WOMEN & SLEEP || Adventures in Sleep for the Pregnant Woman, Part Three: The Third Trimester

Congratulations! You've made it to the final third! Now what?

Many sleep problems return as your body and baby both grow more rapidly as you near the end of pregnancy. You may find you cannot sleep at all at night, thanks to the kicking baby and other pregnancy-related sleep disturbances. Knowing what you can expect and preparing for it can be helpful in getting through these last 13-15 weeks.

The main problems pregnant women experience with sleep during the third trimester relate to the following challenges: 

1. Bladder issues
2. Fatigue 
3. General discomfort
4. Heartburn 
5. Obesity
6. Snoring

Let's take a closer look. 

Bladder pressure returns in the last third of pregnancy because, you guessed it, there's little room left for all your different parts in the presence of your growing baby. You may even feel as if you are being kicked or pushed on by the baby as they float about in the womb. It will make you want to use the bathroom a lot, but don't limit your consumption of fluids if this is the case. Solutions? Time your water drinking so you get most of your fluids during the day, if that helps keep you in bed more at night. Try to lean forward when on the toilet to fully empty the bladder, as well. 

Some people find the new-fangled device, the Squatty Potty, a great tool for helping to void urine as it allows you to tilt your pelvis in a way that makes urination and defecation easier to complete. Fully voiding the bladder may help give you more uninterrupted sleep at night or during naps.

Fatigue comes back again, maybe worse than ever. It's all for the same reasons before: either your body is working in overdrive and you need to rest and recharge your batteries, or you may have some hidden sleep breathing issue or restless legs concern interrupting your ability to sleep soundly.

Solutions? Nap whenever possible, and look into advice from your doctor for any nighttime sleeping issues which might be disrupting your sleep pattern if they relate to discomfort in the legs or breathing.

See Also:
Adventures in Sleep
for the Pregnant Woman, Part One:
The First Trimester
---
Adventures in Sleep
for the Pregnant Woman, Part Two:
The Second Trimester
---
Adventures in Sleep
for the Pregnant Woman, 
Postpartum Edition

General discomfort with your pregnant body is a common problem at bedtime; it's hard to find a comfortable position for sleeping. Your baby maybe be very active, it seems, at night (which is not necessarily true; you might just notice their activity more when you are at rest). Finally, you may suffer from back pain (especially sciatica) from carrying out your load, and that can interfere at night when trying to get comfortable for sleep. 

Solutions? Enjoy the feelings that come from your kicking baby! It's a good sign that all is going well from the inside. Using pillows to prop you up and/or support your back while sleeping is a popular solution when the belly becomes too big to move about easily. Sometimes a recliner makes for the perfect solution, and don't forget to consider propping up the head of your bed by 3 inches. Easy lower-back stretches, massages, and warm baths can help with back pain before bedtime, as well.

Heartburn, gas and reflux come back with a vengeance, too; your digestive system is cramped and overtaxed with processing your meals. It may even make you less hungry; the thought of discomfort after meals can be a real motivation for not eating at a time when your baby needs you to be eating well. 

Solutions? Propping up the head of your bed by 3 inches uses gravity in your favor to keep food moving downward through your digestive tract. This may also be a good time to use a recliner. Eat smaller meals made of complex carbohydrates and lean proteins more frequently to keep a steady supply of nutrients without sending your system into turmoil. Avoid high-fat foods or foods you know will make you gassy. Drink your water, too, as it is essential for good digestion. There are some calcium products that are safe to use for heartburn during pregnancy; ask your doctor if you can't seem to surmount these challenges at night. There's no need to suffer unnecessarily.

Aside from obstructive sleep apnea, obesity during pregnancy
can bring on a host of other unwanted problems. 

Obesity can become a problem at the end of pregnancy. You are supposed to gain some weight, but sometimes the weight gain becomes very hard to control, and yet you still need to eat to support the baby. It is concerning not just from a general standpoint, but because it can become a major risk factor for sleep apnea during late-stage pregnancy; the extra tissue in your neck and throat can threaten to block your airway at night, which puts both you and baby at risk for hypertension, insulin resistance and other problems.

Solutions? Try to exercise however much you are able in order to maintain good metabolism. Choose foods that are nutrient dense but not calorie dense. Avoid empty calories and high-fat foods, especially take-out, fast food and junk food. It's of questionable value to you and your baby. Ask your doctor for help if you wake up with headaches, see a rise in blood pressure, start retaining water unnecessarily, or have sore throats or dry mouth upon awakening as each of these may signal the presence of upper airway resistance or apnea. 

Snoring will likely return in the third trimester. It may be harmless but it could also indicate upper airway resistance or apnea. You don't have to be overweight to snore. You could have allergy issues, or problems with nasal or sinus congestion that mean you have extra mucus or swollen membranes getting in the way of your ability to breathe while asleep. 

Solutions? It never hurts to use saline nasal spray to keep passages moist and to relieve elevated levels of mucus. Ask your doctor to check out your options for safely treating concerns about nighttime congestion.

WOMEN & SLEEP || Adventures in Sleep for the Pregnant Woman, Part One: The First Trimester

See Also:
Adventures in Sleep
for the Pregnant Woman, Part Two:
The SecondTrimester
---
Adventures in Sleep
for the Pregnant Woman, Part Three:
The ThirdTrimester
---
Adventures in Sleep
for the Pregnant Woman,
Postpartum Edition

The first trimester may be smooth sailing for you or it may lead to all kinds of surprises. Knowing what to expect can help to offset the worst things that could happen to your sleep. Now is the time to get into the practice of listening to signals from your body: if you're tired, sleep. If you're hungry, eat. If you feel overwhelmed, slow down. Learn your cues now; this is a skill you will need from here on out, not only for helping yourself but also in your role as a future mother.

The main problems women have with sleep during their first trimester fall into the following categories:

1. Insomnia or daytime sleepiness, or both
2. Swelling and excess bodily fluids
3. "Morning sickness"
4. Nightmares
5. Changes in appetite

Let's take a closer look.
Sleep problems (insomnia or daytime sleepiness) can be blamed mostly on surging hormones (namely, progesterone). This is because your body is in constant chemical flux while it adjusts to the ongoing changes taking place not only in your womb, but in your brain, your blood, nearly every other organ. 

If you can't sleep at night, check in with yourself to make sure it's not due to any stress or anxiety brought about by the uncertainties of pregnancy and future motherhood; these will also interfere with your ability to sleep well.
Solution? Progesterone levels can lead to daytime drowsiness and nighttime restlessness; it's just part of the territory.

Take naps when you can. If you are working while pregnant, ask for a private space to nap during the day; many offices are now more open to cat naps as a way to refresh employees, leaving them more productive. 

Also, don't let insomnia stress you out, and if you find you are worried about your pregnancy and the future, find someone to talk to about it. 

Learn new ways to relax at bedtime and practice simply resting if you can't sleep so that your body still gets a physical reprieve. Being flexible is key.

Extra body fluids means you have more blood in your body as well as more fluids collecting (you'll notice this mostly in your feet or your breasts). The extra body fluids may mean you need to use the bathroom more often at night and find it hard to get in a comfortable position due to the discomfort of swelling. Breasts may feel tender. If you sleep on your stomach, any swelling there could make it hard to achieve a comfortable position for sleeping. 

You may also find it harder to breathe at night; this is because your nasal passages may also be swollen, or you may be collecting the day's swelling in your neck tissues, leading to potential airway blockage as you sleep.

Solution? If you have extreme swelling, mention it to your healthcare professional. Edema can signal potential problems that should be addressed right away. 

If it's just an annoyance, but does not alarm you, then keep drinking your water as a way to flush out your system. Becoming dehydrated will just make you more fatigued. Your body is built to collect some extra fluid during pregnancy so that it can help build the amniotic sac. If that means you need to use the restroom more often at night, then it's something you'll need to adjust to (cutting back at night can help, if need be). 

Also, learning how to sleep on your side can help with multiple comfort issues: left-side sleeping offers some relief from reflux and both partial and complete obstructions of the airway (apnea); it also improves blood flow between your body and your womb and better assists your system in voiding wastes. 

When you lay down at night to sleep, fluids that have collected in your feet will redistribute across all of your tissues (gravity) and that could mean you may be experiencing apneas at night. 

If your bed partner tells you they have noticed you gasping for sleep or snoring when you weren't snoring before, speak with your doctor about getting a sleep study to rule out (or rule in) sleep apnea as the culprit behind your sleep problems. 

Nausea and vomiting, incorrectly dubbed "morning sickness," can happen at any time and doesn't wait until morning to present itself. You may find yourself feeling sick at 2pm or 2am as well as 7am.  

While there's no specific reason behind these side effects of pregnancy, they are usually the result of your swiftly changing body chemistry, matched with heightened sensitivity to odors and taste. Your digestive system is also making changes and the result may lead to feeling sick to one's stomach.

When nocturnal queasiness strikes, it can cut significantly into quality sleep time. If it is an ongoing problem and you are sick and vomiting around the clock, contact your doctor immediately.

Solution? Mild carbohydrate snacks like crackers, kept on your nightstand, can take the edge off nausea. 

So can avoiding high-fat acidic foods before bedtime, which can lead to reflux and gastrointestinal issues. 

Acupressure wrist devices (used for seasickness), when worn to bed, may help. 

Ginger tea at bedtime is helpful for some, but make sure it is only ginger (other herbs can be dangerous to take during pregnancy). 

Ultimately, don't let this common problem get you down; try to remember that it is usually temporary and goes away for most mothers by the end of the first trimester, if not sooner. 

For those who have extreme problems, consulting your healthcare professional about an anti-nausea drug may be the only way to conquer the problem of nausea and vomiting. 

Vivid dreams are a product of brain and body chemistry changes blended with your own anxieties about being pregnant and anticipating the new work of mothering. 

You will have both positive and negative emotions at this time: mood swings are normal as you begin to reinvent who you are with the prospect of becoming a mother. Dreams and nightmares are one way your consciousness allows you to work off some of that extreme anxiety or anticipation. 

You may also just notice your dreams are more vivid because you'll wake up more frequently due to a need to use the bathroom; that unexpected wake time might interfere with one of your REM (rapid eye movement) or "dream" cycles, meaning you are likely to remember your dreams than if you'd just slept right through them.

Solution? If you have extreme emotions about being pregnant, you may want to get some help to manage your anxiety. If it's not extreme, then try capturing your dreams in a journal. 

Vivid dreams, in and of themselves, are not a bad sign of anything. They just happen. If the content and tone of your dreams is more or less positive, especially, try to find ways to enjoy this experience. 

Appetites change dramatically during the first trimester. You are eating for two, after all! Your metabolism is racing! For some women, this means constant hunger and cravings for odd foods; for others, it means food aversions. 

Food cravings and insatiable hunger can keep up the most ardent sleeper. 

For food aversions, the mere thought of certain foods right before bed can launch a wave of nausea.

Solution? Manage your meals so that you have them evenly spaced throughout the day, and choose healthy snacks between them to cut down on hunger pangs. 

It's okay to indulge in cravings if they are healthy, but portions and frequency of cravings of high-fat, less-healthy foods should be held in check. 

Also, try to keep your nighttime foods limited to lower fat, lower acid foods to ward off reflux. 

If you have food aversions, go ahead an honor them as long as they don't get in the way of eating healthy, keeping in mind that, if you don't eat enough calories, by nighttime your hunger pangs may present as nausea. 

Some healthy snacks to have on hand for all hours of the day and night include fresh fruit, cut raw vegetables, avocado, whole grains, whole grain breads and crackers, peanut butter, cereal with milk, hard-boiled eggs, low-fat cottage cheese, cheese sticks, and lean organic cold cuts.

WOMEN & SLEEP || Introducing Adventures in Sleep for the Pregnant Woman

It may or may not surprise the new mother-to-be to learn that their sleeping habits may suffer even before they have their baby, even as soon as a few short weeks into pregnancy. In fact, the sleep deprivation that comes of starting a new family can begin well before the baby is even born!

The first part of a woman's pregnancy is a busy time for the body; major changes are taking place that may not be outwardly obvious. The bloodstream is racing with new levels of progesterone, which can lead to swelling, changes in the actual structure of certain tissues, extreme changes in energy levels, unusual cravings, nausea and, for many, a deep desire to sleep all day every day. 

Over the next few days, SHC will discuss the "adventures in sleep" by breaking down what to expect by way of trimesters before birth and into the days postpartum. Generally speaking, however, a woman who is newly pregnant can expect to experience changes with some or all of the following body functions over the course of their pregnancy. 

Anxiety: The uncertainties of pregnancy, when added to the day's list of other worries, can take its toll on sleep. 

Appetite: Some women have immense cravings and feel like they cannot eat enough. These feelings don't just happen during mealtimes, either; sometimes hunger pangs can wake up the soundest sleepers when they are pregnant. 

Congestion: Your body overall will swell as it holds more fluids, and that can lead to stuffy noses that can make it difficult to breathe comfortably at night.

Fitness impacts: Levels of fatigue may swing high or low depending upon the pregnancy. Also, one's ability to exercise can be interrupted by many of these other symptoms. Exercise can help tremendously with a good night's sleep, but if it's done too close to bedtime, it can leave stress hormones at too high a level to promote an easy transition to sleep. 

Frequent urination: The uterus and the bladder will have many battles over real estate across the entirety of pregnancy as pressure from the uterus will place more voiding demands on the bladder. This can mean lots of nocturnal awakenings to use the bathroom.

General discomfort: The processes that define pregnancy are complex; so many different organs and tissues are undergoing transformation more or less at the same time. Your body, no doubt, will feel different and, sometimes, downright uncomfortable. Sleeping may be an uncomfortable experience as the body shape changes, weight distribution falls out of normal balance and joints and connective tissues try to keep everything in place. 

Heartburn and indigestion: This is a common side effect of pregnancy and can lead to reflux disease at night, which can keep many pregnant women up late (especially if they are having nighttime food cravings). 

Insomnia: There are multiple reasons why pregnant women, who are tired all the day, end up suffering with insomnia as well. Blame it on body chemistry and changes in mood, but don't rule out other possibilities, like sleep apnea or restless legs.

Leg cramps: Again, this is a chemistry imbalance; the body needs its electrolytes and when it doesn't get them in full balance, the legs are often the first place to reveal this problem. Nighttime charleyhorses can result; they are no fun during the day, and at night, they can be tenfold worse because they disrupt your sleep. 

Medications: If you are taking any medications while pregnant, make sure it is safe to do so. And keep in mind that medications are essentially chemistry. You add chemistry to your body chemistry every time you take a drug; at nighttime, this can lead to problems with insomnia when chemistry collides. 

Nausea: Some women experiences runs of nausea that blunt their appetite; unfortunately, morning sickness doesn't always wait until morning.

Restless legs: This could have been a "thing" before pregnancy, or it could happen while being pregnant. There are multiple causes for these and they should be identified and treated whenever possible. One cause among pregnant women is anemia; the twitching and discomfort can make it very difficult to fall asleep.

Sleep apnea: More general edema in the body means plumper tissues and more opportunities to interfere with the upper airway. Swollen areas around the feet during the day can become swollen areas around the neck at the end of the day when the pregnant woman lies down to sleep, as fluids are redistributed. This can lead to sleep breathing disorders like Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea (OSA). 

Snoring: Just as with sleep apnea, the added fluids that build up in the body can create resistance in the upper airway; add to that any congestion issues in the nasal passages and the odds of becoming a first-time-ever snorer are pretty good.

Vivid dreams: Dreams are a product of REM activity. With all the other changes in the body, it's not surprising to learn that the brain is also adjusting, redirecting focus, learning, processing anxiety, consolidating new information as memories. Pregnancy is a heightened state; it makes sense that crazy dreams would follow.

________
Stay tuned: next week SHC will discuss sleep challenges based specifically on what's going on during the trimesters.

Insomnia || Be on the lookout for insomnia's secret cousin: untreated OSA

You can't sleep at night. You've taken every pill, and none of them work. You still get up several hours a night and have trouble falling back asleep. But you haven't had a sleep study yet.

Maybe it's time you had a sleep study.

It has been common practice to separate the majority of insomniacs from other sleep disordered patients and place them in the therapy/pharmacology track to treat their problems with sleeplessness. Overnight sleep studies are expensive and it has been thought that such a diagnostic test would not be the first course of action for someone who seemed to only suffer from insomnia.

However, a recent study published by the Mayo Clinic, led by physician Dr. Barry Krakow, discovered that many people being treated for insomnia, who had failed all pharmacological treatments, actually suffer from undiagnosed and untreated obstructive sleep apnea.

“We are used to seeing insomnia as a psychological condition, but in these drug-failure cases nearly all patients also suffered from a physical condition, obstructive sleep apnea,” said Dr. Krakow.

The study, published last September, observed over 1200 patients with chronic insomnia, 900 of which were using (and failing at) some kind of sleep aid. Those with prescription sleep aids seemed to suffer the most, interestingly, reporting more delayed sleep onset, more wakeful periods during the night and the lowest sleep efficiency, all of which are consistent with severe insomnia. Assessing over 900 of these patients via a sleep study using the most advanced respiratory technology revealed a mind-blowing 91 percent of them had a confirmed diagnosis of moderate to severe obstructive sleep apnea.

This is a huge finding, as many patients may now be prompted to have an overnight sleep study to determine the likelihood they have unresolved apnea, something not commonly done before with patients assumed to only have insomnia.

Dr. Krakow was asked, in a CHEST Physician interview, what made him think to study breathing patterns in insomnia patients who were not complaining of traditional OSA symptoms.

"We asked insomnia patients to tell us why they wake up and found that the causes they attribute to their awakenings are very different from what we see in the sleep lab. Fifty percent say it’s mental and 50 percent say it’s physical," he said. "They’ll also point to things after the fact, such as 'I woke up because my mind is racing' and then realize that the racing thoughts really emerged after the awakening. In the lab, however, breathing events were the most common cause of their awakenings."

It makes sense. Sleep apnea can perpetuate insomnia as it causes sleep fragmentation, which disrupts the sleep cycle with frequent awakenings. Patients awaken upon having apneic episodes but think they have insomnia or need to use the restroom. Frequently rising to urinate may also be a hallmark of  undiagnosed sleep apnea; when the body undergoes an apneic episode, and the patient awakens gasping for air (which they may or may not be consciously aware of), it sets off a chain of stress responses in the body which leads to signals of awakening, which prompt the body to empty the bladder, whether it is full or not.

Senior research investigator Victor Ulibarri also pointed out that “remarkably, greater than 70 percent of this patient population reported sleep breathing symptoms like snoring or gasping
during sleep and suffered from insomnia for an average of a decade, yet none of these patients had previously been evaluated or referred for sleep testing.”

This generates the concern that primary care physicians, who are the chief referring doctors for sleep studies, may not be asking enough of or the right questions during a general healthcare visit to discern whether the origin of a patient's potential insomnia is psychological or possibly physiological. It can also be hard to determine when sleep medications are failing, which can lead to significant problems with evaluating sleep problems on a timely basis when they are initially only linked to insomnia.

Dr. Krakow points out that “doctors may be confused or challenged in sorting out when patients need medication or an evaluation at a sleep medical center.”

Senior research investigator Natalia D. McIver warns that drugs are not always going to be the way a sleep problem is fixed. "Insomnia patients perplexed by their sleeplessness may steer doctors toward quick fixes with pills. But, when we show patients the importance of sleep breathing, they are eager to attempt effective sleep apnea treatments.”

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And they should be. Many medications used for sleep onset for insomniacs depress the respiratory system; if someone with a sleep-breathing disorder takes these drugs, they may in fact make their condition worse.

Ultimately, the research points to more expedited referrals of insomnia patients for sleep testing to rule out sleep breathing disorders so as to identify which patients truly benefit from therapies for apnea versus those who may do better on a sleep medication.

To learn more about the study and how it may impact insomnia and other sleep diagnoses in the future, please check out this video from the Mayo Clinic.


SOURCES

CHEST Physician || OSA and insomnia often share a bed
Mayo Clinic Sleep & Human Health Institute || Insomniacs Failing Drugs Suffer from Sleep Apnea [PDF]
Sleep Review: || A Missing Link: Dr Barry Krakow’s Research on Insomnia and SDB

VISIONS OF SUGARPLUMS || Sleep Hygiene Tip of the Week: 10 foods to avoid eating right before bed

If you are going to eat late at night, such as at a party or for a midnight snack, you could do better by avoiding the following 10 foods. Consuming these could lead to problems with overstimulation, repeated trips to the bathroom at night, gastroesophageal reflux disease (GERD) or heartburn and/or low metabolism leading to weight gain and potential obesity. 

1. Bacon and other smoked meats contain high levels of the amino acid tyramine; consuming these triggers the release of norepinephrine in the brain, leading to wakefulness rather than sleepiness. 
2. Celery is a natural diuretic. What this means is, if you eat a bunch of celery at bedtime, you may need to get up to use the bathroom as your body processes it. 
3. Chocolate has caffeine in it and this will, naturally, stimulate your brain and keep you awake. Studies also show that candy bars right before bed can lead to nightmares. 
4. Cheese before bedtime is going to be a troublesome gut bomb. Just because it is dairy doesn't mean it will be good for you like a glass of warm milk will be. 
5. Citrus fruits are high in acid, which is not the best thing to consume right before going to bed, especially if you also consume something that is high in fat. Fat and acid in the stomach while you sleep do not mix well and can lead to troublesome reflux. 
6. Fatty meats like hamburger and steak may have good quantities of sleep-promoting properties like tryptophan, but the fat and general texture of these foods will slow down digestion and lead to indigestion and heartburn if eaten too close to bedtime. 
7. Ice Cream's high fat is harder to digest, will relax the esophageal sphincter, leading to potential reflux, and the sugar bomb will keep you awake before leading to a hypoglycemic crash. On top of that, the sugar will not be burned off as energy; the body will convert it to fat as a result. You can't win.
8. Nuts may consist of healthy fats, but they are fats, nonetheless and will be harder to digest and potentially lead to heartburn. 
   
9. Pizza's combination of high acid and high fat products is practically a guarantee of heartburn at bedtime, and many people overeat this highly popular food. Best to save your pizza cravings for earlier in the day.
10. Spicy foods do a couple of things to the body: first, they stimulate all kinds of processes, which can disrupt sleep, and second, they inspire the body to generate a higher temperature. Your body, when getting ready for sleep, actually wants to cool down, so this late-night thermal boost can make it hard to sleep.

Sleep Hygiene Tip of the Week || What about those sugarplums anyway? Will eating sugar hurt my sleep?

"Sugarplums," artist unknown.

Sugarplums are actually not fairies, as commonly assumed by fans of the ballet. They are a kind of confection made either of dried fruit (plum) and sugar, or a sugary gelatin confection shaped like a plum and colored purple.

They are an old-fashioned treat that probably isn't consumed as much anymore as was done in the old days. But sugarplums are also a more generalized reference to all things sugary and sweet and enjoyed at the holidays. This can include candy canes, butterscotches, ribbon candies, Turkish delight, pralines, penuche, divinity fudge, white almond bark... ANY candy, really, that is not made of chocolate.

Okay, so it's the holidays, and that means these foods enter into our diets more frequently for a temporary (let's hope!) time in our lives as part of the festivities. And that's okay. But consuming lots of sugary treats will have an impact on your ability to sleep well, so it's a good idea to know what to expect before you launch into a bowl of eggnog taffy or those leftover gumdrops from last night's gingerbread house party right before you go to bed.

What goes up must come down 
Sugary foods eaten right before bedtime can drastically increase, then decrease your blood glucose levels, as your body is forced to release hormones to establish balances between blood sugar and insulin. This swing in hormone release can impair sleep, which is a body process that relies upon, among other things, a balance in your blood chemistry. You may find you have early-night insomnia, for instance, or you wake up an hour or so after falling asleep; this can be due to glucose regulation and even the "crash" (or withdrawal) that comes after consuming a lot of sugar. (This also holds for alcohol "nightcaps.")

This is not the same thing as being "hyperactive." Remember the old days when people said kids who were hyperactive at bedtime probably just ate a bunch of sugar? Not really true. Sugary foods will spike your energy levels briefly but what follows is a downward spiral of energy leading to sleepiness. Here's a great article at Slumberwise which illustrates the sugar-sleep paradox.

Carbo loading
Sugary foods, by the way, are carbohydrate in nature. Other carbohydrates that aren't sugary include foods like rice, bananas, bread, pasta and warm milk, which could actually make you feel more sleepy afterward than straight-up sugary foods might. The body processes these kinds of carbs more slowly than pure sugar (and its cousins, honey, corn syrup, and the like), so you may only feel the hypoglycemic (blood sugar crash) after-effect and not the initial rise in energy (hyperglycemia, or blood sugar high) like you might after eating a candy cane. These carbs inspire your brain to send messages to your digestive system to slow down for the purpose of starting the sleeping process. If you want to sleep, this is not really a problem; however, if you're working the night shift, then you might want to avoid these foods in order to stay alert on the job.

Nighttime bathroom breaks
One of the things that happens when your blood sugar is out of whack is that your body will try to eliminate the excess sugar. Dr. Lynn Maarouf, RD and diabetes education director at the Stark Diabetes Center in Galveston points out that “any time your blood sugar is really high, your kidneys try to get rid of it by urinating, so you are probably getting up and going to bathroom all night long -- and not sleeping well.” This isn't true only for diabetics, but for prediabetics and healthy individuals who have consumed a large amount of sugar in one sitting. That is what the body's filtration system does: it kicks out the excess waste products through urination and/or bowel movement, both which should be more active processes during the day, but not so much at night.

If you are needing to use the restroom all night, you should probably mention this to your primary care physician so they can look for reasons as to why this is happening. It could just be a temporary imbalance in processes brought on by increased sugar intake, but it could also be a sign of metabolic dysfunction or something else entirely, like sleep apnea, which causes the body to frequently arouse due to lack of oxygen, which sends signals to the bladder to be emptied upon awakening.

Here's a great article on sugar intake and sleep quality worth checking out if you are concerned about the possibility of developing or aggravating a diabetic condition.

How to achieve sweet dream
So what does one do with all these wonderful sugarplums winking at us at our neighborhood party, the office kitchen or the family gathering by candlelight? If you already have a known metabolic condition, you know the answer is to stick to the healthy stuff. But if you don't, and you need to get a good night's sleep after the party is over, try to limit yourself to a few sugary treats and break up the sugar infusion with some crudite or a small protein bite in between to keep your blood sugar on an even keel. Drinking water in between also helps you to avoid the sugar-insulin rollercoaster ride by helping you to avoid dehydration, which concentrates your blood sugar and makes you hyperglycemic.

Whatever you do, be prepared. If all else fails, you might not get all your winks that night, and remember, if you're a believer in the fat man... Santa does see you when you're sleeping, and he knows when you're awake...

INSOMNIA CENTRAL || Do you have insomnia... or do you have sleep apnea?

Today Barry Krakow MD pushed this question in an article at Baystreet. From the article:

"Researchers at the Sleep and Human Health Institute and Maimonides Sleep Arts and Sciences, Ltd investigated drug failure in 1210 chronic insomnia patients and found 91% of those who completed sleep studies actually suffered from previously undiagnosed sleep apnea, a critical factor likely to be aggravating their insomnia."

How does this happen?

Insomniacs often find many reasons to explain their sleep problems. Doctors can be misdirected by their insomniac patients' cues as well.

Generally, many patients believe they can't sleep because of stress and anxiety, or pain, or because they have to use the bathroom all night. And while these are all good indications that insomnia is present, there are a number of other things to consider.

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• Insomnia is often the sign of another underlying condition. It isn't often considered a stand-alone diagnosis (though it can be).
• When patients are getting out of bed frequently at night, it might not be because they have to use the restroom excessively. Sleep apnea forces arousal from sleep, and the body responds by sending out stress hormones, which in turn stimulate the bladder, leaving the woken person to believe they are using the restroom because their bladder is full. However, it isn't always full, but it could leave someone feeling that way because of the stress response following the apnea events they aren't aware they're having. This can lead to the bathroom urgency they experience, not necessarily caused by a full bladder itself.
• People really do not know how much they actually sleep at night. As a sleep technologist, I can tell you first hand that the vast majority of my patients sleep most of the night and yet they leave the lab feeling like they didn't sleep at all. Sleep state misperception, otherwise known as paradoxical insomnia, is a subjective sense of never having slept despite objective evidence to the contrary.
  
  From Psychology Today: "[S]leep studies have revealed that people sometimes have great difficulty accurately estimating how long it takes them to fall asleep and just how long they are awake during the night. People who misperceive the sleep state they are in just aren’t good at making these estimates. This is most likely due to high levels of arousal that keep the brain more active even during sleep and make judgments of wakefulness versus sleep difficult."
• Patients using multiple kinds of medications for multiple health issue, including for sleep, may still feel they can't sleep and, ultimately, the interactions of all these medications may truly be to blame. However, doctors aren't always in the know about what's in their patients' medicine cabinets, or they may not be aware of the side effects of additional nutraceuticals, vitamins or supplements their patients are taking because patients may not tell their doctors about these added treatments.
  
  Also important to consider: the most popular approach to treating insomnia is pharmaceutical, which might be part of the problem. Many prescribed sleep aids can actually worsen or lead to apnea. The good news is that some, though not all, sleep health professionals redirect insomnia patients to cognitive behavior therapists instead of, or in conjunction with, prescription sleep aids to see whether behavioral approaches might be more long-lasting and healthy for them. This is one way to avoid adding the complication of apnea.
• Patients with chronic disease may often blame all of their symptoms on their single diagnosis ("it's the MS," or "I have insomnia because of my chemo side effects," for instance). Again, this might be true, but it's just as likely that patients will have multiple conditions, including the presence of restless legs or sleep-disordered breathing, in tandem with other health problems. Doctors may accept this reasoning without looking into the problem further as they aren't often well-versed in sleep health (on average, MDs spend about 1 hour of their entire medical school training learning about sleep). 

If you factor in these pieces of the puzzle, the broader picture of insomnia as a primary condition becomes a little more murky.

Typically, complaints of insomnia do not automatically send patients to sleep labs for overnight studies. However, with the growing number of patients at higher risk for sleep apnea (due to obesity, heart disease, diabetes, pulmonary disease or hypertension), it probably makes better sense to have an overnight sleep study to rule out apnea before tossing out insomnia as merely behavioral in origin. It is possible, of course, to have both, and for different reasons.

It's important to note that patients who are at higher risk for sleep apnea don't generally qualify for overnight home studies because of the general complexity of their health.

If you have insomnia, please open up this discussion with your doctor. The best way to isolate the root cause of any health problem is to sit down and work as a team, and that means insomniacs need to ask for help and demand answers, and doctors need to investigate all the possibilities until the root causes are discovered, and then initiate treatment.

This will mean more tests, more questions, and closer looks at all medications including over-the-counter supplements, but it will also mean getting to the root of your insomnia so you can best treat it.