Are you facing sleeping problems? Consultants at Singapore General Hospital, KK Women's and Children's Hospital, Changi General Hospital and National Dental Centre, give detailed answers to your questions.
Do you toss and turn all night or perhaps your partner’s snoring is keeping you awake ? Lack of sleep may leave you helpless to cope with daily activities and feeling frustrated.
Sleep problems including snoring, sleep deprivation and sleep apnoea, are associated with depression, heart disease and stroke. Even youths today can be deprived of sleep. It is necessary to have a good sleep to ensure optimal health.
Consultants at Singapore General Hospital, KK Women's and Children's Hospital, Changi General Hospital and National Dental Centre, give detailed answers to your questions.
Question by pokkadot
Is it important to sleep early? There is a claim among TCM the body detoxifies Itself from 11pm to 2am, is it true?
Answered by Dr. Adj Asst Dr. Sridhar Venkateswaran Consultant, Respiratory Medicina, Sleep Medicine, Changi General Hospital
It is important to have adequate sleep. It's not a matter of just sleeping early. A person's bed time can be variable, however if they get adequate hours of sleep (and again this requirement varies among individuals), they will feel well rested. There is no evidence of any detoxification process that happens between 11pm to 2 am.
Question by turquoise
Dear Specialists
am female aged 31 with diabetes & depression. Currently, am on zoloft 50mg & lorazepam 1mg at night. However, sometimes it works & sometimes doesn't. Tends to be very sleepy during daytime & which affects my work & also unable to concentrate as well.
My mother who sleeps with me, heard me snoring very loudly as if am in deep sleep but I woke up feeling very sleepy & drowsy the next day as if lots of sleep deprivation.
I've seen ENT specialist too but they told me to inform my psychiatrist (previously psychiatrist advised me to inform ENT). Hence, am lost.
Answered by Dr. Adj Asst Dr. Sridhar Venkateswaran Consultant, Respiratory Medicina, Sleep Medicine, Changi General Hospital
There are a number of factors which may be contributing to your daytime sleepiness. Depression if not well controlled can cause tiredness and sleepiness (although this may not apply to you).
The drugs used to treat depression and some sleeping pills (such as the ones mentioned) may have a hangover effect and cause daytime drowsiness. Thirdly there may be an undiscovered sleep disorder which can cause sleepiness.
An example would be obstructive sleep apnoea (OSA) which causes sleep disturbance by temporary cessation's in breathing during the night caused by partial or complete upper airway obstruction. Even though there is often a room or bed partner, it may not be obvious to them that this is happening for the events are very short and can be missed, and they themselves are sleeping and unaware of it. Snoring, however, is one of the symptoms of OSA.
I would suggest making an appointment to see a sleep physician at a hospital nearest to you.
Question by ho8011
Hi Dr Ling, I used to be able to sleep anywhere anytime so long as I am tired. I remembered that even during younger days school exams period, I will fall asleep when studying or even on the MRT....
However, over the years, not knowingly when it started, I stop having sound sleep. Sleep to me now is a luxury because I only get to sleep couple of hours every other nights...Most nights i toss and turn, take deep breathe and still futile.
My health starts to take a toll 3 years ago when i noticed that my immunity system has weakened. I will be down with flu, frequent headaches almost every month. In places where there are crowded places, i tend to contract flu from the public easily too.
I wish to revert to my younger days where I can just fall asleep at the snap of the fingers....I tried TCM for the last 1 year and recently started yoga classes but doesn't seem to help much. Can you offer me some advice please?
Answered by Dr Lim Li Ling Director, Sleep Disorders Unit, Singapore General Hospital
You are suffering symptoms of insomnia - lack of sleep does affect our immunity and the symptoms you describe are not unusual. Long term poor sleep is associated with many health issues, so should addressed and treated promptly.
There are many possible causes of your sleep problem, for which treatment is directed at the specific cause. The diagnosis and treatment can only be properly assessed with a comprehensive evaluation in the clinic.
You should see your family doctor if you haven't already, who will refer you to a sleep disorders specialist doctor if needed or if you have not responded to the usual forms of treatment for insomnia.
Question by shalineo
I fell asleep fast, even if I visit the loo once in the night, I'm able to fall asleep quickly too but I just get all sort of dreams every night, which affects my sleep quality. Please help. Tks.
Answered by Dr Lim Li Ling Director, Sleep Disorders Unit, Singapore General Hospital
Excessive dreaming can disrupt sleep, and sometimes if this is severe - or if the dreams are recurring bad dreams, there may be an underlying psychological condition like stress or most commonly, depression or anxiety.
There are cognitive behavioural and drug treatments for sleep disturbances of this type. Proper diagnosis can be made only after a doctor's consultation, and the most appropriate treatment depends on the specific cause. You should consult your family doctor if you have not done so, who may refer you to a sleep disorders specialist if needed.
Question by lee
I just want to know : can you cure snoring? ( I know I do not have sleep apnoea). Does the cure involve surgery, and if so, how intensive is it, and most importantly- reliable is it for a permanent 'cure'? Are there any other alternatives that work? thanks
Answered by Dr Eric Lye | Consultant, Oral & Maxillofacial Surgery, National Dental Centre
- Snoring can be treated by dental splints, palatal implants or surgery.
- Simple snoring is considered as a very mild version of obstructive sleep apnoea (OSA) so the surgical procedures that are used to treat this are also milder.
- A proper examination by a trained physician is required to identify the area of the airway where the restriction may lie. Then the problem area/s, which may be the nasal cavity, soft palate, tonsils or tongue, can be treated accordingly. This will give the best chance of long term success, but age and weight are 2 factors that may cause the problem to recur.
- Medications for chronic nasal obstruction, dental splints for mild tongue level narrowing and palatal implants for soft flabby soft palates. A trained physician must be consulted for possibly efficacy of these alternatives.
Question by chrischua
Hi I am 46 years male and do not smoke. My problem is not with falling asleep but staying asleep and the poor quality of sleep.
I have no problem falling asleep but however in the middle of night about 4-5 o'clock, i will wake up and will not be able to fall asleep again. Even if manage to sleep , i wouldl experience poor sleep quality. ie. i will not be able to have deep sleep as before. I will then be awake by 7 and not be able to go back to sleep. This has been going on for me for last few years. I have resisted the use of drug therapy to enable me enjoy deep slumber though on few occassion i have been able to experience better quality until the next morning if i resort to them.
This poor quality of sleep has affected my concentration during the day and cause me to feel sleepy.
Any advice for me as i know drug therapy is not the solution to my sleeping woe. Sleepless and helpless.
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
You have the form of insomnia which manifests as difficulty maintaining sleep, early morning awakenings and unrefreshing sleep.
The common causes of this type of insomnia are psychological disorders like depression or physical problems, like obstructive sleep apnoea - which refers to blockage of the air passage during sleep which causes recurrent awakenings due to difficulty breathing. Your sleep problem is chronic and will have long term consequences on your physical and emotional health if left untreated.
You will need a formal sleep evaluation, and perhaps a sleep study, to determine the specific cause of your insomnia.
I suggest you consult your doctor - you may need to see a sleep disorders specialist, there are many treatment options for insomnia, depending on what the diagnosis is. The key is to get the correct diagnosis, most sleep disorders have specific and effective treatments.
Question posted in Singapore Sleep Society Forum
My daughter starts grinding her teeth during sleep at a very young age. She is now 8 and I have observed that she grinds every night. The grinding is quite intense from my observation, i.e. she clenches and grinds. I have asked if she feels tired or soreness in her jaw. So far it is negative. But I am worried it will affect her quality of sleep. What can I do to help?
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
Bruxism or teeth grinding is common in children. Some studies have noted a 10-20% incidence of bruxism in children under the age of 10 years. Most of these do not go on to adulthood. Problems that may be associated with bruxism include teeth pain, jaw ache, headaches, wearing out of the enamel or dentin of the teeth, and disturbance of bed partners or roommates.
Bruxism usually does not significantly disrupt the sleep of the affected individual. In most cases we do not need to intervene. If the grinding is intense as described in your child or results in any of the problems as listed above, then you can try the following:
- Sleep on the side
- Explore and resolve any possible areas of stress or anxiety as this will aggravate bruxism.
- Consider a dental evaluation as jaw problems or dental malocclusion contribute to bruxism. In cases where anatomical problems are detected and corrected, the bruxism may resolve. A customized mouth guard may also be used to prevent dental erosion in severe cases.
- Consider evaluation by a paediatric sleep specialist, as bruxism is known to be more common in co- existing sleep problems like sleep apnoea or nocturnal myoclonus.
Question posted in Singapore Sleep Society Forum
I am 45 years old, male, working as an Engineer in government sector (before that in a private sector), It has been about 7 years since I am not able to sleep for solid 7 to 8 hours a day, including weekends and public holiday. I usually sleep at about 12am and wake up at about 5am, even if I try to sleep more, I can't. Sometimes, I try to sleep early but I will also weak up early, in all it is still about 5-hour sleep. I guess it could be due to working stress and I worked as a shift worker (3 rotating shifts) for many years before.
I notice that I am not able to focus on my work and have a bad memory during my work and in reading, I seriously wanted to improve my situation and hope that you can give me your kind advice.
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
Normally as we grow older, there is a gradual slight decline in our sleep quality. This is partly due to wear and tear, as our brain's natural sleep mechanism ages, and also as we grow older we tend to develop more medical problems (both physical and emotional) which can affect our sleep. Sleep consolidation, and duration tend to decline with age as a result.
Your symptoms suggest that you are not getting enough good quality sleep to sustain your alertness and focus during the day, and the most common causes of insomnia tend to be psychologically based, such as excessive stress which you describe and conditions such as depression and anxiety.
If the quality of your life has deteriorated significantly, and your sleep quality and quantity are inadequate, you should consult with your doctor to determine what the underlying causes of your insomnia so that specific therapy (which depends on the diagnosis) can be given. If necessary you will be referred to a sleep disorders specialist doctor. Specific therapy includes medication, cognitive behaviour therapy (changing thoughts and actions which affect sleep adversely) and sleep education.
Question posted in Singapore Sleep Society Forum
I am male and past 80 of age. Since 3 or 4 years ago, I was able to sleep easily at around 11pm but would wake up after 2 or 3 am, and again another 1 or 2 times to visit the loo. If I wake up after 4am, I would find it difficult to go back to sleep and would give up trying after 6.30am. Sometimes, I would be waken by the need to visit the loo but at times it would be tossing around too long that I need to go to the loo again. Lately, conditions have gotten worse. Sleep has become shorter and at times I cannot fall asleep easily at about 11.20 pm like I used to do. A senior doctor at a government clinic prescribes me lorazepam 0.5mg but other junior ones reject my request. What shall I do when the senior doctor retires? I take the pill only after I have laid awake for 2 hrs. My mother lived up to 91 and her last 10 yrs were spent awake for the whole night and asleep for half a day in the morning. Is this problem heredity passed to me? I fear to tread in her footsteps. I had severe insomnia when I was about 35 due to intense office politics but the company doctor cured me then. Other senior citizens whom I discussed with said they have the same problem. Is it natural for old people to be like this?
Answered by Adj Asst Dr. Sridhar Venkateswaran | Consultant, Respiratory Medicina, Sleep Medicine, Changi General Hospital
What you are describing seems to be chronic insomnia. Sleeping pills are not the answer in the long term. In fact taking sleeping pills long-term could be counterproductive to your problem. You need to see an insomnia specialist for this problem, but it basically involves good sleep hygiene (practices) measures as well as different forms of cognitive behavioral therapy.
As far as having to go to the toilet all the time, it may be an urological problem (in which case please ask your GP to refer you to an urologist or it may be a primary sleep disorder like obstructive sleep apnoea which predisposes you to recurrent arousals. In any case a sleep study might be useful and your sleep specialist should be able to assist you with this.
Question by wen_soon
I am a 25 yr old female, currently pursuing my phD. I never had problems getting sufficient rest until 4 years ago, when I moved house. In my new place, the shared toilet is located in my room, thus whenever a member of the family enters my room late at night or early in the morning, my sleep would be disrupted. Since that was a problem that could not be solved, I lived with it. I managed to still catch >6hours of sleep a night, though my memory was affected slightly. In the last couple of months, I found myself unable to fall asleep due to unknown reasons. During the occasions when I manage to catch a wink, i'd wake up suddenly, sometimes to think about my work but other times not knowing the cause, and would stay awake unable to fall back to sleep. I go to bed as early as 10pm and set my alarm at 7am, but I am still not getting enough rest. My attention span and memory has been greatly affected by this lack of sleep, and I believe i need to seek help to rectify the problem. I have considered taking sleeping pills, but am reluctant to risk getting addicted. I have a history of very mild heart murmurs, but I'm not sure if that could be an underlying cause. Hope you can give me some advice. Thank you!
Answered by Dr Adrian Siew Ming Saurajen Singapore Sleep Society
Uninterrupted good quality sleep is extremely important. Having people walk into your room to use the toilet is certainly not a good idea as this will interrupt your sleep. Stress, anxiety, depression are also common reasons for poor sleep, insomnia and early morning awakening. It sounds like you have a sleep debt - in terms of quality and quantity. You need to see your family doctor to see if there are any issues relating to stress, airway blockage etc, which can cause this problem.
Question posted at Singapore Sleep Society
My mum is addicted to sleeping pill - Dormicum and she wanted to kick this habit off. Can I know how to help her with this? My mum claimed that without Dormicum, she get fits & shivered at times. She is worried about all these symptoms happening to her when she couldn't purchase the pills from doctors.
Can I know where to seek help for her to quit this addiction? Can going to any hospital help?
Answered by Adj Asst Dr. Sridhar Venkateswaran | Consultant, Respiratory Medicine, Sleep Medicine, Changi General Hospital
The best thing to do would be to make an appointment to see a psychiatrist working in a sleep clinic at a hospital nearest you.
Question posted at Singapore Sleep Society
My partner needs help as he has been having insomnia and sleep deprivation for years and that has lead to Obsessive Compulsive Disorder and health problems. Now he sleeps about 20 mins intervals at night and gets frustrated and wakes up very early in the morning, sometimes 2am or better times 4am. He feels pain all the time and is fatigue almost all the time, now he has developed paranoia from food he intakes must have no trace of oil to being too clean.
He has recently gone to Sayang Wellness for 2 psychiatrist sessions but once it was passed to psychologist, he did not want to go due to costs and he deems he knows he can 'outwit' the doctors. He needs help as he is getting delusional and can't focus and always seems not able to sort his thoughts in his mind.
I would like to send him to the hospital to seek treatment, may I ask the estimated cost for treating sleep disorders?
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
The clinical features you describe in your partner include chronic pain, fatigue, severe insomnia, "paranoia" and "obsessive compulsive disorder".
It is of concern that your partner appears to have little or no insight into the problems, and that he has defaulted from psychiatric treatment. The issues as described above are all likely related, poor sleep is associated with chronic pain, and in the presence of a serious underlying psychological disturbance - close supervision of therapy, which may include medication or counseling, is required, sometimes as an inpatient.
I suggest you encourage your partner to return to psychiatric care, as the mental health issues appear to be significant by your description. You may find information on cost by calling the respective hospitals, those which have specialists in psychological and sleep disorders include IMH and SGH.
Question by janey
I have a lady friend, who is a high achiever, smart, witty A-type personality. She says she hasn't been able to sleep well at night for the past 5 years or more, as her mind is just 'very active' and can't relax. She travels a lot and takes melatonin, which helps her adjust to the different travel zones. I have told her to keep a pen and paper beside her bed at night, so she can just 'dump her thoughts' down on paper and out of her head, so she can relax. ( That worked for me last time when I had sleepless nights).
Why should she be facing this problem? Is it overwork/stress , or mutliple time-zone travel, or the melatonin? Are there long term dependency problems or side effects of such tablets? Look forward to your advise. thanks
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
There are many possible reasons for her insomnia, and it would be best that she is evaluated by a doctor who can make a proper diagnosis during a comprehensive consultation. Stress and frequent long haul travel are certainly contributory factors. Melatonin can be effective for jet lag, and is not typically associated with major side effects and is not habit-forming.
Question by bodhati
Hi, I am 37years old and have problem sleeping for many years already and my friend introduced me to taking Melatonin. It helps me to sleep sometimes but does not always work. I would like to know if there are any side effects for taking Melatonin for long period of time or even be dependent on it? Thank you.
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
Melatonin is an over-the-counter sleeping aid which is useful for jet lag and is typically more effective in older people who may have lower levels of natural melatonin, which is the body's "sleep hormone".
Melatonin should be avoided in people with coronary artery disease, but is generally well tolerated by most healthy people. It is not an addictive sleeping aid and is not associated with dependence.
Question by limsk
HI, My wife (36 years old) has suffered from insomnia for the past 7 years which we believed is due to work stress. I have been trying to help her by trying to get her to relax, do some exercise..etc. Recently, she undergo an operation and hence she can't do any form of exercise for the next few months. I would like to ask what other of ways to solve her insomnia problem so that she can sleep well at night. Thanks.
Answered by Dr Lim Li Ling | Director, Sleep Disorders Unit, Singapore General Hospital
There are various techniques which can help people with chronic insomnia, which include cognitive behaviour therapy (learning ways to relax and to manage stress better) and medication which can help people with chronic sleep disorders. She should see a doctor if her sleep is a longstanding problem, different types of insomnia require different types of treatment, and the best course is ideally determined by a healthcare professional in the context of a proper consultation.
Question posted at Singapore Sleep Society
I have been a light sleeper since I gave birth more than 20 years ago. Still, I would not considered myself an insomniac until the past few years. It started off with some distressing events that had no solution then. Over time, due to perimenopause, I think, the quality of my sleep has deteriorated significantly.
I have difficulty falling asleep and can remain awake till the wee hours of the morning. When I do fall asleep, I tend to wake up suddenly for no rhyme or reason. I have been prescribed a variety of sleeping tabs, gone for acupuncture and consulted the TCM physician, none of which has really worked or has only provided temporary relief. (I have also consulted a psychiatrist and a psychologist but this was of no help either).
Pl throw some light on my condtition and advise if I should consult a sleep specialist as I'm very very weary. My BP has gone up, I'm gaining weight and my memory/brain function is affected
Answered by Question posted at Singapore Sleep Society
By your description, you may be suffering from what is known as "psychophysiologic insomnia", which is a form of insomnia usually triggered by some remote precipitating event, and can go on for years if left untreated. Menopause can worsen existing insomnia because of changes in mood and hormonal levels which can affect sleep.
Besides these 2 factors, other causes of insomnia may also be present. A precise diagnosis can only be made with a comprehensive history and physical examination, a sleep study may be needed (infrequently) in some cases of insomnia in which there are recurrent apparently unexplained awakenings. The problem as you have described is of longstanding, and has affected your blood pressure, weight and memory, which are all known effects of long term sleep deprivation.
You should consider consulting with a sleep disorders specialist who can help diagnose the cause of your insomnia. Specific treatment can then be prescribed depending on the underlying cause.
Ref: V10
