Welcome back! Let’s try to stay awake for this one, ok? We covered a lot of ground in Part 1, this link will take you there if you need a review or missed it: Sleep - Part 1.

Ok, we’re just gonna dive right in and not waste time. The signs and symptoms of insomnia are pretty obvious but let’s take a look at a few.

If you experience any one or more of the following, you might have a sleep issue:

• Loud snoring, spouse sleeps in another room or complains

• Startled awakening from snoring or stopping breathing

• Waking several times during the night

• Daytime fatigue or sleepiness, need for nap, or falling asleep doing quiet activities during the day (reading, watching TV, riding in car as passenger, etc)

• Decreased attention or inability to concentrate or stay focused

• Decreased performance or prone to errors at work or school, driving or doing mundane tasks

• Mood swings, irritability

• Headaches, especially tension type

• Decreased motivation or initiative

• Worsening anxiety and/or depression

• Low libido

• Weight gain and blood sugar problems

• High blood pressure

This list is not all inclusive by any means, but wow, do you see all the similarities to other medical conditions in that list?

For example, how many of these symptoms sound like “attention deficit”? Unfortunately, WAY too many people, especially adults, are misdiagnosed with attention deficit disorder and put on stimulants like Adderall when in fact they have an underlying sleep problem! Of course the stims help them stay awake and focus during the day, but not addressing the underlying issue of sleep just sets that person up for a growing number of problems including the need for higher and higher doses of stimulants, worsening anxiety/depression, increased risk of illness, injury, heart disease and more!

How about the motivation, fatigue and libido symptoms? Sounds a lot like low testosterone, right? This one can be a chicken/egg scenario. For guys, poor sleep does contribute to endocrine changes over time which result in low T. On the flip side, having low T can disrupt sleep. Which one could it be?

We could keep the hits rolling here, but its pretty obvious that sleep can masquerade as many other conditions. If your medical professional is not asking you about your sleep at least annually at your check-up and you feel like sleep might be a problem, YOU need to bring it up! Don’t be one of those guys who winds up with a pill organizer full of drugs masking symptoms and progressively feeling worse and worse. Its a guaranteed way to add more pills as the years go by, all the while having undiagnosed sleep issues as the root cause.

You probably already noticed the first two symptoms on the list are pretty much a slam dunk for someone with sleep breathing disorder and/or sleep apnea. If your spouse is kicking and elbowing you all night, sleeps with ear plugs or has to sleep in another room because your snoring is knocking the paint off the walls, stop reading now and call your doc to schedule a chat and a sleep study ASAP. Sleep apnea and sleep breathing disorders are a VERY serious problem that will literally take years off your life the longer it goes untreated. Here’s a little morsel (don’t eat it): Reducing body weight by even as little as 10% can have a dramatic impact on improving sleep breathing disorders.

One other symptom on the list I think deserves a quick chat is that infamously frustrating issue of waking up multiple times nightly to pee. In medicine, we call this “nocturia”. The urge to urinate, called the micturition reflex, is a fascinating series of events. As the bladder fills with urine, the bladder wall begins to stretch. Receptors in the bladder wall send a signal to the brain that is interpreted as “I gotta pee”. That’s a bit of an over-simplification but you get the drift. You know from experience that the urge to urinate is not an all or nothing. We can often ignore the urge for minutes, or hours in some cases, but the more focused we are on the urge or the more intense it becomes, the more likely we are to go empty the bladder. I know, I know, what does any of that have to do with me getting up to pee at night? Glad you asked…the lighter you sleep (insomnia, sleep breathing problem, etc) the more sensitive you will be to feeling the urge to urinate. Since you’re just lying in bed, there’s not much else to distract you so it doesn’t take a lot in terms of a sensation to encourage you to get up and urinate. Night after night of doing this can become a habit. Now don’t read me wrong here, I’m not saying that waking up several times a night to pee is just a bad habit you’ve created. What I am saying is nocturia is a symptom of an underlying problem! The problem could be as simple as drinking too much liquid or caffeine too close to bedtime. It could also be from prostate issues, bladder issues or a sleep problem. If you’re waking up more than 1-2 times each night to pee, it is worth mentioning to your medical professional.

Sometimes, not sleeping well just boils down to things we do or don’t do before bedtime. We call these things sleep hygiene. Kinda like personal hygiene, they should be something you do every day. Things that are good for you (and those close to you) that become part of your daily routine and help keep you healthy. Here’s a few sleep hygiene tips for you.

1. Bedroom temperature - Humans sleep best when the temperature is between 65F - 68F. Now that doesn’t mean sleeping naked in a room at 65 degrees. You do want some bed covers for cozy snuggles, but not so much that you get too hot. If you don’t want the added expense of cooling the entire house with central air to 65F, consider getting a portable AC unit for your bedroom. Honestly, they are not cheap, usually around $400 depending on your bedroom square footage, but having one can be an absolute life-saver if your central air goes out in the middle of the summer on a weekend when the repair guy can’t get to you until Monday. At least you have one room in the house that you can go cool off in. Those of you who live in the South know what I’m talkin about!

2. Comfort - Make sure you have a comfortable mattress and pillow that fits your body. There are tons of options out there so you have the chance to get pretty picky here. Pillows should be selected based on your dominant sleep position. A side-sleeper needs a pillow with a higher “loft” to support their head and keep the neck (cervical spine) in neutral alignment with the back (thoracic spine). A back sleeper needs a pillow with much lower height and a stomach sleeper would need a very low height pillow or no pillow at all. Those of you who wake up with back pain, neck pain or suffer with recurrent tension headaches, be sure to take a closer look at your pillow height and mattress.

3. Noise & Light - You don’t need a Def Leopard concert in your room at night. Your room needs to be as dark as possible. No need to put aluminum foil on the windows, I mean you can if you want, but room darkening shades work very well. Snuff the night light, you’re a big boy now. A dim clock is fine. You’ll find your eyes adjust to darkness pretty well and your innate radar system knows your dwelling better than you think and will help you avoid tripping. Dead silence is a terrible sleep environment. White noise from a fan, AC unit or white noise generator helps drown out background noise and will keep you in REM and deep sleep for longer periods. There are white noise generator apps for your phone. Don’t use music or TV. Those are not white noise and provide a stimulus to the brain that actually keeps you out of REM and deep sleep. For those of you with younger kids you need to listen for, or the more mischievous teens, there are plenty of cool tech solutions to help in these areas including toddler alarms, cameras with movement alarms and more. Do what you need to do for your family but try to not to let every little sound keep you from a good night’s rest!

4. Consistent bed time - You should plan for at least 8 - 9 hours of time in the bed to allow for at least 7 hours of sleep (minus waking times). We should get in bed and out of bed around the same time every day. At least within an hour on either end. Yup, even on the weekends and vacations! Not to say you can’t stay up late or sleep in occasionally, but doing this every weekend can wreck your sleep rhythms making it absolutely brutal to switch back to your weekday sleep/wake routine. You know we have to have a label for everything in medicine and the sleep nerds even have one for this, its called social jet lag. If you tend to get in the “work zone” in the evenings and lose track of time, set an alarm or deploy some of the amazing tech available on your smarty phone to help remind you when its time to unwind and go to bed.

5. Bedtime Pre-Game - What you do before bedtime is as important for good sleep as any of the above. Turn off the TV and put up your digital devices (if you can) at least 2 hours before bed. If you do watch TV in the evening, don’t watch movies or play video games that get you all jacked up. Nothing like a good rom-com to get you all warm, fuzzy and sleepy. Just kidding, but seriously, no Top Gun Maverick before bedtime (even though its freakin awesome)! It will take your heart rate considerably longer to lower during the night disrupting your deep sleep time. Switch to reading or journaling and use indirect lamp light, not over head lights. Journaling is a great way to clear your head of the day’s thoughts and make your “To Do” list for tomorrow rather than running it through your head for an hour once you lay down in bed.

I get tons of questions about OTC meds and supplements for sleep. That’s a whole other topic and maybe I’ll touch that one in the future. I will say if you’re having enough difficulty with sleep that you’re motivated to take something OTC on the regular, it would be wise to broach the topic of sleep with your medical professional.

Alright, I hope you’re not laying in bed reading this. Get some sleep, tomorrow is gonna be amazing!

Keep Ascending!