Friday, November 09, 2007

Quality of sleep

This is one of those QoL inquiries that I ask early on in my annual physicals. Along with 'how's your energy' and 'are you having any fun?', I feel like these quality of life questions give me a good starting place for assessing my patients' general health. N-QoL (nocturnal quality of life) is one of those fancy catch phrases that medical researchers love. Embedded in your N-QoL is your QoS (quality of sleep of course) and your HUS (hours of uninterrupted sleep).

The urological investigators particularly seek information on HUS as a measure of bladder capacity in men with enlarged prostates. A bulgy prostate partially squashes the urethra. A full bladder generates a certain amount of pressure as it contracts to send urine out the urethra. Pressure falls as the bladder empties, and at a certain point, the pressure is too low in the partially emptied bladder to shoot urine through the narrowed urethra. As a result, men with benign prostatic hypertrophy--an enlarged prostate-- incompletely empty their bladders. They have less bladder capacity for newly-manufactured urine heading down from the kidneys and, therefore, a need to void more frequently. This obviously impacts their N-QoL.

Drugs also impact our N-QoL. I love my improved QoS from melatonin and natural progesterone both of which improve QoD (dreaming). Nexium gives me nightmares. Recent evidence suggests that simvastatin (aka Zocor) can also produce nightmares and reduce QoS. Simvastatin is a lipophilic (fat loving) drug as opposed to pravastatin which loves water. We are all fat-heads insofar as our brain is largely made up of fat, so simvastatin crosses into brain tissue where it may adversely affect sleep in some. As sleep gets a little dicey with aging, simvastatin may not be a good choice of drugs for those with QoS issues.


Jean said...

Another good post. Didn't ever read about the pressure lowering before.
My QoS is probably in the negative now:)
Interestingly, when we have guests my sleep is so much better - I sleep so much better with more people around. maybe I feel safer or know help is at hand if I need it.
Happy Friday, Doc.

Cilicious said...

Ever since I first became a mother 24 years ago, and began to deal with sleep deprivation, getting a good night's sleep has been sort of a hobby.
Especially *uninterrupted* sleep, the most precious slumber of all.
Over the years I've kept mental notes on how this or that helps/hinders.
I need fresh air and a cold room.
I've always slept better when #1: I was ovulating, and #2: everyone was home, but we have been through so many changes (including a move out of state, an empty nest, and menopause) in the past couple years that I've had to develop new sleep strategies.
I swim a couple times a week, walk daily, take black cohosh, and if necessary I'll rely on a bit of melatonin.

Mauigirl said...

Thanks for the helpful info. I'm glad I'm not on any drugs that give me nightmares; I always have had vivid dreams ever since I was a child as it is.

I love the way you write about these subjects - you make all of this interesting and with a spark of humor! Great posts.

Femail doc said...

Jean: I always feel better when the neighbors are home, perhaps for the same reason you like guests in the house. They, unfortuantely, moved to Philadelphia months ago leaving their empty house with the for sale sign behind.

Cilicious: Interesting what drives a mother's sleep, hormones and knowing the little chicks are safe and accounted for. Once the nest empties and the hormones dwindle, new strategies are definitely in order!

The evidence that melatonin is a neuroprotective agent that everyone probably ought to take as they and their brains age is ovewhelming. Three chapters just on melatonin in the New York Academy of Science's book Neuroprotective Agents convinced me to take it nightly.

MG: I love vivid dreams, thanks for the compliment, and your wonderful comments always make me feel like someone out there is paying attention to me. Thanks.