Sleep Soundly Every Night, Feel Fantastic Every Day (10 page)

  
8.
 
Work on your neck by gently pulling your head back, as if you were looking at the ceiling, and continue the breathing pattern.

  
9.
 
Next, go to the muscles of your face and smile widely, feeling your mouth and cheeks tense and then relax. Work on your forehead by lifting your eyebrows as high as you can.

10.
 
Next, relax your eye muscles by tightly shutting your eyes for a count of 5, exhale, and relax for 10.

You may want to do this exercise in this order, or you may find a different progression works better for you. You could do both extremities simultaneously, or one side at a time.

Finally, feel free to vary the breathing counts as it suits your breathing and comfort. The more you use this specific exercise, the more you will come to appreciate its valuable benefit to help you relax and fall asleep or return to sleep.

If you've tried these best practices to achieve longer, restoring sleep and are still having trouble falling or staying asleep, start keeping track of how you sleep by keeping a sleep diary for at least two weeks. I've provided a sample at the end of this chapter.

Your sleep diary is like a mirror reflecting your sleep–wake cycle. If you have noticed that you are more irritated, tired, and frustrated, or that you cry easily, can't concentrate, or have blank memory moments, then a sleep diary will be your best friend. The diary provides the answers to your inner detective that searches for clues to your unrest or discomfort. In your sleep diary, you or your partner can record sleep quality, waking time, quality of focus and energy during the day, and naptime and quality of rest.
If you have a restless mind, also record the thoughts that keep you awake. Finally, you'll write the time of going to sleep and the time of any night awakenings. After two weeks of recording your pattern, you'll clearly see your sleep–wake cycle map and understand why you feel as you do each day.

A sleep expert will want to review this information. Although self-reporting may not be the most reliable, it does tell your health professional what is important to you, how you view the situation, and enables him or her to discern deeper patterns or issues to address.

As you move to the next step and read the chapters associated with the symptoms you identified on the Sleep Disorder Checklist and implement strategies suggested in them, I hope you will see positive changes in your sleep pattern. However, if your symptoms persist for more than three days a week for over a month, it is time that you spoke to your health care professional. Your sleep diary will provide essential information for a diagnosis.

Please fill out sections A and B for each day.

Name:
_____________________________
   
DOB:
______________

Starting Date:
_______________________
  
End:
_______________

Date:
________________

 

 

 

This category of sleep disorders refers to issues in getting to sleep, staying asleep, and the excessive sleepiness caused by disruptions of sleep duration, quality, or timing of sleep. There are 30 sleeping disorders in this category; here, I've addressed the five most prevalent: restless legs syndrome (RLS), periodic limb movement syndrome, insomnia, circadian rhythm disorder, and sleep apnea.

 

 

The amount of sleep required by the average person is five minutes more.

—WILSON MEANER

Joan arrived at the Sleep Disorders Center, casually dressed in jeans, and appeared comfortable as she sat down in my office. I noted in her medical history that she was 45 years old. She carried a journal with her, opened it, and stuck her thumb in between the pages to hold her place during our preliminary small talk.

“Hello, Joan, and welcome. It looks like you have some information to share.”

“I do. Do you want me to dive in and present my case, or do you want to ask me questions?” Since Joan was ready to read her journal to me, I asked her to proceed.

Joan shared her notes. “About eight weeks ago, I woke up around 2:00 a.m. to this intense tingling in my legs. The longer I stayed in bed, the sensation of tingling became like something crawling slowly up my legs. Of course, nothing
was there. I tried propping pillows under my knees and changing positions, but I just had to get up. I could only compare the growing sensations of pain to thousands of pinpricks. This is hard to describe, so you can see why I wrote it all down. I got out of bed, slid down the wall to the bathroom, and ran some hot water. All I could think of was soaking those sensations away. That pattern subsided around 8:00 a.m. I've had two more episodes in the past eight weeks, and I did my homework. I think I have restless legs syndrome, and I wondered what you would prescribe for that.”

“Well, Joan, before I prescribe anything, if I do at all, I need to get a few more facts from you. Can we do that now?” She nodded yes.

“First, Joan, I am going to read nine phrases and you can say yes or no if this sounds like what you experienced, okay?”

“Go for it!”

1.
 
“It just makes me want to move.”

    
“Definitely.”

2.
 
“It feels like I have water running underneath my skin.”

    
“Nope.”

3.
 
“It feels painful.”

    
“Incredibly so.”

4.
 
“It burns and aches.”

    
“Sometimes the tingling could feel like burning, but not aching per se.”

5.
 
“It feels like I have a toothache in my leg.”

    
“Don't know what that means. I have never had a toothache.”

6.
 
“I have the heebie jeebies in my legs.”

    
“Oh my gosh. I have never heard anyone use that phrase but my father. He said he got the heebie jeebies. He said he had trouble sleeping all the time. You don't suppose his heebie jeebies were leg pains do you?”

Joan seemed excited by the possible connection. I said, “I don't know, but I will be taking a brief family history. RLS sometimes has a hereditary factor. If this is the first time you've had this event, then likely it is not hereditary. Most children in families with a genetic factor have RLS in their childhood, and surely by age 20. So, shall we finish?”

7.
 
“My legs feel creepy, crawly, and tingly.”

    
“Yes.”

8.
 
“It feels like I have worms or bugs crawling deep in my muscles.”

    
“Yes.”

9.
 
“It feels like electricity in my legs.”

    
“The tingles could be like that a little. Can you diagnose me yet?”

I laughed and gave Joan credit for her persistence and for doing her homework. I appreciate patients who read and search for answers, and even when they think they have an answer, I still have to conduct the history and examination. When patients like Joan experience strange sensations that wake them up and grow in intensity through the night, they fear it happening again. Somehow being able to put a name or diagnosis to a symptom implies that a doctor will be able to provide a solution.

“Joan,” I explained, “I still want to conduct a neurological exam. I will review your medical records for medications and such. We have more to do before I can offer a final diagnosis. If that works for you, let's move to the next step.”

“Whatever it takes, doctor, you lead the way.”

“Basically, Joan, to meet the diagnostic criteria, you would need to have:

1.
 
Symptoms that are severe at night and usually subside during the day.

2.
 
The irresistible urge to move the legs or arms because of pain, burning, pricking, tingling, or numbness.

3.
 
The sensations following relaxation or a period of staying still, and during sleep.

4.
 
Relief from these sensations during movement.”

Joan's diagnosis did turn out to be RLS, and further medical tests revealed an iron deficiency. These tests included checking her serum iron for the amount of iron in the blood; her serum ferritin for the level of iron stores her body had used; and her transferrin, the protein that carries iron in the blood, to determine the level of transferrin that was not carrying iron. The first step in treatment was for Joan to rebuild her iron stores, and the RLS was eventually eliminated.

There are two types of RLS:

Primary RLS
has no known cause, and stands alone, not being associated with any other disorder.