The Road From Diagnosis to Recovery
The Issue of Sleep

By Dr. Carol Kavanaugh, April 2007

It has been number of months since I have written a new article for our CSSA web site. I have had a number of sinus related illnesses and a great deal of fatigue which I know all of you can relate to so I will not apologize.

In the next several articles I would like to address an issue that is vital to all of us and frequently a problematic one and that is the issue of sleep.

We all know intuitively that we need good quality sleep in order to maintain vitality and balanced moods. And we all know that illness, especially chronic illness, impairs sleep. Additionally, certain medications, notoriously prednisone and stimulant medication such as those sometimes used in sinus decongestant medication, may also severely impair one’s ability to sleep effectively.

For many of us anxiety over the diagnosis of this disease, and sometimes the course of the disease if things are not going as well as we would like, or a reactive depression coupled with the illness, and the use of prednisone in all likelihood would give one a 90 percent chance of developing at least a brief sleep problem.

Most of us recognize the signs of sleep deprivation: In the short term sleep deprivation may cause:

• Decreased Performance and Alertness: Sleep deprivation induces significant reductions in performance and alertness. Reducing your nighttime sleep by as little as one and a half hours for just one night could result in a reduction of daytime alertness by as much as 32%.
• Memory and Cognitive Impairment: Decreased alertness and excessive daytime sleepiness impair your memory and your cognitive ability -- your ability to think and process information.
• Stress Relationships: Disruption of a bed partner's sleep due to a sleep disorder may cause significant problems for the relationship (for example, separate bedrooms, conflicts, moodiness, etc.).
• Poor Quality of Life: You might, for example, be unable to participate in certain activities that require sustained attention, like going to the movies, seeing your child in a school play, or watching a favorite TV show.
• Occupational Injury: Excessive sleepiness also contributes to a greater than twofold higher risk of sustaining an occupational injury.
• Automobile Injury: The National Highway Traffic Safety Administration (NHTSA) estimates conservatively that each year drowsy driving is responsible for at least 100,000 automobile crashes, 71,000 injuries, and 1,550 fatalities.
  

In the long term, the clinical consequences of untreated sleep disorders are large indeed. They are associated with numerous serious medical illnesses, including:

• High blood pressure
• Heart attack
• Heart failure
• Stroke
• Obesity
• Psychiatric problems, including depression and other mood disorders
• Attention Deficit Disorder (ADD)
• Mental impairment
• Fetal and childhood growth retardation
• Injury from accidents
• Disruption of bed partner's sleep quality
• Poor quality of life
  

While not all of these things apply to each of us it is easy to see how important a role sleep plays in getting better. There are easy techniques to follow that each of us can do to help get to sleep that do not require medications. They are usually referred to as ‘sleep hygiene’ techniques. Mostly they are common sense. The following are a list of things that may help.

1. Cut caffeine. Simply put, caffeine can keep you awake. It can stay in your body longer than you might think -- up to about 14 hours. So if you drink a cup of coffee at noon and are still awake at midnight, caffeine might be the reason. Cutting out caffeine at least four to six hours before bedtime can help you fall asleep easier. If you have already had too much caffeine, try eating some carbohydrates like bread or crackers to help reduce the effects.
2. Avoid alcohol as a sleep aid. Alcohol may initially help you fall asleep, but it also causes disturbances in sleep resulting in less restful sleep.
3. Relax before bedtime. Stress not only makes you miserable, it wreaks havoc on your sleep. Develop some kind of pre-sleep ritual to break the connection between all the day's stress and bedtime. These rituals can be as short as 10 minutes or as long as an hour.
   Some people find relief in making a list of all the stressors of the day, along with a plan to deal with them. This can act as "closure" to the day. Combining this with a period of relaxation perhaps by reading something light, meditating, aromatherapy, light stretching, or taking a hot bath can also help you get better sleep. And don't look at the clock! That "tick-tock" will just tick you off.
4. Exercise at the right time for you. Regular exercise can help you get a good night's sleep. The timing and intensity of exercise seems to play a key role in its effects on sleep. If you are the type of person who gets energized or becomes more alert after exercise, it may be best not to exercise in the evening. Regular exercise in the morning even can help relieve insomnia, according to a recent study.
5. Keep your bedroom quiet, dark, and comfortable. For many people, even the slightest noise or light like the purring of a cat or the light from your laptop or TV can disturb sleep. Use earplugs, window blinds or curtains, and an electric blanket or air conditioner- everything possible to create an ideal sleep environment. And don't use the overhead light if you need to get up at night; use a small night-light instead. Ideal room temperatures for sleeping are between 68 and 72 degrees Fahrenheit. Temperatures above 75 or below about 54 can disrupt sleep.
6. Eat right, sleep tight. Try not to go to bed hungry, but avoid heavy meals before bedtime. An over-full belly can keep you up. Some foods can help, though. Milk contains tryptophan, which is a sleep-promoting substance. Other foods that help promote sleep include tuna, halibut, pumpkin, artichokes, avocados, almonds, eggs, bok choy, peaches, walnuts, apricots, oats, asparagus, potatoes, buckwheat, and bananas. Also, try not to drink anything after 8 p.m. This can keep you from having to get up to use the bathroom during the night.
7. Restrict nicotine. Having a smoke before bed -- although it feels relaxing actually puts a stimulant into your bloodstream. The effects of nicotine are similar to those of caffeine. Nicotine can keep you up and awaken you at night. It should be avoided particularly near bedtime and if you wake up in the middle of the night.
8. Avoid napping. Napping can only make matters worse if you usually have problems falling asleep. If you do nap, keep it short. A brief 15-20-minute snooze about eight hours after you get up in the morning can actually be rejuvenating.
9. Keep pets off the bed. Does your pet sleep with you? This, too, may cause you to awaken during the night, either from allergies or pet movements. Fido and Fluffy might be better off on the floor than on your sheets.
10. Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, you can end up associating the bed with distracting activities that could make it difficult for you to fall asleep.

If these techniques are not effective and you still have trouble getting to sleep or maintaining sleep then talk with your doctor. There are several very effective newer sleep agents on the market. While not all doctors are well schooled or interested in sleep disorders, most are. If you find that yours is not, ask for a referral. Effective sleep in combination with appropriate treatment for your Churg Strauss Syndrome will help you on the ‘Road to Recovery’ much faster.

In the next Diagnosis to Recovery Article I would like to talk about some of the sub categories or different types of sleep disorders. God bless and feel better to all of you.

SOURCES: Principles and Practice of Sleep Medicine, Kryger, Meir, et al., Fourth Edition, 2005. Sleep: "Excessive Daytime Sleepiness and risk of Occupational Injuries in Non-shift Daytim
SOURCES: Principles and Practice of Sleep Medicine, Kryger, Meir, et al., Fourth Edition, 2005. Sleep: "Excessive Daytime Sleepiness and risk of Occupational Injuries in Non-shift Daytime Workers," Vol. no. 3. Sleep: "Dose-response Relationship Between Sleep Duration and Human Psychomotor Vigilance and Subjective Awareness," Vol. 22, No. 2. Sleep: "We Are Chronically Sleep Deprived," Vol. 18 No. 10