Answers to Reddit's Top 5 Unanswered Sleep Questions

Thank you to everyone for such a great response to our AMA on Reddit. I tried to answer as many questions as possible, but couldn't get to them all. So, as promised, here are the top 5 questions I didn't get a chance to answer.

Also, if any of you are interested in being a part of a pilot we are running on the PeerWell service, please fill out this form.

#1. What do you mean when you say sleep hygiene?
  • Set a timer before bedtime - Set an alarm 45 minutes before bedtime to remind you to start your bedtime routine.
  • Manage light - Tablet, phone, or tv illuminates with bright blue light, which can cause shallow and fitful sleep. That light confuses the part of the brain affecting circadian rhythm.
  • Avoid alcohol after dinner - Alcohol contributes to shallower sleep in the 2nd half of the night. Use your bed for sleep / sex only - Working in bed or watching tv trains your brain to delay sleep onset. It can cause insomnia.
  • Avoid strenuous exercise before bedtime - While exercising during the day has many positive effects on sleep, exercising within an hour or two before sleep can make it hard to wind down when you want to.
  • Limit liquids - Cutting down on fluid intake after dinner will lead to less trips to the bathroom during the night. Definitely cut any drinks that contain caffeine!
  • Try not to worry - If you like to think as you fall asleep, try to come up with 3-4 optimistic thoughts about the next day and focus on them instead of your worries.
#2. How can I keep the CPAP mask on/make CPAP a more pleasant experience?

CPAP is a very effective treatment for apnea, but almost 50% of people aren’t able to stick with it because it can be difficult to get used to. In fact, some people can take 6 weeks to sleep better and that’s because it isn’t natural for most people to wear something on their face at first. The reason is that while your brain has to get used to wearing CPAP, your nose and face have to get used to it too. One way to make using CPAP easier is to practice during the day. Wear CPAP for 30 minutes in the afternoon while watching tv or at the computer. This will help you adjust to the mask in less time.

Another way to get used to CPAP is to try out several masks. Choose a DME (company that sells CPAP equipment) that let’s you try several masks to find the best fit. You should have a chance to spend 30 minutes wearing them, preferably while actually connected to a CPAP machine and in a laying position. Not all DME companies are created equal, so try to find a local company that gives you the extra attention. Even with this, after a week or two of CPAP use, you may find the mask isn’t comfortable anymore. Don’t hesitate to go back to the DME company to try a new style. There are three broad categories of masks. One sits just under the nostrils (nasal pillow mask), another surrounds the nose (nasal mask), another covers the nose and mouth (full face mask). I have seen most new users opt for the smaller masks such as the nasal pillows because they are less intimidating. But some people breathe out of their mouth in sleep, and then they’d need to add either a chin strap to keep the mouth closed or use a full face mask. Every new mask means a new fit, and may take a week or two to adapt to it.

#3. What are the alternatives for adults if I have sleep apnea?

While CPAP is effective in treating apnea, many people are not able to regularly use it. By all means, try out different masks and give it a few weeks to decide if its a good fit. But for some, an alternative treatment is needed. Two major alternative treatments are surgery or oral appliances. The surgery is done by surgeons called otolaryngologists, also called ENT or ear nose and throat surgeons. These surgeries can include surgeries involving the palate (soft tissue in back of the throat), tongue. There are other surgeons, such as maxillofacial surgeons that operate on the bones of the face to advance the jaw. These surgeries are different, highly effective, but more invasive than the soft tissue surgeries. Not everyone is a good fit for an apnea surgery, so it’s good to discuss all options and I encourage multiple opinions. You can use this website to find a surgeon. If you have an HMO insurance, you may need a referral from your primary care doctor first.

Another option to treat apnea is by using an oral appliance. These are usually made by a special kind of dentist that can be looked up here http://www.aadsm.org/PatientResources.aspx An oral appliance is like a retainer that is custom fitted to your teeth and you wear it during sleep. It moves the bottom of your jaw forward, moving your tongue forward too. It is a good option for apnea when it isn’t as severe. It’s different from the snore guards you see on the internet, since those are only reducing snoring (not apnea).

#4. Sometimes I moan (sexually) in my sleep and my partner/kids are freaked out. What is it?

Catathrenia is a groaning sounds during sleep. Sometimes this can sound sexual. It is often socially disturbing, occurring during exhalation (breathing out). It isn’t very common, and is present in 0.3 to 0.5 percent of patients in sleep clinics. It can be loud, and usually starts in childhood. However, it isn’t brought to anyone’s attention until they get older, living in a dorm with a roommate. It isn’t well understood, and can occur during REM or NREM sleep. It isn’t associated with any psychiatric disorders, and usually isn’t remembered by the person. Some cases have been treated with CPAP, but alternative options would be earplugs. It’s important to know that catathrenia is an noise during exhalation. Don’t confuse this with an obstructive apnea, which is a pause of breathing occurring during inhalation. It’s good to be sure of the difference and a consultation with a sleep doctor is useful for this.

#5. How can I deal with night terrors?

Night terrors, or sleep terrors are dramatic events that occur out of slow wave sleep, usually in the first half of the night. Usually it starts with an abrupt scream, and the person (often toddler) is inconsolable, and doesn’t remember it the next day. They’ll look like they are awake, however. The best treatment is good sleep hygiene, which reduces the chance of it happening. We’ll dedicate a whole post to sleep hygeine, but here is a summary: before going to bed, create a calm, relaxed, dim environment for at least an hour. This allows for faster and deeper sleep at night. The benefit of this is to reduce sleep deprivation. Sleep disruption increases the likelihood of night terrors. Another option is anticipatory awakening. If there is a pattern or timing it usually occurs, a parent can wake the child before the usual time. Unless there is a risk of harm, these measures are the best first things to discuss with your doctor. If there is risk of harm, there are medications, but these should be used sparingly.

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Nitun is a sleep medicine physician. He's built clinics to help people understand their sleep so they can be more alert and effective. He connects the best of tech with the best of medicine.

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