Dr. Winston Nara, MD

There are many reasons for insomnia including medical, psychological, and habits. In the presence of musculoskeletal pain, chiropractor manipulation will reduce pain, improve sleep quality and decrease insomnia. It is a better choice than pharmaceutical if combined with good
sleep hygiene and bedtime habits.

7 to 9 hours is an accurate average sleep duration, the best time to try to get enough sleep is during vacation. Sleep or other medical conditions, medications, lifestyle, bedroom factors affect sleep quality. All of these need to be evaluated before l can give you an informed answer. Don't operate machines, drive or make financial decisions when sleepy.

The epigastrlc and chest pain warrants evaluation of upped abdominal organs, the patients medication suggests attempts to treat GERD. The association with being in bed during sleep is also suggestive of GERD, things that make GERD worse include acidic and spicy meals, obesity, untreated OSA, and hiatal hernia. It is less likely cardiac since it is
relieved by walking and belching. Untreated, GERD may lead to ulcers and esophageal neoplasia. The patient needs to have physical examination, then imaging guided by the examination. Differential diagnosis would include gall bladder, pancreatic disease and other masses, that may mimic these symptoms. Patient should not discount his symptoms.

Dr. Nara

Sleep position is a matter of preference as well as dictated by physical symptoms while in bed. Laying on your back is bad for people with sleep apnea, severe gastric reflux disease and heart failure. However, for a healthy individual position does not matter in short term, in the long term, sleeping without the proper spine alignment may lead to early spine degenerative disease.

Dr. Nara

They do, it can be in a sleep lab or at home.

Dr. Nara

The only cure for obstructive sleep apnea is a tracheostomy. Central sleep apnea and Cheyne stokes breathing disorder will not respond to a tracheostomy since they are related to the central control of breathing during sleep. Tracheostomy bypasses all areas of obstructive apnea from the nose all the way to get air directly into the lungs. Other upper airway surgeries may help, but will not cure sleep apnea.

Insomnia affects 10% of adult population, there are 2 types primary vs secondary. Both are associated with hyper- arousal, increased sympathetic tone and metabolism. Your mom has co morbid anxiety that is affecting her Insomnia. She needs to be evaluated for other medical conditions besides anxiety and treated. Pharmacological treatment alone is not enough, she needs cognitive behavior therapy, sleep restrictions and stimulus control. The treatment usually takes time but with strict focus on non-pharmacological there is a good chance of success. Your mom needs care coordination between a psychiatrist and sleep specialist.

She needs to undergo a sleep study. Of course, she needs review of her medication if she is taking any. A complete neurological examination and endocrine assessment is needed as well.

Your loved needs a complete assessment of pathophysiologic and psychological assessment before your doctor can prescribe a sleeping aid. Insomnia may be masking making neurological, cardiopulmonary and multitude of other diagnosis. In some situations it may be protective to wake up and breathe or address a painful condition. Once a pathology is excluded, then emphasis should be made to pursue a comprehensive treatment including cognitive behavioral therapy in addition to medications. A close monitoring of side effects of treatment is needed while fostering healthy sleep habits.