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Insomnia

Insomnia
Written by
Our Resident GP

We all know what this is, and many of us will have been here too. We can dress it up and give it a lengthy explanation but essentially we’re talking lack of sleep, either not enough of the stuff, poor quality, or non-refreshing in substance.

Although some individuals will steadfastly hold the view that ‘sleep is for wimps’ in reality, insomnia poses a major problem as it can have knock-on effects with regard to physical health, fatigue, mood disturbances, relationship issues and work related problems. A recent study has found that as many as 30% of adults have problems sleeping, women and the those over 65 being the most commonly affected.

Now before labelling yourself as an insomniac, it’s important to recognise that there is a wide range of ‘normal’ sleep requirements. For some, 3 hours will be perfectly adequate to function normally the next day and feel refreshed. Others will need the classical 8 or 9 hours. Moreover the amount of sleep a person needs varies throughout their life. A newborn can easily spend 16-17 hours per day sleeping (though it may not seem like that to parents). As children grow older they require less sleep, possibly 11 hours by the age of 5 and maybe around 8-9 hours as a teenager. By the time someone reaches their thirties they may require less than 8 hours and so on.

As expected, there are numerous causes of insomnia from physical ailments (itching, pain), environmental issues (noisy neighbours), and of course stress and worry. Sometimes though you can just develop bad sleep-affecting habits before going to bed or just simply get out of the cycle.

Now before approaching your doctor for sleeping tablets, there are a few issues any insomniac should try to address first, as far as is possible to do so.

Sleep Hygiene

  1. Avoid caffeine containing tea/coffee after noon (and alcohol)

  2. Avoid ‘siestas’

  3. Ensure the bedroom is kitted out for sleep, and sleep alone. No laptops, Tvs, Stereos, and ideally no electrical equipment atall. Invest in some ‘black out’ blinds if light is an issue.

  4. Try to go to bed at the same time each night and get up at the same time the next morning.

  5. Remove yourself from the bed if unable to fall asleep <30mins, engage in relaxing activity, and try again.

  6. Do not lie in bed awake for prolonged periods, avoid excessive food or fluid intake in the evenings.

  7. If you do smoke, try to avoid doing so too late at night as nicotine is a stimulant.

  8. Exercise! Our bodies aren’t designed to be sat down all day - they need to be worked physically, so try and do some regular exercise but not within 3hours of going to bed.

  9. Progressive muscle relaxation; I call this (probably rather inaccurately) ‘mini-yoga’ which involves the alternation between tensing and relaxing muscles, but it is effective.

  10. Non-pharmaceutical remedies. Before you start thinking ‘hocus pocus’ means of aiding sleep do work, and have been proven to. Examples include herbal night teas such as camomile, fennel or valerian containing products. Lavender on or under the pillow is also very effective. Milky drinks such as Ovaltine or Horlicks work well for some, assuming the palate permits such ‘passers-through.’

Worrying about not getting enough sleep

Many people will just lie in bed and worry about not sleeping and this just makes matters worse. Thoughts such as “I’ll never be able to work tomorrow” or “this is ruining my life” may run through your mind. A vicious cycle is then set up - these thoughts cause even more tension and anxiety further exacerbating the problem.

Try to remind yourself that loss of sleep will not hurt you - nobody ever dies from lack of sleep. You know you will always fall asleep eventually. Lying in bed relaxed and calm can be as refreshing as sleep itself (and possibly even more enjoyable as you’re awake to experience it) Don’t keep looking at the time and try to put sleep per se out of your mind. Tell yourself you don’t care whether you fall asleep or not. Have a daydream instead about a nice holiday or winning the lottery. Some people find it helpful to lie and force themselves to stay awake - this may sound odd but often if someone tries to force their eyes open the urge to close them and go to sleep becomes very strong.

Worrying about other problems

If your mind is working overtime worried about relationships, money matters, or work issues the following steps might help.

  1. Get out of bed and sit somewhere quiet and comfortable with a pen and pad:

  2. Write down the problems and write down everything you can possibly do to tackle them.

  3. Choose the most helpful or realistic solution and write down all the steps you need to take to achieve it.

  4. Write down any obstacles and again your ideas on how to tackle them.

  5. When you’re done, say to yourself firmly ‘OK, that’s it for now. I can’t do any more this time of night and I WILL NOT worry myself over this until the morning.

  6. Spend some time winding down, listening to music, reading the paper, stretching or whatever until you start to feel sleepy again and then go to bed.

  7. If you still find yourself ruminating keep saying to yourself that you’ve dealt with the issue for now and worrying about it this time of night achieves nothing. You can deal with it tomorrow.

Prescription Drugs

If all else fails, there are a variety of prescription drugs available but really these should only be considered as a short term approach to help re-establish a good sleep pattern - as most are potentially addictive if used long term.

Examples include:

Benzodiazepines (eg temazepam) These are effective in increasing sleep duration and decreasing night-time awakenings but do not significantly decrease the time taken to actually fall asleep.

‘Z-drugs’ (eg Zopiclone, Zolpidem) .These are a newer type of sleeping tablet and these days tend to be favoured compared to benzodiazepines. Tolerance and rebound insomnia can develop after repeated use for a few weeks and dependence is a recognised risk and is characterised by dose escalation and withdrawal symptoms. Zopiclone can impair memory and driving ability for upto 11 hours after taking them and increases the risk of being involved in an road traffic accident.

Final word

Try to remember that for the vast majority of sleep sufferers, the problem will eventually, right itself in time. Try not to worry about the problem as this is a major obstacle to getting back to normal. Don’t rely on sleep tablets as these aren’t the answer long term - do your best to tackle the root cause.

References:

Web mentor library, Insomnia

Emis server, Insomnia

Northumberland dept of psychological services & research: Lesley Maunder & Lorna Cameron

Insomnia: Clinical Knowledge Summaries (July 2009)

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