Sleep problems? Our sleep physician answers your questions

According to the National Institute for Health and Care Excellence (NICE), ‘around a third of adults in Western countries experience sleep problems at least once a week’. This alarming statistic, combined with the NHS’ report that the number of sleep diagnostic tests conducted in the UK has doubled in 10 years, shows that sleep disorders are becoming more common – or perhaps that awareness is increasing.

However, although awareness of sleep disorders may have risen, there are still gaps in public knowledge regarding the effect of sleep disorders on general health, the causes of these disorders, and the treatments available.

Dr Coker, accredited sleep physician and founder of The Coker Chest Clinic, has many years’ experience in the diagnosis and treatment of sleep disorders. Here, she answers your most commonly asked questions:

How can I cure insomnia?

Treatment for insomnia involves identifying and treating this root cause, before implementing an effective sleep routine that works well with your lifestyle. We can also prescribe safe, non-addictive medications and other therapies, which will aid in establishing and maintaining this sleep routine.

Patients who attend The Coker Chest Clinic presenting with insomnia suffer from a poor sleep routine due to shifts at work, or post-traumatic stress disorder (PTSD) resulting from a very stressful situation or trauma or as a result of a medical condition.

Insomnia treatment requires a holistic approach that encompasses the expertise of a multidisciplinary team, hence some cases are referred to other specialists including psychiatrists to treat PTSD or other psychological issues.

Why do I keep waking up in the night?

When it comes to waking up throughout the night, there are multiple possible causes. The most common is a sleep-related breathing disorder known as obstructive sleep apnoea (OSA); this is where oxygen saturation drops due to poor breathing, and the brain alerts you by waking you up in response.

This is followed by periodic limb movement disorder (PLMD). PLMD is a condition where you develop a jerking action in your legs whilst asleep, and are again woken up by this movement. The movement ceases when you wake up, which is why you may not be aware that you have this disorder.

Lastly, environmental factors can cause you to wake up in the night. These include temperature, noise, light, and movement by your partner.

I’m tired all the time but my doctor says there is nothing wrong with my tests. What now?

There is a broad spectrum of tests available for sleep disorders, but unfortunately, not all doctors request the relevant tests. For example, they may conduct tests which analyse kidney and liver function, full blood count and inflammatory markers. However, these will not provide sufficient data to form a correct diagnosis. Instead, patients require tests which look into a wider range of factors that impact sleep quality.

There are many types of sleep tests, but each one is tailored for a specific issue. These tests can only be completed in a sleep clinic by a specialist.

Why do I wake up with my heart pounding?

A pounding heart refers to palpitations, which is when you feel a fluttering or pounding sensation in your chest, which can last for a few minutes after waking up. Common causes include menopause, thyroid gland disorder and heart problems; however, the most common cause is OSA.

This occurs when you stop breathing, and your oxygenation drops to below normal, healthy levels. This causes the heart to react by speeding up, missing a beat or adding an extra beat. On many occasions, you may have palpitations throughout the night, but not necessarily wake up.

We advise that if you are concerned you may have sleep apnoea, that you attend an appointment with a physician rather than a cardiologist. This is because, more often than not, OSA is the cause of the palpitations, and this is unlikely to be detected by a cardiologist. If a physician suspects that you are suffering from a heart problem, they will refer you to a cardiologist.

I once treated a male patient who presented with heart palpitations, and whose wife had reported that he snored on occasion. He sought help from his GP and was referred to a cardiologist who was unable to identify the cause. The patient then requested a second opinion during a consultation with a private GP, who referred him to a sleep clinic. Indeed  his history of excessive tiredness and feeling not refreshed on waking up in the morning suggested a sleep condition. His 24 hours ECG, confirmed the presence of palpitations. When he attended my clinic, I analysed the data from the recommended sleep test, found that it was consistent with a sleep disorder and issued treatment. After a follow-up monitoring using an ECG, his results were back to normal because he had been treated for his sleep disorder.

This patient case is an example of how we treat the root cause of sleep disorders, rather than just the symptoms.

How do I know if I have a sleep disorder?

If you notice unusual symptoms that deviate from your normal behaviours or that start to affect your daily life, it is important to seek advice from a physician right away. Warning signs of sleep disorders include:

• Snoring
• Waking up feeling unrefreshed
• Having a restless sleep
• Suffering with brain fog
• Poor concentration or memory problems
• Morning headaches
• Excessive daytime tiredness
• Weight gain or inability to lose weight
• High blood pressure (this affects 80% of patients that visit The Coker Chest Clinic with sleep problems)
• Palpitations

Risk factors include having diabetes; a family history of OSA, high blood pressure, heart attacks or stroke; and age, especially in patients who are above the age of 65.

What should I do if I suspect that I have a sleep disorder?

If you are experiencing any of the above warning signs, please make an appointment for consultation at The Coker Chest Clinic using our online booking system, by emailing  [email protected] or by calling 020 7118 5600 today.