Brief Answer:
Proper approach to treating sleeplessness

Detailed Answer:
Good morning, though it is possible that a less than satisfactory night of sleep may not be making that all that easy.... :)

Thank you for your question. I would like to share my thoughts with you for your consideration which I hope you can use as a way of having a dialogue with your doctor regarding your problem of sleeplessness. In my medicine my philosophy is always to obtain historical perspectives about the problem, collect hard data (where possible), consider the options for intervention, and then, after a conversation decide on next steps as well as having a contingency plan in case things don't go the direction you're looking for.

So often, doctors and patients are looking for the QUICK FIX....and in some cases that's reasonable....For example, cut your finger with a sharp knife and it's bleeding...Fix? Put pressure, stop bleeding, stitch if necessary...easy.....that's a quick fix and it works. Got a sore throat? Test with Strep culture...Positive? PENICILLIN (so long as patient not allergic)....and the results are in hand within a few days at worst....quick fix and it works virtually 99% of the time.

Difficulty sleeping???? Different animal in my estimation. Many things to consider...many things to ask about, many situations that can be contributing..even without the patient's knowledge.....a quick fix such as a sleeping medication may not work (often doesn't in my experience) and may be INAPPROPRIATE for the patient since we're not doing anything to discern a cause or etiology.....what if it's physical, what if it's psychological, what if it's both? If all it were turned out to be jet lag.....you wouldn't be writing the question.

Therefore, what I'm suggesting is that you ask your doctor to do what is called a solid HISTORY and PHYSICAL examination with appropriate laboratory tests to check for REASONS. First thing to consider is whether you're having this problem just within the last few days, few weeks, few months, or few years. And when I say "last few days"....I really honestly mean to say that the patient prior to just a FEW DAYS ago could sleep like a newborn baby without the slightest trouble in the world......that would really and truly be a problem of a few days duration....as opposed to something that is simply getting worse and worse and worse over years and years but is now so impossible to ignore that they have to ask for help. See the difference. The latter is really a CHRONIC problem.....but by virtue of it becoming so bad more recently patients AND doctors will sometimes just assume it to be NEW....and that's usually not the case.

In your case at age 70...we know that # of hours of sleep as we age begins to decline and so that whereas we used to require 8-10 hrs. of good uninterrupted sleep to feel refreshed...now we only require 6-8 or even less to be fully functional. That's normal physiology. If, however, in addition to reduced hrs. for physiological reasons we throw in a 60-90 min. period of time one is laying in bed without being able to fall asleep...well, now the number of SLEEP hrs. reduces by that number so even though a person is in bed.....they ain't getting the bang for the buck they thought they'd get.

Then, there's the person who falls asleep relatively easily but, is up and down...is it to go to the bathroom because of taking diuretics at night for high blood pressure? Is it a prostate gland that prevents them from being able to sleep more than a couple hrs before having to get up and empty the bladder that's not even really full? Is it a bladder infection (often times unnoticeable to patients over the age of 60-65 in the same way a 20-30 year old recognizes an infection) that is getting them up incessantly, is it a new medication whose side effects could include insomnia, restlessness, irritability? These all have to be considered and RULED OUT by history and that's primarily the job of the doctor to go through that checklist of items. If all that is negative then, the next step is to determine if there are metabolic or pathophysiological reasons for the insomnia. Does the person have poorly controlled diabetes, headaches, thyroid problems, adrenal problems, kidney problems, or ANEMIA, among other problems that are causing symptoms of restlessness? Does the person have cardiac trouble, congestive heart problems, breathing issues, and of course the very familiar SLEEP APNEA which is the cause of nearly 30% of all diagnoses of insomnia in patients aged 30-70?

Did the person suffer a stroke? Are they depressed, anxious, suffering from PTSD, do they have nightmares, etc. etc. etc. These must all be considered and factored into the equation when making a diagnosis of insomnia.

If the primary doctor has already gone through the litany of all these steps and carefully discarded each and every possibility then, I would STILL NOT OFFER a prescription for sleep until at least a sleep study has been performed since now we can get those COLD HARD DATA that was talking about initially. Such a study will measure every pertinent aspect of sleep and within the report and conclusions of the expert looking at the report will almost always fall out a set of possibilities which can now be MORE PRECISELY targeted and addressed....and sleep medication is often not even on the list of options when it comes to actions following a sleep study....unless the study is dead normal....which is unlikely in someone who is having a chronic issue of insomnia at age 70 who is metabolically in great shape.

Let me repeat that: Sleep Medication is often NOT EVEN ON THE LIST of options when it comes to actions following a sleep study unless the study is dead normal.

In your case the very simple and most obvious answer to WHY you may not be sleeping well is that you are also suffering from CHRONIC BACK PAIN. Please don't spend any more money on mattresses and ask your primary doctor to look into some of the things I've mentioned. If back pain is truly only at nighttime then, it could certainly be something to do with posture or position, less likely due to your workout schedule unless you are performing tasks which are clearly outside your physical limits but I find that to be less likely a cause since doing that should cause pretty significant ACUTE PAIN and soreness that you'd notice during the days as well.

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your question and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 33 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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