SIMPLY HEALTH: Insomnia

posted 04/21/2008
Sleep-that innocent, delicious state. We never gave it a second thought in childhood. As adults, we may yearn for that elusive-head down, lights out, gone. What happened? For some of us, sleep difficulty started in the teen years; for others, sleep became mercurial with pregnancy or parenting. Or maybe sleep deteriorated with menopause or aging. Perhaps, your sleep troubles are intermittent and wax and wane with stress and demand. Whatever the trigger, insomnia affects one third of us at some time in our lives and nearly ten percent of us have chronic insomnia.

What we call sleep is actually a pattern of varying brain activity that repeats in cycles about every 90 minutes. Sleep ranges from light to deep and includes rapid eye movement (REM stage) or dreaming, which comprises about 25-30 percent of total sleep. Although the exact purpose of sleep is unknown, there are theories suggesting that during sleep, the brain replenishes nutrients, consolidates memory and reorganizes its neurons or nerve connections. The length of time we spend in various sleep stages does change over our lifetime, tending toward shorter sleep with less dreaming as we age.

Insomnia can take several forms: difficulty getting to sleep, waking up during the night, waking up too early or all of the above. Treatment of insomnia depends somewhat on its form. Regardless of when it occurs though, proper sleep hygiene is an integral part of the solution. Many chronic insomniacs have learned not to sleep by repetitive poor sleep habits.

Here are many factors that commonly affect sleep:

Alcohol: A drink or hot toddy at bedtime may seem to help you fall asleep, but alcohol disrupts the sleep cycles and causes wakening during the night. It also dehydrates you which can add to sleep woes.

Symptoms of Insomnia:

Memory impairment
Difficulty concentrating
Fatigue
Anxiety or irritability
Depression
Sleepiness

Sleep shorter than 7 hours per night impairs focus on tasks, decreases reaction time and increases incidence of car accidents.

Sleep shorter than 5 hours per night impairs judgment, decreases the speed and accuracy of mental tasks and increases risk-taking behaviors.

Comfort: If your mattress is too soft or hard, pillow is too high or low-your body may not relax. If you have joint pain or pain from a chronic disease, a pain reliever, muscle relaxer or hot bath may help you sleep better. Relaxation tapes can also be quite effective.
Exercise: Regular daily exercise promotes good sleep, but avoid exercising before bedtime as it may stimulate you.
Fatigue: It is easier to sleep if you are tired but it can be more difficult to sleep if you are overtired.
Food: Eating within two hours of bedtime frequently disrupts sleep and can cause indigestion. Going to bed hungry can shorten sleep time.
Habit: Having a regular bedtime works well for babies-and adults too!
Health Status: Poor sleep may be caused by allergies, asthma, heart disease, high blood pressure, hyperthyroidism, snoring and sleep apnea. A medical evaluation can help sort this out.
Light: Light levels including moonlight can disrupt sleep for many people, so room-darkening shades or a sleep mask can help considerably, especially if travelling.
Nightmares: If you are experiencing recurring or frequent nightmares, seek professional help. There are specific kinds of therapy and medications to effectively resolve those bad dreams.
Stimulants: Caffeine, even 8 hours before bedtime, may make it difficult to sleep-so stop caffeine at noon. If you are very sensitive, avoid any coffee, tea, cocoa, chocolate or even sweet desserts in the evening (some people get a zing from sugar too). Decongestants in cold products may also keep you awake so check the ingredient list. Some people are also stimulated by certain vitamins and prescriptive medications; avoid taking these at bedtime unless specifically instructed to do so.
Sound: Snoring spouses, crying babies, television, and noisy neighbors can disrupt sleep. Or, you may be someone who wakens easily to any sound. Soft foam earplugs can be a lifesaver. Others do well with "white noise" or other soothing, sleep-promoting sounds available as sleep aids.
State of Mind: Unwind in the hour before bedtime. Read quietly, take a bath, meditate, do a crossword or Sudoku puzzle. Avoid emotionally jarring movies, TV, books or phone conversations. If you are stressed, it is hard to turn off your brain at night. Try keeping a journal or notepad at the bedside so you can write your thoughts or a to-do list for tomorrow-then let go of it. Feeling depressed can have a profound effect on sleep cycles and may require a variety of treatment including medication and counseling.
Temperature: Use blankets and clothing to suit you. Cooler bedroom air often is better than warm dry air. If hot sweats are waking you, a consultation with your health care provider may be in order.

If you can't get to sleep within thirty minutes of going to bed, don't toss and turn. Get out of bed and read, meditate or do other quiet activity for a while then go back to bed and relax. Follow the same procedure if you waken during the night. Save the bed for sleep-not eating, arguing or thrashing about. Getting upset and frustrated about lack of sleep causes increased stimulation and decreases the chances of falling asleep. People with chronic insomnia can develop "bed-dread" which sets in as bedtime approaches, creating anxiety about not being able to sleep, which only aggravates the situation. Turn the clock away from you so you cannot see it at night and avoid looking at it if you do waken. Sometimes, accepting some sleep disruption calmly will allow you to sleep better the following night.

Many prescription sleeping pills are heavily advertised as the ultimate solution for heavenly sleep. Beware though-they are only appropriate for very limited use. Sleeping pills can cause memory lapses and psychotic side effects can occur. If used daily, they rapidly lose effectiveness and may lead a sleep-deprived person to increase their dose, causing increased side effects or risking a fatal over dose.

The best sleep prescription is to develop and maintain good sleep habits. However, if your insomnia is especially difficult and does not respond to the suggested sleep practices, then seek professional medical evaluation.

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