Sleep issues

Posted on 17 April 2013

We know we should get eight hours of rest at night and most of us take solid slumber for granted – until we’re kept awake by a colicky baby, the neighbour’s alarm or a restless spouse… But what if what’s keeping you from a good night’s rest comes from within, not without? What if your own body prevents uninterrupted sleep?

Words Deidre Donnelly

Waking up a lot at night is more common as we age, but if you’re young and waking up more often than normal, there could be a psychological or physiological reason,’ says physician Dr Mahomed Bahadur from Mediclinic Highveld. Listen to your body’s signals, as they may wake you up to something else going on…

1. If you… struggle to breathe
It could be nocturnal asthma, a heart condition, a panic attack or sleep apnoea
Jolting up gasping for air can be more terrifying than your worst nightmare. Snorers often stir when their breathing is temporarily interrupted, forcing them to change position to clear their airways. Breathlessness can have more serious implications if you don’t snore and if it happens frequently. Asthma, for instance, can show in shortness of breath and coughing fits in the wee hours, says Dr Bahadur. These symptoms (called paroxysmal nocturnal dyspnoea) can also point to heart failure. ‘When we lie down, there’s a redistribution of the fluid that accumulates in heart patients’ lungs, which disrupts breathing.’ For this reason, heart patients’ should use more pillows. Consult your GP if you suspect you may have either of these conditions, and bear in mind that they could indicate panic disorder (hence nightly panic attacks) or the sleep disorder obstructive sleep apnoea (OSA). ‘Up to 70% of people with panic disorder experience the sensation of choking at night and have to rush to the window,’ says Dr Irshaad Ebrahim, who heads up several sleep clinics, including one at Mediclinic Constantiaberg . ‘Left untreated, OSA increases the risk of cardiovascular, pulmonary and other diseases.’

2. If you… get leg cramps
It could be nutrient deficiencies or restless-leg syndrome (RLS)
There are many reasons for getting leg cramps, like over-exercising, pregnancy or deficiencies in magnesium, potassium, calcium or iron. In such cases, ease the cramps with stretches, antispasmodic medication, raise your legs with a pillow, and drink water and take supplements. Certain medications, like statins, can also cause night cramps. ‘To check whether this is the case, you’d have to stop taking the statin and see whether the symptom abates,’ says Dr Bahadur. Something else that impacts particularly at night is RLS, a neurological condition marked by the irresistible urge to move one’s limbs. It can exist alone, or it can be a result of other serious conditions, like diabetes, Parkinson’s, rheumatoid arthritis and more, says Dr Ebrahim. RLS is often under-diagnosed, so see a sleep specialist if you’ve ruled out the more common reasons related to circulation, medication, exercise or nutrient deficiencies.

3. If you… have bouts of coughing
It could be acid reflux
There’s a good chance it’s acid reflux, which in its severe form is called gastroesophageal reflux disease (GERD). It’s common: in one US study, GERD was the leading cause of disrupted sleep in people between 45 and 65. You’re especially prone if you smoke, eat late at night, indulge in alcohol, fatty or spicy food, or are overweight. ‘Think about it,’ says Dr Bahadur. ‘Gastric content stays in the stomach for six hours after eating. So if you eat dinner at 19h00 and go to bed at 21h00, there’s a few hours of digestion to go. When you lie down, there’s a backflow of acid into the oesophagus, which may cause a cough, wheezing and a hoarse voice.’ Manage acid reflux by avoiding ingesting food too soon before bed, using more pillows and cutting down on the food culprits. If symptoms persist, you should consider a gastroscopy, says Dr Bahadur, to check whether or not you have GERD.

4. If you… are woken by headaches
It could be neurological
They’re bad enough by day but imagine being rudely roused by a throbbing head at the same time every night. Many over-50s experience these headaches, which can be mild to severe and are mostly benign. If so, a cup or two of coffee (or 100-200mg caffeine) before bed (yes, before bed) can help. However,  if painkillers or caffeine don’t work, or you’re under 50, an alarm-clock headache could be cause for alarm. ‘If your headache comes with early-morning nausea, it could be a sign of something intercranial, like a tumour or pressure build-up. Check for symptoms like double vision, being off balance or limb weakness, as these could warrant a neurological exam and possibly a brain scan,’ says Dr Bahadur.

5. If you… wake up in a sweat
It could be tuberculosis or glandular cancer
First, rule out the basics. Are you getting enough air? Is your clothing or bedding synthetic? Night sweats occur in menopause, during stress, as a side effect of medications like antidepressants, and when you’re ill with a cold or the flu. But since South Africa has a high rate of tuberculosis, be wary of other telltale signs, like fever spikes, respiratory problems or weight loss. ‘If you have these symptoms, get a proper evaluation and an X-ray to find out,’  says Dr Bahadur. Together, night sweats, weight loss and fever are also known as the ‘three B symptoms’ of lymphoma, the glandular cancers. ‘Since night sweats can have such sinister causes, rather have a thorough medical examination than leave it be.’

6. If you… suffer from backache
It could be lifestyle related or a spine problem
The most common cause? Poor posture while sleeping thanks to a mattress that’s too hard or soft, giving you insufficient support. Ideally, you should buy a new mattress every eight to 10 years and sleep on your back with an orthopaedic pillow to support spine curvature. Night-time backache could also result from a back problem you’re less aware of by day, because as circulation slows down while we rest, pain from inflammation increases.
Dr Bahadur suggests you ask yourself some questions about how your lifestyle: ‘Are you wearing comfortable shoes? Are you sitting all day or working on your feet in heels? If these lifestyle factors are all answered and your symptoms persist, have a clinician do a proper examination, which may involve an X-ray or an MRI scan, to establish the cause.’

7. If you… urinate often
It could be heart failure, an infection or diabetes
The elderly often complain of this. Sadly, ‘nocturia’ is a natural consequence of ageing, which comes with bladder prolapse and less production of the antidiuretic hormone that regulates fluid retention. But if you’re under 50 and expelling large amounts of urine several times per night, you may have diabetes, says Dr Bahadur. If, on the other hand, your bladder empties in a dribble, it could be a bladder or urinary tract infection – common in women and easy to treat. In men, prostate enlargement called benign prostatic hyperplasia can also lead to nocturia. More worrying is that frequent night-time toilet trips often occur in the early stages of heart failure. By day, a patient’s compromised circulation means sluggish urination. But when they lie down and blood flow returns to the urinary system, it makes up for lost time. If you’re going more than three times per night, get yourself checked out.

8. If you… have dizzy spells
It could be an inner-ear infection
Dizziness results from many things, including benign paroxysmal positional vertigo. This inner-ear disorder occurs when the calcium crystals (otoconia) on the inner-ear lining detach and migrate to
one of the semicircular canals of the middle ear, where they collect. When you move your head – as you do when you toss and turn in bed – your balance is affected and you get vertigo. ‘Just like when you get off of a merry-go-round,’ explains Dr Bahadur. Certain repositional exercises can help these calcium build-ups in the ear, so speak to your doctor.

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.

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In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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