Sleeping well is necessary for well-being and good health. To help rest we can follow healthy habits, a balanced diet and exercise regularly. But we want to highlight a third pillar, just as important, that is here to stay: adequate sleep at all stages of life.
Do I have insomnia or do I have poor sleep quality?
Insomnia is the most frequent sleep problem, affecting around 20% of the population in Spain. It should be noted that a subjective complaint of “poor sleep quality” is not always true insomnia, or it is transient insomnia. A true “insomnia disorder” consists of little satisfaction for the quantity or quality of sleep (initial cost of falling asleep, cost of maintaining sleep with longer or shorter wakings, definitive awakening very early or combinations of the above), which occurs at least 3 nights per week for a minimum of three months, causing a clear deterioration in normal daily functioning and that it is not fully explained by other sleep disorders (for example sleep apnea or restless legs syndrome), substance use or other medical or psychological illnesses.
A subjective complaint of “poor sleep quality” is not always true insomnia
Faced with a problem of insomnia, there are a series of measures that must always be applied, alone or combined with other more complex ones, and which should be almost “a philosophy of life” regarding sleep, helping to prevent poor quality of sleep:
- Regular sleep times : get up and go to bed every day at about the same time. Constant changes in sleep schedules favor poor regulation of the biological rhythms that regulate it
- Eat at stable times and avoid large meals near bedtime, to sleep with the digestion done. Recent studies suggest that eating all meals a day between 8 a.m. and 8 p.m. helps control metabolic problems and improves sleep quality.
It is also not convenient to go to bed hungry. If you notice a slightly empty stomach, eat something light before bed, such as a little warm milk or yogurt (dairy products contain tryptophan, which makes it easier to induce sleep). Try to avoid fluid intake as much as possible at bedtime (they can cause nocturia, the need to urinate at night).
- Limit the intake of substances with a stimulating effect , such as coffee, tea or cola, especially from 5 to 6 pm. It is also convenient to limit alcohol consumption, especially at night, causing shallow, shallow sleep and awakenings. Limit or use tobacco, especially at night, since nicotine is a stimulating substance.
- Avoid long naps during the day (no more than 20-30 minutes) and flattering situations.
- Do physical exercise during the day , at least several days a week. Exercise should be mild-moderate, never strenuous, for at least an hour, best in sunlight, and always at least 3-4 hours before going to sleep. Avoid exercising at night without light due to its stimulating effect.
- To sleep well you need to be physically and mentally rested when going to bed. Exciting activities in both directions should be avoided two hours before bedtime. Activities such as watching television, using tablets or other mobile devices, talking on the phone, listening to the radio, etc. should not be done in bed. Our brain needs to associate the bedroom and the bed to sleep.
- At first or when you wake up at night, if you cannot fall asleep in 20-30 minutes, uncomfortable and tense, you have to get out of bed and leave the bedroom for a while, avoiding physical activities or activities that require concentration . When the “eyelids are heavy,” go back to bed. Better less time in bed, but used, helps not to associate the bed in a tense way with the problem
- Avoid looking at the clock at night , it does not contribute anything positive to know what has fallen asleep and what remains to sleep, only worry and negative thoughts about the situation that they activate (set the alarm and turn it around, forgetting about it as much as possible )
Obstructive sleep apnea-hypopnea syndrome (SAHS)
The second most frequent sleep problem is obstructive sleep apnea-hypopnea syndrome (SAHS). It affects 10% of the population, 20% of those over 65 and 2-3% of children, and many of the cases are not diagnosed or treated.
SASHS causes daytime sleepiness, hyperactivity, tiredness, and poor performance
It consists of the existence of significant rates of total respiratory pauses (apneas) or partial (hypopneas) during sleep with a duration of at least 10 seconds in adults and about 5-6 seconds in children , causing momentary drops in oxygen saturation in blood (not always), awakenings or micro awakenings and more superficial and less effective sleep than desired. It causes a feeling of unrefreshing sleep , a feeling of excessive drowsiness during the day in sedentary and monotonous situations in adults, hyperactivity and attention deficit in children, tiredness and lack of performance. It is frequently accompanied by significant snoring, need to urinate several times at night (nocturia), dry mouth or throat when getting up or at night, headaches, predisposition to metabolic problems and, in adults, hypertension of difficult control. Sometimes it is more serious when sleeping in a specific body posture, most often on your back. For the accurate diagnosis of its severity and repercussions, specific tests are required, polysomnographic sleep studies.
Being overweight, obstructive and / or irritant problems of the upper respiratory tract (deviated nasal septum, tonsils and large vegetations, chronic rhinitis, nocturnal gastroesophageal reflux) predispose to the disease, and therefore it is necessary to try to avoid it. Chronic sleep deprivation, alcohol and excessive tobacco or at night …
In the case of confirmed diagnosis, the measures to be adopted are:
- Progressive loss of excessive body weight for age and sex
- Correct possible obstructive problems of existing upper pathways (most important in children)
- Avoid sleeping in the body position where you snore the most or have seen predominant respiratory pauses and, in significant cases, the use of devices that administer positive air pressure during sleep (CPAP) to control the problem and reverse symptoms. In selected cases, Mandibular Advancement Devices (DAM), special custom-made splints worn during sleep inside the mouth, may be helpful.