Relationship between sleep hygiene and substances

Avoid Alcohol as a Hypnotic 

Although alcohol use before bedtime can help some people to fall asleep more easily, it has been shown that use of alcohol to promote sleep (i.e., larger quantities than is typical for the individual) results in more fragmented sleep, more awakenings during the night, and/or early morning awakenings.

Caveats/considerations: While some may tolerate a glass or two of wine at dinner, others may find that this makes their sleep more fitful, while still others may find that this promotes the occurrence of early morning awakenings. Quite apart from its effect on sleep maintenance, another possible reason to curtail or eliminate alcohol consumption is that while in active behavioral treatment, one of the greatest difficulties that patients have is to remain awake until the prescribed bedtime. Drinking alcohol will only serve to make this task more difficult. So the patient may be encouraged to temporarily suspend alcohol consumption during active treatment so that they can stay awake at night.

Avoid Nicotine 

Nicotine is a stimulant, and it has been demonstrated that chronic cigarette smokers have experienced significantly improved sleep when they quit.

Caveats/considerations: It is possible that during the early stages nicotine withdrawal may actually exacerbate sleep disruption,especially in the patients who are most addicted. Patients should therefore be educated about the effects of nicotine on sleep, and then encouraged to work on sleep and smoking cessation at different times. One thing that could be tried during active sleep treatment would be to have patients experiment with changing the times of smoking to see what changes might benefit sleep. For example, patients could be encouraged not to smoke in the middle of the night when they can’t sleep, as such smoking might be training them to wake at night to smoke. A consistent change in this regard might at least alter that pattern without having to go through full smoking cessation. Further, smoking cessation techniques might aide in this process (e.g., the use of a icotine patch) and represent a reasonable first step in smoking cessation.

Avoid Caffeinated Products within 6 Hours of Bedtime

Rationale: Caffeine works as a stimulant in your body and can keep you awake.

Caveats/considerations: It is unlikely that caffeine in the morning is going to have much if any impact on night-time sleep, even in the most sensitive of patients. In addition, there is some evidence that stimulants, used judiciously in the earlier part of the day, may actually provide some benefit, especially to those patients engaged in sleep restriction therapy, in that it can help them to remain more awake and alert during the day. Permission to use caffeine may actually serve to decrease patients’ anxiety about not sleeping at night, and this may aid in promoting better sleep. On the other hand, the length of time before bed that caffeine should be curtailed before it is an issue will vary from patient to patient, and this is one rule that will require tailoring. Although decaffeinated products contain much less caffeine than their caffeinated counterparts, it is possible that small amounts of caffeine in the evening, especially in the most sensitive individuals, may still serve to be an irritant to sleep onset. This is an example of how a modest infraction may serve as a predisposing factor to sleep problems even if it is not a direct cause. Patients should be encouraged to read product labels and make sure that they are not inadvertently consuming caffeine late in the day. It can be illustrative to point out that many lighter-colored sodas and some aspirin brands contain caffeine.

                               Avoid Liquids Before Bedtime


 Some drugs or substances have a negative influence on the sleeping pattern due to a central stimulant effect on the brain. Some of these substances are medical drugs that have been prescribed by doctors. But sometimes even medical experts are not fully aware of these possible side effects of the medicine.
Liquids close to bedtime will fill your bladder and result in discomfort while you sleep, causing you to wake more frequently.

Caveats/considerations: Patients who wish to drink small amounts of liquid may do so by restricting intake to less than 6–7 ounces in the 4 hours prior to bedtime, and by making sure they void before going to bed. As stated earlier, there may be medical problems or conditions that require patients to be better hydrated, and this should supersede any sleep habit instruction. There should also be awareness of the fact that some conditions (e.g.,enlarged prostate) and some medications (e.g., diuretics) may necessitate middle of the night voiding regardless of how much liquid restriction takes place. Some patients, such as those on continuous positive airway pressure (CPAP), report waking in the night with a dry mouth.These patients should be encouraged to take a few sips of water in the middle of the night, perhaps even to have a small cup ready next to their bed to avoid having to get up. However, they should be dissuaded from drinking large amounts.If patients do wake in the night with even a mild sense of bladder distension, they should be encouraged to get up and void. Attempts to go back to sleep with bladder distension are likely to fail or will result in repeated arousals.

 Avoid Benzodiazepines and other substances

The most relevant drugs that can cause severe sleeping problems are SLEEPING PILLS. Sedative substances used for short term therapy of insomnia or anxiety disorders (benzodiazepines) are the most common cause of chronic disturbances of normal sleep. These drugs are highly effective in promoting sleep during a limited period, but will cause a disruption of the normal sleep pattern within a couple of weeks. Due to tolerance effects the patients usually will need more of the drug to achieve the same effect. This can cause addiction and disturbed sleep.

Other possible drugs with a negative influence on your sleep:

  •     Anti-hypertensive drugs
  •     Asthma medication (theophylline, beta-sympathomimetics)
  •     thyroid hormones or other hormones (thryroxin, steroid medication) diuretic

No hay comentarios:

Publicar un comentario