an autodidact meets a dilettante…

sleep apnoea mask – looks great, feels even worse?

I went to a Science in the Pub talk last night, not knowing what to expect. The three speakers were all researching sleep, and the focus was mainly on insomnia and sleep apnoea. How fortunate, for I’m having a problem with insomnia at the moment. I may well have a problem with apnoea too, but because I sleep alone I can’t monitor it. Sleep apnoea is about blocked airways that reduce the intake of oxygen, causing sleep disturbance. Here’s an extract from the Better Health Channel on the subject:

In most cases, the person suffering from sleep apnoea doesn’t even realise they are waking up. This pattern can repeat itself hundreds of times every night, causing fragmented sleep. This leaves the person feeling unrefreshed in the morning, with excessive daytime sleepiness, poor daytime concentration and work performance, and fatigue. It’s estimated that about five per cent of Australians suffer from this sleep disorder, with around one in four men over the age of 30 years affected.

So it’s much more common among older males, and it correlates with excessive weight and obesity. Some years ago, when I had a sleeping partner, she expressed a concern about what she thought might be my sleep apnoea, but since then I’ve lost a lot of weight, and my overall health – apart from my bronchiectasis – has improved, so I don’t intend to worry needlessly over that, but it was interesting to hear about the CPAP mask and other treatments being offered, including the possibility of surgery to the uvula and tongue. Also that the evidence is mounting about the long-term effects of sleep apnoea, upon the heart particularly, though not surprisingly with obesity, confounding factors are hard to control for. The problem I’m having at the moment, though, is ‘advanced circadian rhythm’ insomnia, which has only been happening over the past few weeks and which I’m hoping will sort itself out. Our roughly 24-hour circadian rhythms, our body clock, when running at its best, gives us at least eight hours sleep, optimally between 11pm and 7am, though there is enormous individual variation, and huge variation in tolerance of sleep deprivation, possibly due to genetic factors. Amongst the many varieties of body clock-related sleep disorder, two were focused on last night; delayed-phase and advanced-phase circadian rhythms. The terms are largely self-explanatory. In the delayed-phase type, you stay up late and find it hard to get up in the morning, a common teenage problem (or habit). In the advanced-phase type, which I’m now experiencing for the first time in my life, you find yourself falling asleep alarmingly early, and then waking up – and being alarmingly wide awake, at 4am or sometimes even earlier.

The Circadian Sleep Disorders Network is a great place to learn about the problems, and possible solutions for having a body clock that’s out of synch with the day-night cycle or with your work or other commitments. These problems can lead to all sorts of stresses, but what I took from last night’s session, though it was never explicitly stated, was that your attitude to wonky sleep patterns might be causing more stress than the patterns themselves. In my case, though it’s irritating, I tell myself I needn’t stress over it as I have to get up around 6am for work anyway, and as long as I’m awake and fully operational until 5pm, or 7pm for cooking and eating dinner, it’s no big problem. I’ve not noticed excessive daytime sleepiness or poor concentration (but maybe I’m not concentrating enough). Though I do hope it will right itself, just because being abnormal feels – abnormal. Then again, I’m abnormal in so many other ways that are far more stressful.

Advanced-phase sleep disorder is apparently much less common than delayed phase, though that might just be that it’s less often reported precisely because it doesn’t disrupt work routines. The main treatment is the use of bright light, though I’ve found myself falling asleep in the bright light of the lounge room, or in my bedroom with a bright reading lamp left on. But there’s more to it than just leaving the light on. Here’s a summary from the Sleep Health Foundation:

Bright light visual stimulation should occur in the evening before you go to bed. The light should be brighter than normal indoor lighting. You can obtain it from specialized light boxes, or portable devices that you can wear, e.g. eye glasses. A few examples can be found by a web search for “bright light therapy”. You may need an hour or two of bright light therapy before bed. Some will benefit from nightly use for a week. Others will need longer, sometimes several weeks, to get maximum benefit. It is best used late in the evening, perhaps turning the bright light device off half an hour before bed.

Something to think about if this keeps up. Another treatment is with melatonin, the ’sleep hormone’:

One option is to take a 2mg slow release melatonin tablet (Circadin™) as close to your new (later) bedtime as possible. A second option is to take a small dose of melatonin (0.5 mg), about half way through your sleep period. This could be at a time when you wake up on your own. To change your hours of sleep, you should gradually delay your bed time (e.g. 20 minutes later each night) until you get it to the time that you want. As you delay your bedtime, you will also be delaying the time of your bright light exposure and melatonin intake.

Obviously, neither of these treatments are simple or guaranteed to be effective. Cognitive behaviour therapy was suggested by the experts, if these approaches were unsuccessful, but I know next to nothing about that. For now I’m not too worried, I just hope the problem goes away without my noticing.