Archive Monthly Archives: July 2018

Clinical explanations for understanding “why can’t I sleep” may include physical barriers such as weight and sleep apnea, consequences of sleep deprivation can range from impaired intention to increased risk of morbidity and mortality

Why Can’t I Sleep? – Clinical Explanations & Tips on How to Fall Asleep

Article at a Glance

  • Short-term consequences of sleep deprivation include deceased attention and memory retention, sleepiness, increased risk of accidents, increased hunger and decreased mood.
  • Long-term consequences of sleep deprivation includes increased risk of disease and death, increased obesity, and increased risk of chronic diseases such as type 2 diabetes, heart disease, and depression.
  • Weight, sleep apnea, and hypogonadism can be physical barriers to healthy sleep.
  • Tips on how to fall asleep include decreasing light exposure, lowering temperature of the room, exercise earlier in the day, and avoid caffeine and exercise closer to bed time.

Sleep has been hailed as a critical factor contributing to our overall wellness for many decades, but diet and exercise are often perceived as the ultimate priorities for effective health management. Yet, nutrition and fitness cannot compensate for the effects of poor sleep quality. In fact, both the length of time we spend sleeping each night as well as the quality of the sleep we achieve play a major role in our vitality, largely dictating our risk of developing serious diseases such as type 2 diabetes and cardiovascular disease.

It can be safely assumed that everyone has experienced a poor night of sleep at least once in their lifetime, and although sleep deprivation is rampant across the country, it is impossible to gauge just how many individuals are affected by lost sleep. What we do know is that roughly 50-70 million U.S. adults have a sleep disorder.[1] With that said, even undiagnosed sleep issues raise serious concerns: both repeated instances of severe sleep deprivation as well as chronic sleep deprivation can have negative impacts on key health outcomes.

Within this guide, we will take a closer look at the complex ways in which sleep affects our health. We will also explore the most common causes of disordered sleep and present tactics for overcoming these and other impediments to achieving ample, quality sleep.

Short and Long-Term Consequences of Sleep Deprivation


Consequences of sleep deprivation can have short term and long term effects, short term consequences of sleep deprivation may include problems with memory to increased moodiness and hunger, long term consequences of sleep deprivation include increased risk of developing chronic diseases such as cardiovascular disease and type 2 diabetes

The Textbook of Age
Management Medicine: Volume 1
highlights both short- and long-term
consequences of sleep deprivation. On a short-term basis, individuals who have
recently experienced lack of sleep may experience:

On a long-term
basis, consequences of sleep deprivation include:

Yet, the question remains: Why does lack of sleep increase our risk of these serious health issues? While there is still much to be learned about the impact of sleep on the body, we do know inflammation certainly plays a role in the relationship.

Sleep and Inflammation

Inflammation is one of the long term consequences of sleep deprivation, inflammation due to sleep deprivation is a large contributor in the development of cardiovascular disease

Inflammation is a well-established agent in the development of cardiovascular disease. A sustained increase in low-density lipoprotein (LPL, also known as the “bad” cholesterol), results in an accumulation of LDL in previously damaged arterial walls. This results in an inflammatory response that propagates plaque formation, thereby contributing to cardiovascular disease.

In the Textbook of Age Management Medicine: Volume 1, the relationship between sleep and inflammation is explored in great detail. In summation, sleep deprivation is inversely associated with plaque formation and coronary artery calcification in middle-aged adults. Sleep deprivation is also inversely associated with the thickness of the carotid intima media, or the innermost layer of artery walls. Several pro-inflammatory markers are inversely associated with sleep duration. In other words, the fewer hours a person sleeps, the more likely they are to experience elevated levels of inflammatory markers. In fact, these markers can be elevated in as little as one night of complete missed sleep. Because pro-inflammatory reactions are linked to a host of serious health conditions, such as stroke, cardiovascular disease, and type 2 diabetes, achieving the recommended number of hours of sleep each night is essential to long-term wellness.

Yet, while it is abundantly clear that sleep quality and duration are critical to health, many individuals still struggle to achieve a restful night of sleep. What are the most predominant barriers preventing us from achieving quality sleep?

Why Can’t I Sleep – Physical Barriers


There are many physical barriers that may explain “why can’t I sleep”, sleep apnea and weight regulation are large contributors as barriers to healthy sleep

There are many possible causes behind sleep deprivation, which is why the issue cannot be met with a “one-size-fits-all” approach to treatment. The inability to get to sleep – and remain sleeping for a full seven to nine hours – can be a result of either physical or psychological difficulties. For individuals struggling with psychological barriers, behavioral and cognitive treatments can be explored to enhance sleep without medical intervention.

With that said, many sleep issues are related to physical issues. Below, we’ll explore some of the most prevalent physical barriers to sleep.

Sleep Apnea

Obstructive sleep apnea (OSA) occurs when the airflow is insufficient for metabolic demands. The collapse of the pharynx results in this obstruction: when muscle dilator activity becomes insufficient to maintain the pharynx, obstruction occurs.

Weight Regulation

Weight regulation is a key player in the prevention and treatment of OSA. Results of a randomized control study of patients with type 2 diabetes and an average BMI of 36 and an average AHI of 23.2 show individuals who lost 22 pounds or more in a one-year period witnessed an improvement of 9.7 in their AHI scores. They were also three times as likely to have a complete remission of OSA. The reduction of AHI scores was directly related to the degree of reduction in weight. It can therefore be concluded that OSA could simply be considered a complication of obesity in many cases.[3]

Weight loss, like sleep complications, cannot be approached the same way for every patient. A combination of reduction in calories, adherence to a healthy eating plan with restricted or no intake of processed foods, and a tailored exercise program can be personalized to meet the weight loss needs and goals, as well as the personal preferences and lifestyle considerations, of each patient. Compliance is the most critical factor of all weight loss endeavors, which is why starting with a patient-oriented approach is essential.

Hypogonadism and Sleep

There is a suspected relationship between sleep disorders and hormones. Specifically, testosterone impacts the organization of circadian rhythms and timing of sleep. This relationship takes on a cyclical pattern: total sleep deprivation can also lower testosterone.

Additionally, the Textbook of Age Management Medicine: Volume 1 indicates there is a relationship among hypogonadism, or the failure of the reproductive organs to produce appropriate hormone levels, and OSA. The text examines study findings which point to a significant negative correlation of testosterone levels with AHI, indicating that low testosterone is associated with higher OSA symptoms.

Testosterone has been observed to have a destabilizing effect on ventilation. Leuprolide used to treat androgen deprivation has been shown to increase apneic episodes, but it should be noted that these findings were discovered in studies performed on obese men. With that said, similar findings have been observed in hypogonadal men treated with testosterone replacement.

Hypogonadism in males can either be primary, meaning it originates from a problem in the testicles, or secondary. In the latter case, low hormone levels could result from an issue in the pituitary gland, or the part of the brain signaling the production of testosterone. This can be either an inherited trait or acquired as a result of injury, infection, normal aging, or obesity.[4]

The most effective treatment of hypogonadism is therefore dependent on its underlying cause. In obese patients, for example, dietary and lifestyle changes can be prescribed to manage hypogonadism. Testosterone replacement therapy is also a viable form of treatment for many men and can result in increased energy, libido, erectile function, and an overall improved sense of wellbeing, in addition to improved sleep cycles. If the condition is a result of a pituitary issue, pituitary hormones may be administered to restore fertility and stimulate the production of sperm.

Other Sleep Impediments


Blue light from devices such as computers and smart phones can answer the question “why can’t I sleep” for many patients, exposure to certain types of light can be a barrier to healthy sleep, tips on how to fall asleep include turning off devices to create a dark room and lowering the temperature to create a better sleeping environment

In addition to the factors described above, there are a number of other lifestyle considerations that could inhibit proper sleep. Sleep hygiene, a term that was coined in the late 1970s, aims to control environmental and behavioral factors that can promote better quality sleep through certain habits and practices. Worry and stress, the intake of stimulants such as alcohol, caffeine, and nicotine, failure to establish a regular sleep schedule, and exposure to light (including blue light from devices such as smart phones and tablets) can all impair sleep hygiene.[5]

Tips on How to Fall Asleep


Beyond treating known issues contributing to sleep problems such as obesity, OSA, and hormone imbalances, quality sleep may be achieved by making some simple adjustments to your daily routine. Here are some tips worth considering, which D’Alessandro recommends both for his clients and anyone seeking improved sleep behaviors:

  1. Spend at least 20 minutes in a dark, cool room prior to going to sleep. This includes staying away from both handheld devices such as tablets and smart phones as well as larger technology, including televisions. The light from these devices can alter the body’s natural rhythm, making it more difficult to ease into deep sleep.
  2. Lower the temperature. A decrease in core temperature is necessary for entering REM sleep. Elevated temperatures, on the other hand, can cause restlessness and poor sleep.
  3. Avoid caffeine and exercise sessions too close to bed time. These factors can lead to increases in heart rate and blood pressure. Exercising and taking in caffeine too close to your normal bedtime may therefore make it difficult to bring your vitals down to baseline measures when it is time to sleep.
  4. Consider taking naps. When taken early in the afternoon or earlier in the day, naps of no more than 30 minutes have shown to improve cognition and focus. The catch is that limiting naps to 30 minutes or less is the required “sweet spot” needed to reap the benefits: any longer and you may experience an adverse effect, feeling groggy upon waking up. Additionally, naps should also be taken in a cool, dark place.[6]
  5. Exercise and weight train early, if possible. The increased muscle protein and fuel breakdown resulting from exercise requires our body to crave more recovery. Therefore, your body will make a more concerted effort to enter deep sleep if you work out regularly. You may also be more likely to stay asleep. Again, however, be mindful of avoiding exercise in the hours leading up to your normal bedtime.

The Solution for Sleep in Middle Age & Beyond


Cenegenics physicians provide more than quick fixes on how to fall asleep, Cenegenics physicians examine the reasons why you can’t sleep and attempt to alleviate the consequences of sleep deprivation through expert treatment that will better your sleep quality

Sleep is critical to mental and physical functionality at every stage of life, but it may have the greatest potential to be impacted as we age. When individuals experience natural age-related changes such as a decline in metabolism and hormonal variations, they may become more susceptible to conditions such as OSA, obesity, and other factors that influence sleep duration and quality. Thus, treating the underlying conditions contributing to sleep deprivation – rather than providing “quick fixes” for sleep issues – is essential to achieving lasting results.

Clinicians specializing in age management are therefore best equipped for helping middle-aged and older populations achieve better sleep. These experts take an all-encompassing approach to treatment, factoring in all of the different biomarkers which could impact sleep quality and duration. Through exercise, nutrition, and other lifestyle recommendations along with medical treatment if needed, they can help patients achieve better sleep patterns to make lasting improvements in sleep quality and duration, as well as overall wellness.

Key Resources on How to Fall Asleep


This guide was produced with contributions from the following key resources:

Joshua D’Alessandro

Nutrition and Exercise Counselor | Cenegenics New York City

The Cenegenics Education and Research Foundation

The Textbook of Age
Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and
Hormone Replacement Therapy

Available on Amazon

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Education Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

Next Steps to Combating the Consequences of Sleep Deprivation


Register for your complimentary phone consultation.

We hope the information above assisted you in your research process.

Additional Information on Why I Can’t Sleep


Sleep Apnea – What is it?

Sleep Stages

What is Age Management Medicine?

Defy Your Age

Watch Now: 3 Tips for Better Sleep

Sources on Sleep Disorders


[1] “Sleep and Sleep Disorder Statistics.” American Sleep Association. Retrieved from URL: https://www.sleepassociation.org/about-sleep/sleep-statistics/

[2] “Sleep Deprivation: Symptoms, Causes, Treatments.” American Sleep Association. Retrieved from URL: https://www.sleepassociation.org/sleep-disorders/sleep-deprivation/.

[3] Foster et al. “A Randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study.” Archives of Internal Medicine. 28 Sept. 2009. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/19786682.

[4] “Male hypogonadism: Symptoms and treatment.” Journal of Advanced Pharmaceutical Technology & Research. Jul-Sept 2010. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255409/

[5] “Sleep Hygiene.” American Sleep Association. Retrieved from URL: https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips/sleep-hygiene/.

[6] Kutscher, S.J. “Sleep and Athletic Performance.” Principles and Practices of Sleep Medicine. 646-652. 10.1016/B978-0-323-24288-2.00064-7.

Obstructive sleep apnea occurs when airflow repeatedly stops and starts during sleep, obstructive sleep apnea symptoms can range from loud snoring to decreased libido, you may want to speak to a Cenegenics physician to understand how to diagnose sleep apnea and how sleep apnea is treated

Obstructive Sleep Apnea: What is it?

Article at a Glance

  • Obstructive sleep apnea (OSA) is a common sleep disorder in which your breaths become shallow or you stop breathing multiple times throughout the night.
  • OSA can be characterized by loud snoring, daytime sleepiness, and abrupt awakenings accompanied by gasps or choking sounds.
  • Obstructive sleep apnea is diagnosed via a full-night polysomnography and can be treated with PAP therapy, surgery, retainer devices or pharmaceuticals.
  • Weight can be one of the causes for OSA, so weight management may be a consideration when formulating a treatment plan.

Obstructive sleep apnea (OSA) occurs when the airflow is insufficient for metabolic demands. The collapse of the pharynx results in this obstruction: when muscle dilator activity becomes insufficient to maintain the pharynx, obstruction occurs.

OSA is an epidemic largely affecting obese individuals. While prevalence in the U.S. is estimated at 2% to 24% of the population, it is likely closer to the upper margin of this range because many patients are undiagnosed. In specific, OSA is moderately associated with a body mass index (BMI) of greater than 35, as well as hypertension and an increase in age up to 65 years. It also occurs more often in men than women, at a ratio of 2-3:1.[1]

Obstructive Sleep Apnea Symptoms


Obstructive sleep apnea symptoms can include:

  • loud snoring
  • excessive daytime sleepiness
  • episodes of breathing cessation during sleep
  • abrupt awakenings accompanied by gasps or sounds of choking
  • Morning headaches
  • decreased libido
  • difficulty concentrating
  • mood changes

While not everyone who snores has OSA, it is still recommended for snorers and individuals experiencing other symptoms to seek professional input from a physician.

How to Diagnose Sleep Apnea


To form a diagnosis, physicians will recommend patients to undergo full-night polysomnography, either in-lab or at home with a portable monitor. The test will measure critical parameters such as heart rate, leg movements, breathing patterns, and oxygen saturation. The number of respiratory events, including apnea (the repeated stopping and starting of breath), will be recorded to form the patient’s Apnea/Hypoapnea Index (AHI) score. Diagnoses are made at the following rates of interrupted breathing:

  • Mild: More than five times per hour, but fewer than 15
  • Moderate: More than 15 times per hour, but fewer than 30
  • Severe: 30 or more times per hour

Treatment of OSA


Depending on the findings, the physician may recommend treatments such as changing the sleeping position or the implementation of oral appliances. These appliances include mandibular reposition appliances which hold the jaw in place, as well as tongue retaining devices, which hold the tongue in a forward position to optimize airflow. In certain individuals, surgery may also be recommended to resolve sleep apnea. Removal of the tonsils and/or adenoids, for instance, may facilitate an improved airflow. While pharmacology is not typically a primary treatment option, limited corticosteroid use may improve airflow in patients with concurrent rhinitis.

One viable treatment option for all levels of OSA is positive airway pressure (PAP) therapy. Machines consisting of a mask to cover the nose and mouth, as well as a tube connecting to a motor which blows air into the tube, can help to ensure ample levels of air are reaching individuals while they sleep. Yet, compliance with PAP is poor, with 46% to 83% of patients being noncompliant.[2] Thus, where applicable, alternate therapies should be considered. In individuals with a BMI greater than 25, weight loss is one behavioral therapy that should be explored.

Next Steps on How to Diagnose Sleep Apnea


Register for your complimentary phone consultation.

We hope the information above assisted you in your research process

Key Resources on OSA


This guide was produced with contributions from the following key resources:

Joshua D’Alessandro

Nutrition and Exercise Counselor | Cenegenics New York City

The Cenegenics Education and Research Foundation

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Available on Amazon

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Education Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

Additional Information on Obstructive Sleep Apnea


Why Can’t I Sleep? – Clinical Explanations

Sleep Stages

What is Age Management Medicine?

Defy Your Age

Watch Now: 3 Tips for Better Sleep

Sources on OSA


[1] Young et al. “The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults.” The New England Journal of Medicine. 1993. Retrieved from URL: https://www.nejm.org/doi/full/10.1056/nejm199304293281704.

[2] Weaver, T.E., and Grunstein, R.R. “Adherence to continuous positive airway pressure therapy: the challenge to effective treatment.” Proceedings of the American Thoracic Society. 15 Feb. 2008. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/18250209.

Sleep plays an important role in dealing with stress and reducing inflammation, individuals who cannot recall the last night of sleep that lasted seven to nine hours need to consider seeking help in order to prioritize their sleep schedules

Sleep Stages

The human body has been conditioned to recognize patterns of restfulness and sleep times over thousands of years. The circadian rhythm encompasses physical, mental, and behavioral changes taking place over a daily cycle, which is a result of exposure to light and darkness in our environment. This rhythm is responsible for dictating the drive to sleep not only in humans and animals, but it also plays a role in the functionality of plants and microscopic organisms.[1]

Daylight is among the most powerful influencers compelling us to sleep. When our eyes pick up light rays, they are converted into electrical waves that pass to the optic nerve. Thereafter, the optic nerve relays the message to the body’s “Master Clock,” or the Superchiasmatic Nucleus (SCN), which acts as a master circadian pacemaker controlling the timing of sleep-wake cycles.[2] The SCN comprises thousands of neurons which work in tandem with one another to relay messages across the entire body. As the day winds down and the sun begins to set, the optic nerve then relays this new message to the SCN, which then releases serotonin. Our bodies convert serotonin into melatonin, allowing us to relax and ease into the first stage of sleep.

Textbook of Age Management Medicine Volume 1 is available on Amazon, Cenegenics Senior Physician Jeffrey Leake is the co-author of the Textbook of Age Management MedicineIn the Textbook of Age Management Medicine: Volume 1, authors Jeffrey P. Leake, MD and Todd D. Greenberg, MD note that sleep is classified into three separate phases: wakefulness, non-rapid eye movement (REM) sleep, and REM sleep. Joshua D’Alessandro, New York City-based Nutrition and Exercise Counselor, explains that these categories are further classified into the five stages of the sleep timeline:

  • Sleep Stage 1: After the first ten minutes of sleep, we remain aware of the environment around us. This cycle is brief, lasting seven minutes at most.[3] During this phase, we remain relatively alert and can be woken easily. To facilitate a transition into the next stage, it is recommended that individuals aim to minimize disruptive sounds and shut off all lights.
  • Sleep Stage 2: The second stage occurs within 10 to 20 minutes of initiating sleep. At this point, the SCN has released melatonin, which is taking effect throughout the organs and muscles. This is also when the body begins to slip into a deeper state of sleep.
  • Sleep Stages 3 & 4: Usually within the first 30 to 40 minutes of sleep, we slip into progressively deeper levels of sleep. Known as “Slow Wave Sleep,” (SWS) these stages are particularly difficult to awaken from and often lead to grogginess if interrupted.[4] The pituitary gland releases the appropriate hormones during these phases as well, effectively increasing the release of growth hormones and other androgen hormones. Growth hormones are responsible for muscle protein synthesis, the efficient storage of fuel, restoration of metabolism, and overall recovery. It is therefore absolutely essential that we stay asleep during this phase, which comes just before REM sleep. We will examine the relationship between sleep and hormones in greater detail in an upcoming section.
  • Sleep Stage 5: The fifth stage, REM sleep, comprises roughly 25% of the entire sleep cycle and occurs first within 70 to 90 minutes after falling asleep. Because the sleep cycle repeats, REM sleep is experienced multiple times each night. REM cycles can last for up to 90 minutes, and it is recommended that the body achieves around six full REM cycles to maximum recovery. This can add up to seven to nine hours of sleep.
    REM sleep stimulates the areas of the brain used for learning, and lack of REM sleep is linked to health conditions such as migraines. During REM sleep, signals are sent to the spinal cord to halt movement. Dreaming also occurs during REM.[5]

In individuals who cannot recall the last night of sleep lasting seven to nine hours, serious changes need to be made to rearrange schedules for prioritizing slumber.

Key Resources


This guide was produced with contributions from the following key resources:

The Cenegenics Education and Research Foundation

The Textbook of Age Management Medicine Volume 1: Mastering Healthy Aging Nutrition, Exercise and Hormone Replacement Therapy

Available for purchase here

Joshua D’Alessandro

Nutrition and Exercise Counselor | Cenegenics New York City

Textbook Authors:

Jeffrey Park Leake, M.D., CPT

Dr. Jeffrey Park Leake is a Partner and Director of Education at Cenegenics Elite Health specializing in age management and wellness. Having trained hundreds of physicians worldwide, Dr. Leake is also the Director of Education for the Clinical Strategies for Healthy Aging course at AMM Education Foundation.

Todd David Greenberg, M.D., CSCS

Dr. Todd Greenberg is a practicing physician with a broad range of expertise, including wellness, exercise, sports injuries, and MRI of sports injuries. He is a Radiology Clinical Associate Professor at the University of Washington.

Next Steps


Register for your complimentary phone consultation.

We hope the information above assisted you in your research process.

Additional Information


Why Can’t I Sleep? – Clinical Explanations

Sleep Apnea – What is it?

What is Age Management Medicine?

Defy Your Age With Cenegenics

Watch Now: 3 Tips for Better Sleep

Sources


[1] “Circadian Rhythms.” National Institute of General Medical Sciences. Aug. 2017. Retrieved from URL: https://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx

[2] Moore, R.Y. “Suprachiasmatic nucleus in sleep-wake regulation.” Sleep Med. Dec. 2007. Retrieved from URL: https://www.ncbi.nlm.nih.gov/pubmed/18032104.

[3] “Understanding Sleep Cycles: What Happens While You Sleep.” National Sleep Foundation. Retrieved from URL: https://sleep.org/articles/what-happens-during-sleep/

[4] “Sleep and Sleep Disorder Statistics.” See above.

[5] “What is REM sleep?” Eunice Kennedy Shriver National Institute of Child Health and Human Development. 01 Dec. 2016. Retrieved from URL: https://www.nichd.nih.gov/health/topics/sleep/conditioninfo/rem-sleep.

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