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SLEEP
MEDICINE

This Is Not

a Zolpidem

Deficiency

By Timothy Hlavinka, MD

W e have all heard the question, in many different variations sleep pathology and counter them. Good sleep hygiene is a given for

from many different patients and family members. "Hey
these patients. They have read every book under the moon, because
doc, you got anything for insomnia, my sleep is terrible?"
After we run through the litany of established diagnostics and thera- they were still awake! Good sleep begins on arising, and what is done
in the first hour of awakening begins to set the circadian rhythms that
peutics, including the latest "state-of-the-art" medications or treat- are disturbed in sleep disorders. Early morning sunshine and movement
ments, the eye rolls and shoulder shrugs we experience coming from are critical in resetting these rhythms. Since a sleep disorder almost
our patients are almost palpable. And with reason. Sleep is critical — never has a single cause, evaluating for sleep "disturbers" is critical. Caf-
the understatement of the year. How we feel and function on a given feine tolerance is variable, but its contribution to sleep disturbances is
day is defined by the quantity and quality of our sleep. easily identified by an historical query ... if you have ever had caffeine
Broadly speaking, there are many alternatives for that index patient withdrawal, your sleep is sensitive to caffeine. Alcohol, a diet high in
... for whom everything has been studied and tried and they are still refined sugars and late-night eating that will disturb glucose levels are
zombie-like in our offices. For simplicity, I will cover those therapies also contributing factors. Combined, they affect sleep stages and impair
that are delivered by a healthcare provider. There are many self-help and sleep quality by sedation and spikes and drops in blood glucose that
self-administered therapies, but literature is scarce regarding outcomes. may provoke awakening. Indeed, critical information from a CGM may
I will cover a functional medicine approach, psychological interven- be the most important clue in evaluating these patients. Comorbidities
tions and acupuncture and related practices. like thyroid dysfunction, menopause, andropause and obesity must be
An intriguing approach, fostered by functional medicine providers, addressed. Sleep disturbances are common symptoms of endocrine de-
is to recognize the critical times of the day and activities that produce ficiency or excess. Therapies may be the only intervention necessary to

24 SAN ANTONIO MEDICINE • March 2024