Healthy Pilot #12 – Sleep Problems And Solutions

If youre not getting enough shuteye, youre not alone. Sleep problems impact all walks of life and occupations. But fatigue hits pilots harder.


Healthy Pilot has been covering the BasicMed checklist in the past few installments, but we will be departing from that protocol in coming issues to cover health problems that impact the population in general and pilots in particular. Sleep disorders are up first, a condition that seems ubiquitous. For pilots, fatigue caused by sleep problems can have profound consequences. After all, it’s hard to pull off at a rest area when you’re shooting an ILS.


It’s more than just fatigue. Chronic lack of sleep can actually make you ill. According to recent posts at our sister site University Health News, Vitamin D levels needed for optimum health can be compromised with insufficient sleep. Lack of sleep is also associated with weight gain and the host of health complications that result, including joint pain. Studies also show that sleep problems can even affect cholesterol and triglyceride levels.

Could it be Sleep Apnea?

Obstructive sleep apnea occurs when throat muscles relax and collapse the airway, leading to what’s known as “fractured sleep.” Central sleep apnea is a signaling problem in the brain, which fails to trigger breathing. There is a strong association between sleep apnea and diabetes, obesity, and cardiovascular disease. Sleep apnea directly increases your risk for having high blood pressure, cardiac arrhythmias, and stroke. Untreated sleep apnea is also associated with increases in insulin resistance, gastrointestinal reflux disease, and cognitive impairment.


An overnight sleep apnea test, called polysomnography, is required to diagnose obstructive sleep apnea. This recording of sleep and breathing usually involves in-laboratory measurement of brain waves and arousals, eye movements, chin movements, airflow, respiratory effort, oxygen levels, electrocardiographic (ECG) tracings, body position, snoring, and leg movements. In-home testing is also widely available.

The most common and effective conventional treatment for obstructive sleep apnea symptoms is continuous positive airway pressure (CPAP), which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels. Patients will often report feeling dramatically better after beginning treatment.


Studies show that treatment with CPAP reduces excessive daytime fatigue and increases energy. A randomized controlled trial in 2011 specifically looked at fatigue and found that three weeks of CPAP therapy significantly reduced fatigue scores to the point that participants were no longer suffering from clinically significant levels of fatigue after the three-week intervention period. Self-reported energy levels also increased significantly.

However, some individuals simply cannot tolerate CPAP as a sleep apnea treatment option because ofnasal congestion,and the pressure felt because of the high flow of air created by the device. Other conventional sleep apnea solutions include surgery or a sleep apnea mouth guard, known as “mandibular advancement devices” or splints.

Oral appliances, which hold the mandible in a protruded position during sleep, are increasingly used for mild to moderate sleep apnea symptoms, as well as in more severe patients who are unable to tolerate or refuse CPAP. Although oral devices generally do not work as well as CPAP in reducing the actual number of episodes and increasing oxygen, they do help with sleep apnea symptoms and increase energy in sleep apnea patients. Studies have found that overall improvements and outcomes seem comparable with both types of treatment.

Mind over Sleeplessness

One of the key strategies that sleep specialists employ to help patients overcome behaviors that contribute to chronic insomnia is stimulus control therapy. This approach includes tactics such as removing yourself from the bedroom if you can’t fall asleep, and not watching television or surfing the internet while you’re in bed. Instead of staring at the clock, get up and do a boring task. Only return to bed when you’re sleepy.

Similarly, if you’re having sleep troubles, limit your cell phone use around bedtime. One study found that people who spent more time on smartphones, especially close to bedtime, were more likely to have shorter sleep duration, poorer sleep quality and take longer to fall asleep. So, turn off your cell phone, computer and television at least an hour before bedtime.

One approach that helps in many cases is cognitive behavioral therapy for insominia (CBT-I). While CBT-I is not a quick fix, it can be a long-term solution that doesn’t involve medications. Among the strategies called for by CBT-I are the following:

1. Stop clock-watching.People with insomnia can become chronic clock-watchers, obsessing over how long they’ve been trying to fall asleep, how many more hours they have before morning. Chronic clock watching leads to obsessive thinking. Turning the clock away from your bed or putting it out of site and out of reach are two ways to reduce the temptation to check the time.


2. Sleep less.It may seem illogical to suggest that you sleep less, but sleep reduction therapy is based on the idea that some people may actually spend too much time in bed. Taking too many naps or staying in bed for too many hours may actually disrupt normal sleep patterns. For example, if you barely get six hours during the night and then take a nap in early evening, the recommended therapy might be to go to bed at 1 a.m. and wake up at 7 a.m. During the next several weeks, you gradually go to bed a little earlier, eventually forgoing the evening nap. This approach can help reset your sleep/wake schedule.

3. Control your environment.The bedroom should be designated for sleep and sex—not working, reading, watching TV, eating, or surfing the internet. In addition, a cool, dark room that is quiet can help you sleep better. Avoid alcohol and caffeine close to bedtime. And although daily exercise is helpful, give yourself several hours between exercise and sleep time.

Pills and Potions

While prescription sleep aids may keep you from counting sheep, like many prescription drugs, they are not always safe to use.First and foremost, most of these medications are addictive so many people who use them become dependent upon them.

In reality, some of these prescriptions are actually habit-forming narcotics and are not intended for long-term use. This means that even when a person’s sleep disorder is resolved, trying to get off the medications poses a whole other set of challenges.Prescription sleep aids also come with a host of side effects.

Besides the potential dangers associated with sleep aids, these drugs aren’t always needed. In fact, many doctors believe most people don’t actuallyneeda prescription sleep aid, and the vast majority of people with sleep disorders can find relief in other ways.

These natural remedies for insomnia are non-habit forming. There is little downside to trying one of these approaches and it might be just the thing you need to get a good night’s rest.

  • Melatonin:Melatonin is a hormone secreted by the pineal gland in the brain that helps regulate circadian rhythm.As we age, the amount of melatonin produced in our body decreases; so the older we get, we are naturally inclined to sleep less. The use of melatonin supplements enables a person to fall asleep without feeling “drugged” and to remain awake and alert during the daytime hours, decreasing those excessive fatigue feelings. Melatonin is alsohelpful for people with jet lag or forthose who work night shifts, as it helps readjust the body’s sleep cycle. The dosage for melatonin is one 3 mg tablet one hour before bedtime.
  • 5-HTP: A serotonin deficiency (neurotransmitter deficiency in the brain) can be an underlying root cause of both insomnia and depression.If your lack of sleepis accompanied by persistent feelings of sadness, hopelessness, or negativity, taking 5-HTP may help you. A serotonin precursor naturally produced by the body, 5-HTP is also prepared in a supplement formfrom the seed pods of a West African plant calledGriffonia simplicifolia. This 5-HTP has the ability to be converted into the mood-regulating neurotransmitter serotonin as well as the sleep-inducing hormone melatonin. It is a close relative of tryptophan—an essential amino acid found in certain foods that is also a precursor to serotonin. (Have you ever felt sleepy after eating that Thanksgiving turkey?Tryptophan is the reason why!)


  • Valerian root tea: If, in addition to insomnia, you experience feelings of anxiety, stress and worry, Valerian root tea can help ease your tensions and rest your mind.Valerian root (Valeriana officinalis) contains a number of active chemical compounds including different alkaloids; however, the most important ingredient in Valerian root is gamma-aminobutyric acid, or GABA.GABA has often been referred to as “the brain’s own anti-anxiety medication.”It is the same active chemical that is triggered by taking the anti-anxiety prescription drugs, Valium and Xanax.
  • Antioxidant Supplements: Aside from diet and exercise, natural remedies for sleep apnea should focus on increasing antioxidant capacity. Why? Sleep apnea is associated with oxidative stress, the excessive build-up of free radicals. It is also associated with decreased antioxidant capacity (abilityof the body to counter oxidative stress) and decreased blood levels of various antioxidants, such as vitamin E and carotenoids (such as beta-carotene).The excessive oxidative stress associated with sleep apnea then leads to what is known as “endothelial dysfunction,” in which the blood vessels do not properly relax and contract. Endothelial dysfunction is the primary mechanism causing atherosclerosis, heart disease, heart attacks, and strokes. Various types of antioxidant supplements have been researched as treatments and found to be beneficial as natural remedies for sleep apnea.
  • DHA: Another supplement that may be helpful for those with sleep apnea symptoms is an omega-3, such as fish oil, especially one which is concentrated in the omega-3 fatty acid DHA. Low omega-three levels, especially DHA levels, are related to more severe sleep apnea. Omega-3 fats are one of the top natural remedies for sleep apnea because they protect cells against stress; sleep apnea causes long-term oxidative stress and puts severe demands on the body which is thought to deplete the omega-three levels. Taking an omega-3 fish oil with concentrated levels of DHA may improve sleep apnea symptoms while improving your cardiovascular health.
  • Vitamin D: One last vitamin is worth mentioning when it comes to natural remedies for sleep apnea symptoms: Vitamin D levels have been found to be lower in patients with sleep apnea compared to those without the disorder. Vitamin D deficiency has been found to be particularly prevalent in those sleep apnea patients who also have issues with blood sugar and insulin regulation, including those with diabetes, prediabetes, metabolic syndrome and insulin resistance. The more severe the sleep apnea symptoms and blood sugar dysregulation, the lower the vitamin D levels.
    Treatment with vitamin D may help ameliorate the blood sugar disturbances and inflammation associated with insulin resistance in sleep apnea patients. Even if you do not have poor blood sugar metabolism, it is strongly recommended that you make sure your vitamin D levels are optimal by taking at least 2000 IU of vitamin D daily and having your blood levels checked yearly. This is because vitamin D deficiency is so common and linked to many fatigue symptoms, including mood disturbances and muscle pain. Many patients report relief from feeling so tired all the time when their vitamin D levels are optimally treated.