Pink Prescriptions - November 2018

Sleepless in The Lowcountry


November 2018 Issue

Losing sleep over not being able to fall—or stay—asleep? If so, you’re not alone.
This month we went to our Lowcountry medical experts to find out some of the reasons—
and some of the remedies—for sleeplessness. Here’s what they had to say.

I wake up tired, what am I doing wrong?
You may not be doing anything wrong. One of the first questions we ask is whether you are snoring loudly, or have been noticed to stop breathing—both are possible signs of sleep apnea. Sometimes people can’t settle and have to move throughout the night, which is restless legs syndrome. If you think this is happening to you, discuss it with your physician as there are good treatments for WEB Dr.Knoble editedboth of these conditions that can give you a good night of restful sleep.

Dr. Laura Knobel is a board certified Family Physician seeing patients of all ages in Plantation Park in Bluffton. She has a direct primary care practice where you can get your primary care for $50 a month or less. Office phone: 843-836-2200. Website:


I fall asleep on the couch with the television on and then go to bed around 1 or 2 a.m. Is this affecting my quality of sleep?
Do you have trouble falling back to sleep when moving from sofa to bed? If you have a poor sleep habit that prevents you from getting a good night’s rest, such as staying up too late, falling asleep somewhere other than where you will sleep through the night, or waking up too early, consider implementing a bedtime routine that allows for optimal rest. Not getting enough sleep can have both short and long term negative effects on your health, contribute to poor work performance, and increase your risk of injury.

How much daily sleep is enough? (These are typical recommendations and may vary for individuals)
• Infants: 16 hours  
• Teenagers: 9 hours      
• Adults: 7-8 hours        
• Elderly: 6 hours

Sleep eludes me. Do I have Insomnia?
Feeling sleepy from time to time during the day is normal. However, insomnia may cause other symptoms as well, including lack of energy or motivation, difficulty concentrating, mood swings, headaches, stomach aches, or impaired driving ability. If insomnia begins to impact your daily activities, it is time to see your doctor.

Is there a formula for getting a good night’s sleep?
While there is not a foolproof way to ensure a good night’s sleep, there are things you can do to help:
• Do not eat a large meal before going to bed.  
• Avoid heavy foods such as fried, cream sauces, spicy and sugary. Also avoid sugary drinks, especially with caffeine.
• Avoid caffeine, alcohol, tobacco or medications that can disrupt sleep.
• Go to bed and get up at the same time every day, including weekends.
• Try to exercise 30 minutes each day, but not within several hours of bedtime.
• Make sure the room temperature is comfortable and the bedroom is dark and quiet.PinkRx Evans1118
• Avoid taking naps after 3 P.M.

Randall B. Evans, MD, FCCP is a provider with Southeast Lung Associates, the region’s pulmonary, critical care, and sleep medicine specialists headquartered in Savannah, GA. Dr. Evans treats patients at the Hilton Head office of Southeast Lung Associates located at 23 Main Street, Suite 202 Hilton Head Island (843) 682-3583.


Should I take medication to help me sleep?
Tens of millions of Americans struggle to sleep at night, and many of them turn to sleeping pills for relief. Prescription and over-the-counter sleep aids are especially popular among older adults. It’s estimated that roughly one in three adults aged 65-80 use OTC drugs at least occasionally to fall asleep, meds like Benadryl and Tylenol PM are the pills of choice.

Studies have linked regular, long-term use of OTC sleep medicines to some potentially serious side effects. Many sleep aids contain diphenhydramine, which is an antihistamine and can cause the unwanted side effects of constipation and confusion among others.

There is also growing worry about another more-serious risk associated with OTC drugs. Evidence is growing that long-term use appears to increase the risk of dementia—the longer the use, the greater the risk. The links between OTC drugs and dementia are far from clinically certain, but research is ongoing.

Prescription sleep aids carry their own risks. Headaches, dizziness, nausea, vomiting, and hallucinations are a few of the short-term concerns associated with hypnotic sleep aids such as Ambien, Sonata, Lunesta and others. These drugs are only meant to be used sparingly. The manufacturers of both Ambien and Lunesta define long-term use as anything beyond 28 days.
The real question is why aren’t you sleeping? Cognitive behavioral therapy should always be the first line of treatment and includes things like establishing a consistent sleep routine, purposely restricting time spent in bed, and practicing meditation.
Rx Burke0718
David Burke, RPh is a registered pharmacist and partner of Burke’s Main Street Pharmacy. He is the Chairman of the HH Hospital Board of Governors and a member of the Cardinal Health National Advisory Board. Burke’s Main Street Pharmacy prides itself on being large enough to serve you and small enough to know you. Located at 1101 Main Street, Hilton Head Island; 843-681-2622.

Is there a correlation between lack of sleep and obesity?
Recent literature suggests that there is a definite correlation with suboptimal sleep and developing obesity. Short sleep is associated with low leptin levels (leptin suppresses appetite) and increased ghrelin levels (ghrelin stimulates appetite). This, in turn, leads to an increased body mass index (BMI) and leads to excess fatigue and low energy. As a result, people experience increased weight and decreased activity level and exercise capacity.

I wake up every night and it’s hard to go back to sleep. What should I do?
Sleep maintenance insomnia is a problem of waking up one or more times throughout the night with difficulty falling back to sleep. Here are some tips to help you get back to sleep:

• Do not look at your bedside clock; turn it away from you.

• If you are awake for more than 20 to 30 minutes, get out of bed and engage in low stimulation activity such as reading in a low light environment, soft and relaxing music, etc. Try not to turn on the television.

• Avoid late night “blue light” exposure several hours before bedtime. Blue light, common in electronic devices such as cell phones, TVs, and computers, sends “wake signals” to your brain, suppressing melatonin, which is necessary for sleep. Consider using a blue light filtering device, if necessary.

• Try taking melatonin 2 to 3 hours before bedtime. Melatonin is a normal hormone, which is secreted in the evening time before sleep. Melatonin shuts down your wake brain, allowing your sleep brain to operate properly.

• Nighttime alcohol leads to sleep fragmentation and poor sleep quality.


How does daytime napping effect night time sleep? What best way to nap?
This depends on how long you sleep at night. If you sleep only 3 to 4 hours each night, naps are beneficial to reach to the appropriate 7.5 to 8 hours of sleep normally recommended for adults. In this situation, napping 1 to 2 hours is probably beneficial, allowing you to go through at least one nonREM - REM cycle.

If you sleep 8 to 10 hours per night and still require 1 to 2 hour naps per day, you may have an undiagnosed sleep disorder leading to poor sleep quality.

If you just need a short nap, the best nap duration is 20 to 30 minutes (avoiding REM sleep). Generally, these short naps are refreshing, and you don’t wake up feeling sleepy or groggy. Napping around 2:00 P.M. is optimum for most people.

PinkRx Manos1118Peter N. Manos, MD, is a Beaufort Memorial board-certified, fellowship-trained physician specializing in the treatment of Pulmonary Diseases, Sleep Disorders, and Critical Care Medicine. His practice, Palmetto Pulmonary Medicine and Sleep Disorders Laboratory is the only American Academy of Sleep Medicine accredited facility in the Lowcountry. A graduate of the Medical University of South Carolina, Dr. Manos is a Fellow in the College of Chest Physicians and Diplomat in Sleep Medicine. He can be reached at 843-521-8484.

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