Q: What are the common hormonal imbalances?
A: Hormones play an important role in the regulation of metabolism, growth, and sexual function. Abnormalities in the level of hormones such as insulin and thyroid hormone can affect many systems and organs in the body. Most hormonal imbalances are rare, with diabetes mellitus and thyroid disease being the most common in the US. In fact, these are so common that they should be tested for if anyone complains of fatigue during the day.
Q: How does diabetes affect sleep?
A: No specific abnormalities in sleep have been noted with diabetes. Obviously, having a hypoglycemic attack during sleep can be dangerous because it can be missed and may make you lethargic in the morning. Many people with sleep apnea have diabetes or are in a prediabetic stage. Sleep apnea is often under-recognized in the diabetic population. If you have diabetes and think you may have symptoms of sleep apnea, it is important that you consult your doctor.
Q: How do inadequate amounts of thyroid hormone affect sleep?
A: Low levels of thyroid hormone (hypothyroidism) can cause a drop in the amount of slow wave sleep. The most important sleep link with hypothyroidism is sleep apnea, which does not go away if just your hypothyroidism is treated–so it is important to be treated for both conditions.
Q: How does hyperthyroidism (high levels of thyroid hormone) affect sleep?
A: If you produce too much thyroid hormone, your metabolism increases greatly and not surprisingly, can lead to problems with insomnia. This may result in daytime mood changes and exacerbate your already low frustration and tolerance levels as well as increase your irritability. Treatment of hyperthyroidism will settle this down and help restore more restful sleep. During this phase of the illness, sedative medication may be helpful.
Q: What is the link between heart disease and sleep?
A: A large number of heart conditions can be affected by normal hormonal and nervous system changes that occur during sleep. Studies in large populations suggest that about 1 in 5 heart attacks and about 1 in 6 sudden cardiac deaths occur in the hours between midnight and 6am. This nocturnal risk of worsening heart disease may be a result of the fact that many people are unaware of their symptoms while they are asleep at night.
Q: How can sleep increase the risk of having a heart attack?
A: During the different stages of sleep, there are changes in hormonal levels and the action of the nervous system in the body responsible for “fight or flight” responses (the sympathetic and parasympathetic systems). Sleep-induced instability in these systems can cause increased strain on an already sick heart and lead to problems with heart rhythm and rate, angina, and heart attacks. Some cardiac medications and medications taken for high blood pressure can also trigger violent dreams (thereby increasing activity) and cause poor sleep. Having a sleep disorder such as sleep apnea also increases the risk of heart strain.
Q: What can I do to ensure that my sleep is not putting my heart at any risk?
A: Firstly, all people with heart disease should examine their lifestyle and make sure that they are at their ideal weight, exercising within their limitations, taking their medications, eating well, not smoking or drinking alcohol excessively, and having regular checkups with their cardiologist. Those who think that their medications are causing problems, or that they may have sleep apnea (which is a major risk factor for heart attack), should discuss it with their doctor. Effective blood pressure control and reporting any heart-related symptoms that occur at night are crucial to managing the condition.
Q: How does heart failure affect sleep?
A: Heart failure, if it is poorly controlled or very severe, can cause nocturnal waking, often with a sensation of shortness of breath and panic. Sleep apnea can coexist with heart failure and also disrupt sleep. Sometimes people with severe heart failure can experience breathing pauses because of poor circulation to the respiratory control centers in the brain. This can add to feelings of daytime fatigue and sleepiness. None of the experiences described above are “normal,” so if you have any of these symptoms you must talk to your doctor. A specialist should investigate breathing disruptions in heart failure so that you are treated appropriately for the condition.
Q: What digestive problems can affect sleep?
A: Any problems with the digestive system can disrupt sleep during the night and lead to a feeling of being unrefreshed during the day. The most common problems are uncontrolled diarrhea resulting from an infection of the gut, inflammatory bowel disease that is poorly controlled, or irritable bowel disease. Problems with acid reflux (heartburn) are also very common.
Q: I have problems with heartburn (acid reflux) at night–is this normal?
A: About 7 in 100 otherwise “healthy” people experience heartburn on an almost daily basis. Most of these people also experience significant heartburn at night, disrupting sleep and leading to feeling unrefreshed in the morning. Many of us will experience occasional heartburn, often after spicy food, or if a large meal is eaten close to bedtime. Nocturnal reflux may be a sign of sleep apnea.
Q: What can I do about my heartburn at night?
A: There are simple lifestyle measures you can take to reduce the degree of heartburn. These involve eating smaller meals in the evening, several hours before going to bed. Elevation of the head of the bed can also be useful (you can buy a special bed or use bricks to prop up the head of the bed and create a tilt). Sometimes, people find it useful to use several pillows so that they are not lying completely flat. An antacid may also be useful. Avoiding foods that provoke your heartburn is a good idea and avoiding alcohol before bedtime is also recommended. However, if your heartburn persists, you must seek medical advice. Investigation and treatment are now fairly straightforward. Untreated heartburn increases the risk of peptic ulcers and, in the long term, of developing esophageal cancer.
Q: Why is heartburn worse at night?
A: There are many factors that can contribute to worsening of heartburn at night, including the position that we sleep in and a reduction in swallowing frequency and salivation (production of saliva) during sleep. Thus, acid that refluxes up the esophagus tends not to be washed back down into the stomach. Acid secretion in the stomach is also enhanced during the night. Alcohol and sedative medication can delay acid clearance, making reflux worse.
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