Wake Up to the
Healing Properties of Sleep
Sleep is essential to our physical and mental health.
Adequate sleep may play a role in helping our bodies
recover from illness or injury. Studies have shown that sleep
deprivation results in a loss of strength, an impaired immune
system and an increase in blood pressure.
In general, most healthy adults need an average of seven to
nine hours of sleep a night, although individual sleep
requirements vary. The need for sleep does not decline with
age, although the ability to maintain it may be reduced. To
get an idea of whether you are getting enough sleep, take the sleep
quotient quiz below.
Causes of Sleep Deprivation
Sleep is also important for emotional and
mental functions. Sleep loss can affect concentration and
impair the ability to perform tasks involving memory,
learning, logical reasoning and mathematical calculations. A
recent study reported in The New York Times suggests
that chronic lack of sleep may even make the aging process
For people living with HIV, sleep disturbances may result
in potential decline in quality of life. For example, sleep
disturbances may cause daytime fatigue and affect functional
status and quality of life. Many HIV-positive individuals with
daytime fatigue also have medical sleep disorders. Thus,
proper diagnosis and medical treatment of the sleep disorder
may produce significant improvement in quality of life.
Complaints of sleep disturbance have also been associated with
depression and pain, both of which may also make it harder to
fall asleep or lead to nighttime or early morning awakenings.
Insomnia, which is difficulty falling asleep or staying
asleep, is also widespread and underdiagnosed in HIV-positive
Although most of the FDA-approved HIV antiretrovirals can
cause fatigue, it is interesting to note that most of them
have been shown to cause some type of sleep disturbance as
well. In clinical studies, many of the available drugs caused
insomnia less than 1 percent of the time.
One major exception, however, is Sustiva (efavirenz), which
lists some type of sleep disturbance as a more common side
effect, especially during the initiation period for the drug.
Regardless of which drug may be causing a sleep disorder, a
change in dose scheduling, nutrition or exercise may alleviate
this side effect. Check with a healthcare professional,
treatment advocate or nutrition advocate before making changes
to your medication regimen.
According to a report in the November issue of Pediatrics,
HIV-infected children appear to have a higher than normal rate
of sleep disturbance than children who are not HIV-infected.
HIV-infected children participating in the study woke up more
frequently, stayed awake longer, and reported a greater level
Prompt diagnosis and interventions to promote sleep may
improve the quality of life and prevent additional compromise
of immune function in people living with HIV.
Healthcare providers who treat HIV-positive individuals
need to be aware of medical sleep disorders as treatable
causes of daytime fatigue and insomnia. Often, they pay
attention only to measurable physical symptoms such as fever
or weight loss, granting more attention as measurable symptoms
change and the individual becomes sicker.
Types of Sleep Disorders
What are some common sleep problems?
Insomnia -- difficulty falling asleep or
staying asleep -- affects one in every three people.
Insomnia may be caused by stress,
medications, pain, illness, noisy surroundings, even sleeping
pills. Short-term insomnia, lasting up to three weeks, may
result from anxiety, nervousness and physical and mental
tension. Long-term insomnia stems from health conditions such
as depression, and can also be brought on by chronic drug or
alcohol use, excessive use of beverages containing caffeine
and abuse of sleeping pills.
- Sleep Apnea -- or
trouble breathing during sleep -- affects more than 12
million people in the United States. Loud snoring, daytime
sleepiness, and tiredness are the most common signs. Most
people are not aware of having any problem.
Treatment of Sleep Apnea may
involve a change in sleep position, weight loss, or other
- Narcolepsy is a
neurological sleep disorder that affects one in 2,000
people. Symptoms can include chronic daytime sleepiness,
spells of muscle weakness, lifelike hallucinations and
paralysis while falling asleep or awakening. Medications
and lifestyle changes can help manage symptoms.
- Shift Work Problems are
caused by working non-traditional hours and affect one in
five people in the United States. Shift work interferes
with sleep, workplace performance, health and home life.
Sleep specialists can help shift workers to solve sleep
problems and schedule activities to minimize disruption of
- Seasonal Affective Disorder
(SAD) is a type of depression that reappears at the
same time each year (usually fall). SAD is associated with
an abnormal response to environmental cycles such as
seasonal changes in day length or temperature. SAD is
effectively treated with high intensity light.
- Jet Lag is the
inability to sleep after having traveled across several
time zones and your biological rhythms become "out of
sync." (See "Sleep
and the Traveler" below.)
- Environmental Interferences
may also play a role in your sleeplessness. A distracting
sleeping environment such as a room that's too hot or
cold, too noisy or too brightly lit can be a barrier to
sound sleep. Other influences to pay attention to are the
comfort and size of your bed and the habits of your sleep
partner. If you have to lie beside someone who snores,
can't fall or stay sleep, or has other sleep difficulties,
it often becomes your problem, too. Help your partner get
the professional advice he or she needs.
Psychological factors, particularly stress, are considered
by most sleep experts to be the leading cause of short-term
sleeping difficulties. Usually the sleep problem disappears
when the stressful situation passes. However, if short-term
sleep problems are not managed properly from the beginning,
they can persist long after the original stress has passed.
Insomnia can be brought on when depression is suspected.
Many depressed people complain of insomnia without recognizing
that they are depressed. If you have lost interest in
activities you used to enjoy or if you have feelings of
hopelessness or suicide, your sleep problems may be a result
of depression. Talk to your healthcare provider about any
sleeping problem that recurs or persists for longer than one
week. When the depression is treated, the accompanying sleep
problems usually disappear.
Give Yourself Time
Changing your sleep patterns cannot be done overnight, but
changes can be made in a relatively short period of time. If
you're plagued by serious fatigue or more than transient
insomnia, don't delay in seeing your doctor.
Most of us, however, simply need to be a little more aware
of the fact that a good night's sleep is just as important to
our health as exercise and good nutrition. Make a few small
changes and you'll soon find yourself feeling better.
Many sleep problems can be improved by changing your sleep
habits, reducing stress, improving your diet or exercising. If
problems persist, it may be time to seek professional help.
Consume less or no caffeine, nicotine and
alcohol. Watch out for the caffeine in soft drinks and
chocolate as well as in coffee. Nicotine can inhibit sleep as
well. Although alcohol may initially cause sleepiness, it can
interrupt your sleep later in the night because alcohol
becomes a stimulant when the body metabolizes it.
- Exercise regularly, but do so
in the daytime. Exercising regularly can greatly improve
the quality of your sleep and increase the amount of deep
sleep, but do it at least three hours before bedtime. Some
people may need to exercise up to six hours before bedtime
in order to allow themselves enough time to unwind. The
best time to exercise to benefit sleep is in the
- Don't stay in bed tossing and
turning. If you can't go to sleep after 30 minutes, get up
and involve yourself in a relaxing activity until you feel
sleepy. Remember, try to clear your mind; don't use the
time to solve your daily problems.
- Go to bed at the same time
every night and get up the same time every morning. This
is one area where the body craves consistency. Don't sleep
in on the weekends to make up for lost sleep. If you do
end up suffering from sleep deprivation during the week,
go to bed earlier but get up at the same time on Saturday
- Establish a regular bedtime
routine, such as walking the dog, taking a bath, and
reading a book. It doesn't matter what you do. Just be
consistent and your routine will signal your brain that
it's time to snooze.
- Use the bedroom for sleeping
or sex only. Leave TV-watching, bill-paying and other
activities to another part of your home so that your brain
associates the bed and bedroom with sleep.
- Try a relaxing routine before
bedtime, like soaking in hot water (a hot tub or bath),
reading a book, listening to relaxing music, or practicing
deep breathing. You can also try drinking a glass of warm
milk, which is high in L-tryptophan (a natural sedative).
- Drink less fluids before going
- Avoid heavy meals and foods
and drinks high in sugar close to bedtime.
- Use sleeping pills sparingly
or not at all. Although sleeping pills are temporarily
helpful for addressing sleep disorders, they should be
used for the shortest possible time, and in the smallest
effective dose. Sleep-promoting medications can eventually
cause sleep disturbance, side effects, a sleep
"hangover" during the day, and dependency on the
Are You Getting Enough Sleep?
Read the statements below and choose each
one that has applied to you in the past year. If you choose
one or more statements, discuss your sleep with your health
- Falling asleep is hard for me.
- I have too much on my mind to
go to sleep.
- When I wake up during the
night, I can't go back to sleep.
- I can't relax because I have
too many worries.
- Even when I sleep all night, I
feel tired in the morning.
- Sometimes I am afraid to close
my eyes and go to sleep.
- I wake up too early.
- It takes me more than 30
minutes to fall asleep.
- I am stiff and sore in the
- I feel irritable when I can't
- I feel that I am dreaming all
Sleep and the Traveler
Every day, millions of travelers struggle
against one of the most common sleep disorders: jet lag.
Jet lag results from an imbalance in our body's natural
"biological clock" caused by traveling to different
time zones. When traveling to a new time zone, our circadian
rhythms (24-hour cycle) are slow to adjust and remain on their
original biological schedule for several days.
Some of you will be traveling for the holidays and may find
the following tips useful in minimizing some of the side
effects of jet lag.
- Select a flight that allows
early evening arrival and stay up until 10 p.m. local
time. (If you must sleep during the day, take a short nap
in the early afternoon, but no longer than two hours. Set
an alarm to be sure not to oversleep.)
- Anticipate the time change for
trips by getting up and going to bed earlier several days
prior to an eastward trip and later for a westward trip.
- Upon boarding the plane,
change your watch to the destination time.
- Avoid alcohol or caffeine at
least three to four hours before bedtime. Both act as
stimulants and prevent sleep.
- Upon arrival at a destination,
avoid heavy meals (a snack is OK).
- Avoid any heavy exercise close
to bedtime. (Light exercise earlier in the day is fine).
- Bring earplugs and blindfolds
to help dampen noise and block out unwanted light while
- Try to get outside in the
sunlight whenever possible. Daylight is a powerful
stimulant for regulating the biological clock. (Staying
indoors worsens jet lag).
- Bring elements or objects from
home like a picture of a friend or loved one, favorite
pillow, blanket or even a coffee mug to ease the feeling
of being in a new environment.
- Check with the hotel to see if
voice mail services are available to guests. Then,
whenever possible, have your calls handled by the service.
- Check your room for potential
sleep disturbances that may be avoided, such as light
shining through the drapes, unwanted in-room noise, etc.
- Request two wake-up calls in
case you miss the first one.
Nancy Wongvipat, M.P.H., is a health education specialist
in AIDS Project Los Angeles' Education Division. She can be
reached by calling (323) 993-1511 or by e-mail at nwongvipat@APLA.org.