cauter then tested the volunteers for insulin resistance—how well the body uses the insulin to regulate sugar levels in the body (the greater one’s resistance, the less effectively the body uses insulin). The results were astonishing. Those with five hours sleep had 50 percent more insulin resistance than those with eight hours. Researchers found that the results were comparable to what you’d expect to see in people decades older.

Accelerated Aging
When lab animals are deprived of sleep, they succumb to infections, their hair falls out and they rapidly waste away. “It could be a faster aging process or it could be an immune system gone haywire,” says Meir Kryger, director of the Sleep Disorders Centre at St. Boniface General Hospital in Winnipeg. “There are so many hormonal changes that are dependent on a normal sleep-wake pattern. Lots of things go wrong if you don’t sleep properly.”

Growth hormone is suppressed, for example, in people who don’t experience deep sleep. Children with sleep apnea—who sleep poorly because they frequently stop breathing—are often small as a result. Adults see changes in their fat-to-muscle ratio, which means more sagging and the likelihood of middle-aged paunch.

Sleep Therapies
The solutions to sleeplessness are better than ever, but it helps to understand the nature of your problem. “Most of the population are, at some point, unable to sleep for a short period of time,” says Dr. Mohamed Hussain, medical director of the Tri-Hospital Sleep Laboratory West in Mississauga. It could be triggered by grief, hardship, jet lag, divorce or pressures at work. The majority of people get over it quickly. But for some, sleep disturbance lasts longer. Since depression is a chief cause of chronic insomnia, you might need to treat that first.

Some steps you can take to solve sleep problems include exercising—but not within three hours of bedtime—and staying awake. Tempting as it is, insomniacs shouldn’t nap: It can sap your weak sleep drive. Go to bed at night only when you’re drowsy, and force yourself out of bed if you don’t drift off within 20 minutes or if you wake up and can’t get back to sleep within 20 minutes.

But what insomniacs need most is to break the panicky association between bed and sleeplessness. “People with insomnia tend to spend a lot of time in bed even if they don’t sleep,” says Régine Denesle, a psychotherapist at the sleep clinic at Sacré-Coeur Hospital in Montreal. “They toss and turn, which makes them more anxious and less likely to get to sleep.”

Sleep specialists in Canada and abroad have had remarkable success recently using cognitive behaviour therapy (CBT), which combines relaxation techniques, basic psychotherapy and “sleep restriction”—actually a restriction of the time spent in bed. At Denesle’s Montreal sleep clinic, 85 percent of CBT participants have cut their insomnia symptoms by at least 75 percent.

Two large studies, one in Scotland and one in the United States, indicate that people treated with sleeping pills revert to their dysfunctional sleep patterns within one to two years after treatment. But CBT-treated people don’t relapse.

Dr. Charles Morin, president of the Canadian Sleep Society, recently conducted a study at his Laval University sleep centre. After CBT, fully 80 percent of those who’d been habitually using sleeping pills were drug-free after ten weeks. Seventy percent remained drug-free one year later.

After toughing it out, Pascale Rigaud decided to get help. She consulted a doctor, who referred her to the insomnia program at Sacré-Coeur Hospital. In April 2003 she started CBT treatment with Denesle. “There were seven in the insomnia group I attended,” says Rigaud. “We introduced ourselves and talked about our sleep problems.” She learned breathing and muscle-relaxation techniques to soothe her nerves during the day and at night.

From the start she was asked to record exactly how long she slept each night. Insomniacs are notorious for underestimating their sleep, experts say, but Rigaud was pretty accurate—up to five hours, sometimes six.

The next step was harder; Rigaud and her classmates had to limit their time in bed. It’s a counterintuitive strategy yet is simple enough for anyone to try. Participants figured out how many hours they slept each night on average and set an alarm to rouse them at the end of that period—which was never to be less than six hours.

Denesle felt that a big part of Rigaud’s problem was that she was going to bed too early and thus spending too much time in bed, so she recommended that Rigaud stay up until 11 p.m. and set the alarm for 6 a.m.

Instead of obsessing about getting to sleep, insomniacs using this approach start worrying about how to stay awake, and there are noticeable improvements in just a week or two. “Insomniacs feel they are victims of something they can’t control,” says Morin. “Once they see they can sleep, they realize they are in control.”

For Rigaud, the tactic was magical. “To stay awake, I’d go for walks and watch the late news instead of the 6 p.m. news,” she says. “If I started to nod off, my husband kept me distracted until bedtime.” And in a snap, Rigaud’s attitude towards sleep changed.

“It was a big relief not worrying about waking up at night. I was so tired I began sleeping well after only a few days.” After a combination of therapy and 21û2 months of sleep restriction, Rigaud felt she had turned a corner, and she hasn’t looked back. Now she’s sleeping about eight hours a night. “It’s wonderful.”

To find a list of sleep centres across Canada, contact the Canadian Sleep Society at www.css.to. For a CBT program, contact the psychological association in your province or ask your physician for a referral to a behaviour therapist with this type of training.

If You Still Can’t Sleep
What Works:
Hot water. In some studies, a hot bath beat drugs in producing more deep sleep. Here’s how: An hour or two before bed, take a long hot soak. This will raise your body temperature. By bedtime it should start to fall, an internal signal that it’s time to sleep.

Prescription drugs. The newest pill on the market in Canada, Starnoc (zaleplon), is a favourite with doctors. “Starnoc is an excellent drug,” says Hussain. “It has a short duration—four hours. After that, your ability to function is good, unlike with other drugs, which have a hangover effect.” It is only recommended for short-term use.

Worth a Try:
A new pillow. Fold your pillow in half; if it doesn’t spring back, it’s time for a new one. Down pillows work well because they mold to your sleeping posture.

Over-the-counter medications. Most contain sedating antihistamines. But Dr. Peter Edmison, of the Academy of Dental Sleep Medicine in Ottawa, recommends them for only occasional use at best. Hussain warns: “They make you drowsy but don’t give you quality sleep. They could also lead to a psychological dependence.”

Aromatherapy. While not all sleep experts agree, the University of Toronto’s Dr. James MacFarlane says it may help. “When you inhale lavender, it slows brain-wave activity,” he says. “It’s a pharmacological nudge that, combined with relaxation techniques, can lead to good sleep habits.” At the University of Miami Medical School, 40 adults who were given three minutes of lavender aromatherapy showed increased beta power, suggesting increased drowsiness, and they reported feeling more relaxed.

Doubtful:
Melatonin. Although it helps reset the body clock in shift workers and jet-lag sufferers, studies haven’t proved that melatonin reduces regular insomnia. While not approved for sale in Canada, melatonin can be ordered from the United States for personal use.

If You Snore
What Works:
A tennis ball in a sock. People tend to snore when they are on their backs. Edmison suggests placing a tennis ball in a pocket sewn onto the back of your pyjamas. (A backpack containing an object also works.) “This will prevent you from sleeping on your back,” he says.

Worth a Try:
The Sealy snore-reduction pillow. By positioning your head and neck to keep your airways open, pillows with this design may reduce snoring not caused by sleep apnea, a Stanford University study found. You can order one from www.sealybedding.com. Count on paying upwards of $125, including taxes and duty.

Doubtful:
Nasal strips. “These only work if snoring is caused by an obstruction such as a deviated nasal septum,” says Hussain. They hold open and thus widen the nasal passage. “I do not use them in my practice because they convey false hope of a remedy for a serious condition.”

Antisnoring sprays. These oil-based sprays could potentially get into your lungs and cause serious problems. “I do not recommend them,” says Edmison.

Habitual snorers and insomniacs should always consult a doctor or sleep specialist.

Adapted from an article by Alexis Jetter

20 Ways to a Good Night's Sleep By Alison Ramsey 1. Curb caffeine and alcohol. For some people, a small amount of caffeine even early in the day can cause problems falling asleep ten to 12 hours later. Others have learned to avoid caffeinated drinks and foods within six hours of bedtime. Find your susceptibility by eliminating caffeine after lunch. Though alcohol may help you fall asleep, it can increase the number of times you awaken during the night. Skip the nightcap and see if your sleep improves. 2. Beware heartburn. Eating too fast, tomato products and spicy foods give many people heartburn, which makes falling asleep difficult. Lying down makes it worse, and the continued discomfort can also wake you up. 3. Restrict fluids. Drinking too much of any beverage can create the need to urinate during the night. Try to restrict your fluids before bedtime to help promote an uninterrupted night's sleep. 4. Snack wisely. A small, low protein, high carbohydrate bedtime snack, such as juice and cookies, eaten about an hour before bedtime can help you fall asleep sooner. 5. Don't try so hard. Anxiously watching the clock may actually cause insomnia. If you have clocks in the bedroom with luminous dials, get rid of them. 6. Exercise—at the right time. Don't exercise two to three hours before bedtime, but try a brisk walk, a run or a bicycle ride in the afternoon instead of a coffee break. 7. Avoid nicotine. Cigarettes are a stimulant, and addiction can create a night-time deprivation that can rouse sleepers. 8. Turn down the heat. Most sleep scientists believe that a slightly cool room, between 16° and 18° C contributes to good sleep. 9. Lighten up, or down. Try increasing your exposure to bright light in the evening. If sunlight isn't available, consider a lightbox. As little as one to two hours of evening bright-light exposure may help you sleep longer in the morning. Conversely, bright light can disturb sleep. Keep your bedroom dark with shades or lined drapes, or try wearing an eye mask. 10. Jot your worries down. If worries rankle when bedtime approaches, keep a worry book by your bedside. Jot down a brief note about what's on your mind and set aside time the next day to address the problem. Problems often seem smaller in the morning. 11. Calming tea. If you don't like warm milk, try a cup of hot chamomile, catnip, anise or fennel tea. All contain natural ingredients to aid sleep. Health-food stores often have special blends of herbal tea designed to help you relax. 12. Listen to music. Soft, soothing music can lull you to sleep. Some recordings designed for that purpose include composed music, sounds of waves rhythmically breaking, or the steady pattern of a heartbeat. For this to work, your record, cassette or CD player must turn off automatically. 13. Wiggle your toes. Lie on your back and wiggle the toes of both feet, at the same time, up and down 12 times. Reflexologists say this will relax your entire body, inside and out. 14. Rub your tum. This soothes the digestive system and aids relaxation. Lie on your back and place your hand on your navel. Begin gentle small clockwise circles. Let your circles gradually become bigger. When your circles reach the outside of your stomach, gradually decrease their size until your hand returns to your navel. Reverse direction and repeat. Repeat entire process with your other hand. 15. Don't read right before bed. Wait at least a half hour or longer before going to bed after reading or watching television. Let your stimulated mind have a chance to get rid of the images it sees. 16. Deep breathing. Slowly inhale while lying on your back, filling your belly, chest and top of lungs. Hold for a second or two, then exhale. Don't force your breathing; it's not a contest to see how much air you can take in. Continue for four or five minutes. 17. Try valerian. Valerian is the leading herbal sleep remedy. A half hour before bedtime, take 300 to 600 mg of concentrated (4:1 or 5:1) valerian root supplement, or 2 to 3 grams of the dried root in a capsule, or 5 ml tincture . 18. Visualize. Lie with your eyes closed and imagine you're in a peaceful place. It may be a sunny beach, in a hammock in your backyard or in a forest. 19. Imagine it's morning. Imagine your alarm has sounded and it's time to put your feet on a cold floor, take a shower and get ready for work. The more unpleasant you can imagine it, the more you won't want to do it. And the more you'll just want to stay in bed and sleep. 20. Progressive relaxation. This exercise is most effective when you tape record the instructions in advance, preferably in your own voice. Lie on your back, close your eyes, and listen. ( This is a mild form of self-hypnosis. The objective is to tense the muscles of each designated area, then relax them.) a) Feel your feet. Feel the weight of your feet. Feel your feet relax and sink into the bed. b) Feel your lower legs. Feel the weight of your lower legs. Feel your lower legs relax and sink into the bed. c) Feel your knees. Feel the weight of your knees. Feel your knees relax and sink into the bed. d) Feel your upper legs. Feel the weight of your upper legs. Feel your upper legs relax and sink into the bed. e) Feel your hands. Feel the weight of your hands. Feel your hands relax and sink into the bed. f) Feel your lower arms. Feel the weight of your lower arms. Feel your lower arms relax and sink into the bed. g) Feel your elbows. Feel the weight of your elbows. Feel your elbows relax and sink into the bed. h) Feel your upper arms. Feel the weight of your upper arms. Feel your upper arms relax and sink into the bed. i) Feel your pelvic and belly area. Feel the weight of your pelvic and belly area. Feel your pelvic and belly area relax and sink into the bed. j) Feel your back. Feel the weight of your back. Feel your back relax and sink into the bed. k) Feel your chest. Feel the weight of your chest. Feel your chest relax and sink into the bed. l) Feel your shoulders. Feel the weight of your shoulders. Feel your shoulders relax and sink into the bed. m) Feel your neck, both front and back. Feel the weight of your neck. Feel your neck relax and sink into the bed. n) Feel your skull. Feel the weight of your skull. Feel your skull relax and sink into the bed. o) Feel your mouth. Feel any tension in your mouth. Feel your mouth relax and any tension slide off into the bed. p) Feel your eyes. Feel any tension in your eyes. Feel your eyes relax and any tension slide off into the bed. q) Feel your entire face. Feel any tension in your face. Feel your face relax and let any tension slide off into the bed. r) Mentally scan your body. If you find any place that's still tense, relax it and let it sink into the bed. If you feel you have a sleep disorder, consult your doctor or a sleep specialist.