As answered by Issue Reviewers
Q: Is it normal to awaken to use the bathroom several times per night?
No. This reflects either fragmented sleep, resulting in periods of wake after each sleep cycle, bladder irritability or increased urine formation. Knowing if the amount of urine is large or small is useful.
If one awakens for any reason during the night, one will feel that one’s bladder is full. Thus, some people awaken because of disturbing environmental stimuli or other reasons and think they were awakened to urinate when it was the other way around. That being said, awakening several times during the night to urinate raises the following possibilities: untreated obstructive sleep apnea, prostate enlargement, diuretic substances (such as tea, coffee, or alcohol) taken prior to bedtime or increased evening fluid intake.
Although it is common to get up at least once to use the bathroom at night (also called nocturia), it should not be considered normal. Nocturia can disrupt sleep, contribute to daytime sleepiness and increase the risk of falls or injuries. Nocturia can have many causes; among them, caffeine ingestion, medications, increased fluid intake before bedtime, urinary tract infection and obstructive sleep apnea.
Q: As I age, I find I’m waking up earlier and earlier, but too tired to get out of bed. How can I curb this?
As we age, our internal clock (circadian rhythm) undergoes changes that favors early awakenings and early bedtimes. This is called advanced circadian cycle. It is considered a disorder if it causes significant symptoms. One treatment option is to allow yourself to sleep in accordance with your own clock. Try to go to bed earlier if you feel sleepy and wake up naturally.
An advance of the internal clock in the brain is often seen with aging. The best way to counter this is to ensure bright evening light until about 8PM, then minimizing the light. Avoid light before 6AM in the morning. Evening darkness and light too early in the morning will make this pattern worse. Sometimes, use of a light box in the evening is necessary.
It is normal to have one’s biological clock move earlier (phase advance) with aging, but usually both the wake and sleep onset times move earlier. My first suggestion would be to move the bedtime earlier to correspond with the earlier wake time and avoid activities (put down the iPad) such as using personal screens in bed that may delay sleep onset. However, what the writer may be complaining of is not the normal phase advancement with aging but, rather, he/she is experiencing early morning awakening. Causes of early morning awakening include stress and depression, which can increase in prevalence with age (and certainly have increased with the pandemic), but also disturbing environmental stimuli, evening consumption of alcohol and sleep disruption from medical disorders (e.g., heart failure or emphysema) that may be more common with aging. In summary, this is a complicated question and seeing your primary care physician and/or a sleep specialist may be in order.
Q: I fall asleep with the TV on, but I’ve read that’s bad for me. Why?
It might be tempting to unwind by watching TV or other electronic devices in bed, but as you become engrossed in the content, it will be harder to fall asleep and you may end up staying up later than you anticipated. Coming up with a relaxing bedtime routine that doesn’t involve electronics can help the body and mind prepare for sleep and may result in a more restful and restorative night.
Habituation to noise is possible, but fluctuating noise and light can cause arousals. Light exposure, if you are close to the TV, can disrupt sleep even if eyes are closed. Needing a TV to fall asleep also may suggest the development of an “association disorder” or inability to fall asleep in any other circumstance. If you wake up, the temptation to channel surf may further disrupt sleep. If you also have a snack, that is the end of undisturbed sleep.
Electronics emit blue light that can interfere with the signals that tell the brain to produce melatonin, a sleep promoting substance. Furthermore, falling asleep with the TV on can be restless as the volume fluctuates and disrupts what would otherwise be a restful sleep. Watching TV also promotes bad “sleep hygiene” as the brain can start identifying the bedroom as a place to watch TV instead of a place to sleep, so the habit could contribute to symptoms of insomnia.
Everything is relative. Some people find falling asleep to TV helpful for them and do not have insomnia. Even if you are using a sleep timer, the noise of the TV turning off can cause an arousal.
Q: I live alone. How can I find out if my snoring is a concern?
There are many symptoms of sleep apnea, of which snoring is just one, so not knowing whether or not you snore should not prevent you from seeking evaluation for possible sleep apnea (with other prominent symptoms being awakening gasping for air, unrefreshed or awakening with a dry mouth). That being said, there are apps that will record your snoring and, in pre-pandemic times, individuals without regular bed partners would often have friends or family report on snoring or, at times, symptoms would be reported during a medical procedure, such as colonoscopy or surgery.
There are several smartphone apps that can monitor for snoring and provide you with trackable information. Some people are aware of waking up with a gasp, choke or snort that could indicate concerning snoring. But snoring isn’t the only indicator of a potential sleep problem. If you don’t feel rested by your sleep, mention it to your doctor. They may recommend further testing, which can now often be done in the comfort and convenience of your own bed.
If you live alone, then snoring is not always a concern (who are you disturbing?). If you are curious, recordings can be done with a cell phone and played back, several applications can enable this. If you are concerned about sleep apnea, then direct measurement is best. Go through an MD and perhaps take a home sleep apnea test. In the near future, I expect that over-the-counter, medical-grade apnea diagnostics will be available.
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