• Common Cause of Tiredness
• Dizziness Caused by Head Movement
• Sleep Problems
• Understanding Sleep as You Age
• Medicines and Sleep
• Other Causes of Sleep Problems
• Managing Sleep Problems

About 5-15% of the general population have problems with tiredness and sleep. Some persons are also bothered by tiredness and dizziness without falling. (For falling, see "Daily Activities- Lower Extremity) These problems are most often seen in persons who have a number of bothersome health or social conditions.

For many persons, tiredness means both a lack of energy and the inability to complete usual activities. Not getting enough sleep or having fitful sleep is a common reason for being tired.

In addition to sleep problems, there are other causes of tiredness:

* Severe dieting can lead to tiredness because of the lack of all of the required vitamins and calories.

* Allergies and breathing problems can cause fitful sleep and tiredness.

* Being too active and too stressed by activities can also lead to a fitful night's sleep and tiredness. Many adults are balancing jobs and other activities. Having an irregular schedule or using pills or coffee to stay awake will catch up to you and cause tiredness.

* Anemia (low red blood) can cause tiredness. If it occurs, it is usually due to a lack of iron in the diet and is seen especially in young women who are menstruating and not eating properly.

* Pills, such as antihistamines (like Benadryl), many blood pressure and "heart" pills, and most antidepressants and tranquilizers can cause tiredness. Illegal drugs and alcohol cause these problems as well.

*Often the cause if unclear or leads to a label such as "chronic fatigue" or "low blood sugar". Sometimes these labels make sense but often they don't help make the problem more understandable or easier to treat. The good news is that in well done studies of chronic fatigue, 7 of 10 persons benefit from 12 weeks of regular exercise. (See "Exercise").

Sometimes diziness will happen whenever the head is moved side to side or up and down. This type of dizziness often improves with the following exercise. While sitting, you move your head side to side and up and down several times. You do this with your eyes open and your eyes closed. Repeat this several times a day. You gradually increase these movements and make them faster as the dizziness gets better. Then you start doing them in a standing position.

Few things in life are as pleasant as a good night's sleep.The amount of sleep each person needs is different, but the typical range is between seven and eight hours a night. Your needs are fairly constant through adulthood. Later, aging reduces the length of sleep you can expect at any one time. With increasing age, many persons wake up several times each night.

Sleep apnea (breathing that stops for short periods of time) disturbs sleep in some persons. Persons with sleep apnea generally feel tired after sleeping. They are often unaware they do not breathe well during sleep. Others will notice that they snore loudly and stop breathing for short periods. Persons with sleep apnea may be overweight and have high blood pressure.

Being depressed can cause sleep problems. Not everyone who is depressed feels sad. Some lack energy, sleep poorly, eat poorly, are irritable, or have little interest in activities or friends. Depression can usually be successfully treated with counseling and/or medication. (See Emotional Care)

A General Approach.
(The following suggestions help about 2 of every three persons who have sleep problems.)

• Go to bed only when sleepy. There is no need to sleep eight hours every night and there is no benefit from staying in bed when you cannot sleep. Staying in bed more than five hours a night is of no value if you are not sleeping.
• Use your bedroom only for sleeping. For safety your bedroom area should have a smoke alarm, a lamp that's easy to turn on, and a telephone by your bedside.
• After turning off the light, give yourself about 20 minutes to fall asleep. If you are still awake or if you lose your drowsiness, get up and go into another room until you feel sleepy again.
• Follow a regular schedule. Get up at the same time. Don't have one schedule for the work week and one for the weekend. A regular routine at bedtime, like reading a book or taking a warm bath, will tell your body it's time to sleep. Write down what you are doing each day. See if you are pushing yourself too hard.
• Avoid daytime naps. If you take daytime naps, you are likely to stay awake at night. If you must nap, take a short nap before 3 PM. If you usually feel so tired during the day that you fall asleep without planning to nap -- please talk to a doctor.
• Try to exercise regularly. Brisk walking four times a week improves sleep. Moderate exercise several hours before bedtime will also help you sleep.
• Be aware of what you eat and drink. Avoid drinking caffeinated (coffee, cola) beverages late in the day. As a stimulant, caffeine can keep you awake.
• Don't drink alcohol to help you sleep. Drinking even small amounts of alcohol can make it harder to stay asleep. This is a very common occurrence.
• Smoking is not only dangerous (starting a fire by falling asleep with a lit cigarette), but nicotine is a stimulant and will keep you awake.

If you still have difficulty, try these "tricks:"

• Try not to worry about your sleep. Some persons find that playing mental games is helpful. For example, think black - a black cat on a black velvet pillow on a black corduroy sofa, etc.; or tell yourself its five minutes before you have to get up and you're just trying to get a few extra winks.
• A warm bath with a drink of warm milk or herb tea may help. However, beverages taken before bedtime may increase the need to go to the toilet.
• Several studies show that exposure to very bright light for one hour during the morning will help sleep by resetting "REM" patterns closer to normal.
• Keep a diary of your sleep for a week. This will help you and your doctor decide on the best treatment for you. For example, if you have trouble staying asleep, you may limit your sleep time to 5 hours. Then gradually over a week, increase sleep time by 30 minutes a night until you wake up feeling rested. Don't spend more time in bed than that.

Should I Use Medications? Sleep medicines you can buy without a prescription usually contain antihistamines. These medicines are generally not harmful if used only a few times a year, but they can make you drowsy and more likely to have accidents the next day. Kava and veleran are herbal remedies for sleep. However, they have side effects. Melatonin is helpful if your sleep clock needs to be reset.

Prescription sleep medicines are often habit forming and may build up in your body. The effects of sleep medications do not last when the pills are stopped. You need to talk to a doctor about any medications you are using for sleep.

Special Treatments

• Best Treatment for restless legs and leg cramps: stand two feet away from a wall and lean forward against it keeping your feet flat to the floor. (See also Exercise #7 p.30) Hold and repeat. Quinine works well for leg cramps and clonazepam and drugs for Parkinson's disease may help restless legs. These medications must be prescribed by a physician.
• Treatments for snoring included weight loss if needed, no alcohol at dinner, and devises such as chin straps, and nose vents. Sleeping on the side (place a tennis ball on the back of the pajamas) may also help.
• Treatments for sleep apnea include devices to be worn at night (trouble some), continuous air pressure using a device through the nose (bothersome), and even surgery (50% effective). The cheapest and safest first approach is to reduce weight when necessary and avoid alcohol.
• Your doctor may recommend that you visit a sleep clinic. Sleep clinics may be used used to make diagnoses and recommend treatments for persons who have sleep apnea or severe sleeping problems not responding to any of the above described approaches.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.