A collaboration with HealthXchange for the Singapore Sleep Awareness Week 2010

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The Online Sleep Forum has now closed. Please find below, the Q&As conducted for the Online Sleep Forum, for your reference. Please also refer to the Sleep Articles and Sleep Tips pages for more FAQs and online sleep resources.

FAQ

Teeth Grinding in Children

Question:
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?

Answer by Dr Jenny Tang:
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:

1. Sleep on the side
2. Explore and resolve any possible areas of stress or anxiety as this will aggravate bruxism.
3. 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.
4. 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.

Is it important to sleep early?

Question:
Is it important to sleep early? There is a claim among Traditional Chinese Medicine (TCM) that the body detoxifies itself from 11pm to 2am, is it true?

Answer from Dr. Sridhar Venkateswaran :
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.

Snoring

Question:
I 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, I am lost.

Answer from Dr. Sridhar Venkateswaran :
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:
I just want to know:

1. Can you cure snoring? (I know I do not have sleep apnoea).
2. Does the cure involve surgery, and if so, how intensive is it, and most importantly
3. Is it reliable for a permanent 'cure'?
4. Are there any other alternatives that work? Thanks.

Answer from Dr Eric Lye:

1. Snoring can be treated by dental splints, palatal implants or surgery.
2. 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.
3. 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.
4. 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.

Insomnia

Question:
I have trouble sleeping for so long a time until I have perhaps forgotten how to sleep... I remembered the times during school days where I can fall asleep so easily during exam periods that it never occur to me that sleeping can be a chore. I now tend to worry in the day "how am I going to sleep tonight?", "will I be able to sleep" and I dread the nights....having to wake up every other hours to toilet/tossing & turning trying very hard to fall asleep. I tried to seek medical help via TCM, but it is not effective. I tried to do yoga too but still futile. What else can I do to help myself to get decent easy sound sleep every night? Can you help advice me please?

Answer by Dr Cheong Tuck Hong:
Your problem is one of insomnia i.e. difficulty falling asleep. Obviously something is bothering your sleep to the extent that you are 'stressed' by the thought of it. Sleep is a time of rest for the body, and likewise lying on the bed to sleep should be a 'welcoming' activity for us all. We need to find out exactly what is bothering you. Are you stressed by work and carrying on all these stress to bed? Is your mind actively thinking of work or family problems when you should be relaxing and gliding off to sleep? Medicines are only stop gap temporary measures. What is important is first to find out what exactly is the reason behind your inability to get a good night's sleep. You should consult your doctor and if necessary see a sleep specialist.

Question:
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.

Answer from Dr Adrian Siew Ming Saurajen:
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:
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.

Answer from Dr Lim Li Ling:
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:
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?

Answer from Dr. Sridhar Venkateswaran :
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:
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 would experience poor sleep quality. i.e. I will not be able to have deep sleep as before. I will then be awake by 7 am 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 to enjoy deep slumber; though on few occasions 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 causes me to feel sleepy. Any advice for me as I know drug therapy is not the solution to my sleeping woe.

Answer from Dr Lim Li Ling:
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: 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?

Answer from Dr Lim Li Ling:
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.

Excessive Sleeping & Dreaming

Question:
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. Thanks.

Answer from Dr Lim Li Ling:
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.

Sleeping Pills

Question:
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?

Answer from Dr. Sridhar Venkateswaran:

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.

Light Sleepers

Question:
Slight noises (such as neighbours/family members sneezing, coughing and flushing toilet) can cause me to wake up easily at night. I will have difficulty going back to sleep later. Is this normal and what can be done to overcome this problem?

Answer from Dr Adrian Siew Ming Saurajen

Some patients are very light sleepers. They can wake to very slight noises or changes in the environment. Most patients will be able to go back to sleep unless it is towards the end of their sleep cycle and the body has had enough rest. Sometimes if you are very stressed then you may also be more sensitive to external stimuli. I would suggest that you try and mask the environmental noise by improving the sound proofing in your room or by wearing earplugs. If that does not help you may wish to see your family doctor.