This year, World Sleep Day takes place on March 15, and is dedicated to raising awareness of sleep health. Like eating healthy and drinking plenty of water, getting a restful night's sleep is extremely important for your mental and physical health. For example, restful sleep can:

  • improve mood as it restores the body and increases energy levels
  • result in a more restored immune system as it can restore and repair the body, making you feel more refreshed in the morning
  • promote heart health, as your heart rate slows and blood pressure drops during sleep, allowing your heart and vascular system to rest.

There are three questions I ask my patients that define a restful night’s sleep:

  1. Can the person get to sleep comfortably?
  2. Does the person stay asleep at night?
  3. Does the person wake rested?

Let’s break each down below.

Can the person get to sleep? 

Are they falling asleep quickly or does it take hours to finally drift off to sleep?

Sleep hygiene is the term we use to explain good habits before bedtime such as avoiding screen time and stimulants prior to bed. Studies have shown that electronic devices emit blue light that can suppress melatonin production and alter circadian rhythms, leading to disrupted sleep. Similarly, stimulants lead to increased alertness within the body which can result in difficulty falling asleep.

Fifty percent of all chronic insomnia is the result of pain somewhere in the body. Relieving chronic muscular pain can be helped with Epsom salt bath prior to bed. Anti-inflammatory supplements or NSAIDs for a short time may be helpful. The best advice is to consult with a doctor or therapist regarding the part of the body that is problem some. 

As we age our production of melatonin decreases, which results in insomnia and restless sleep. Supplementation is sometimes necessary. Valerian root is the only supplement that has been found to benefit all stages of sleep, so it helps in getting to sleep and staying in restful deep delta wave sleep.

Does the person stay asleep at night? 

Are they waking throughout the night often to urinate?

Awakening from sleep is often related to suffocation. A worldwide meta-analysis of over 8,000 articles estimates that obstructive sleep apnea (OSA) is prevalent 54% worldwide and 56% in the U.S., making it among the most popular forms of sleep disordered breathing (SDB). According to the Mayo Clinic, people with OSA repeatedly stop and start breathing during their sleep. This is caused when the muscles in the back of the throat—which support the back of the mouth (soft palate), tongue, and side walls of the throat—relax too much to allow for proper breathing. This relaxation of the muscles causes the airway to narrow or close as you breathe in, causing impaired breathing. When this happens, your brain senses the drop in oxygen and buildup of carbon dioxide and wakes you up for you to re-open your airway. When the airway is obstructed by the tongue, there is negative pressure on the chest during inspiration. This results in increased blood flow to the right atrium, which stimulates the production of a diuretic hormone as the body thinks it has too much fluid. The result is that the bladder fills and during the awakening from not breathing the person now needs to use the bathroom.

It is very important that if you find yourself constantly awakening at night with trouble breathing, seek evaluation from a sleep physician.

Does the person wake rested?

If a person can get to sleep and stay asleep, then they should wake rested, however many do not. Some people wake exhausted.

Not waking rested is associated with restless sleep. This can be due to many factors, including GERD (gastroesophageal reflux disease), anti-depressant drugs (SSRIs), recreational drugs, psychosocial problems resulting in teeth grinding, and nasal obstruction.

The nose is responsible for 50% of airflow resistance, therefore it is imperative to have an optimal functioning nose to ensure proper breathing while sleeping. Not to mention, proper breathing is necessary to filter, moisten, warm and humidify air, and to mix with nitric oxide in our sinuses before entering our lungs. This is our immune system.

The use of nasal sprays that do not cause a rebound effect like over-the-counter decongestants and antihistamines are important for daily use. In a study published by myself and Joseph Baba, we found that utilizing a mixture of the hyperosmotic saline and xylitol (Xlear Nasal Spray) was effective in reducing soft tissue hypertrophy (increase in muscle size) of the nasal complex. This should be considered for both prevention and treatment of soft tissue obstruction as it assists with increased nasal volume and flow to improve sleep breathing disorders. Xylitol is anti-microbial, so in addition to reducing swollen tissue, it also kills germs that can cause infections.

As we come upon World Sleep Day, let us remember the importance of a restful night’s sleep for mental and physical health. If you’re struggling with poor sleep, don’t hesitate to reach out to a professional for assistance.


Resources

  1. World Sleep Day https://worldsleepday.org/ 
  2. PC Neuzeret, L Morin. Impact of different nasal masks on CPAP therapy for obstructive sleep apnea: a randomized comparative trial. Clin Respir J 2016. [Epub ahead of print].
  3. Viviano J, Klauer D, Olmos S, Viviano D. Retrospective comparison of the George Gauge registration and the sibilant phoneme registration for constructing OSA oral appliances. Jour Craniomand & Sleep Practice. 2019 Nov 26;1-9.
  4. Singh GD, Olmos SR. Use of a sibilant phoneme registration protocol to prevent upper airway collapse in patients with TMD. Sleep Breath. 2007 Dec;11(4):209-16.
  5. Olmos SR. Comorbidities of chronic facial pain and obstructive sleep apnea. Curr Opin Pulm Med. 2016 Nov;22(6):570-5
  6. El-Solh AA, Moitheennazima B, Akinnusi ME, Churder PM, Lafornara AM. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep and Breathing 15, 203-208 (2011).
  7. Steven Olmos and Joseph Baba. “Improved Nasal Volume Utilizing Hyperosmotic Saline Xylitol Mixture (Effective Alternative or Adjunct to Decongestants and Antihistamines)”. EC Pulmonology and Respiratory Medicine 8.5 (2019:): 444-452.
  8. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090#