Sleep and insomnia
A bad night's sleep
Every now and then we all have a bad sleep. We usually put it down to a stressful day or a particularly humid night. In the morning we wake up a little grumpy an not very will rested. Pretty much all of us have experienced bad sleep at one time or another. But if you fall into a pattern where it’s happening more regularly than not and sleep simply isn't satisfying any more, then you may have insomnia.
Waking up to the facts.
Insomnia is a very common sleep disorder where people have difficulty falling asleep, or wake up often during the night and then have trouble going back to sleep. It can even mean waking up too early in the morning or finding that your sleep is particularly un-refreshing.
Contrary to popular belief, insomnia isn't defined by the number of hours you sleep every night, because the amount of sleep a person needs varies. While most people need between seven and eight hours of sleep a night, some function perfectly well with less. Despite this, insomnia tends to increase with age and affects roughly about 40% of women and 30% of men.
Types and causes of insomnia
There are in fact 2 types of insomnia; primary and secondary:
Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.
Secondary insomnia means that a person is having sleep problems because of something else. Something such as a health condition like depression, heartburn, asthma, arthritis pain, or even a medication they are taking.
Interestingly, insomnia can vary in how long it lasts and how often it occurs. It can be short-term and this is called acute insomnia. Or it can last a long time and this is called chronic insomnia. It seems that emotional and physical factors create the right environment for insomnia to develop, because it can come and go without warning.
Short-term, or acute insomnia can last from one night to a few weeks and is often caused by emotional or physical discomfort, and can often be related to a single specific event.
- Significant life stress, like job loss or change or death of a loved one;
- Severe illness like a bad case of the flu;
- Environmental factors like noise, light or extreme temperatures both hot and cold;
- Things that throw off a normal sleep schedule like jet lag or switching from a day to a night shift.
Long-term or chronic insomnia is when a person has insomnia at least 3 nights a week for 1 month or longer. This can be caused by a variety of factors and often occurs along with other health problems. Common causes of chronic insomnia are depression, chronic stress, or pain and discomfort at night.
Sleep Apnoea: It is estimated that about 5% of Australians suffer from a sleep disorder called sleep apnoea. While sleeping, the muscles of the throat relax to the point of blocking the airway above the voice box. Breathing stops for between a few seconds and up to one minute, until the brain registers the lack of breathing (or a drop in oxygen levels) and sends a small wake-up call. The sleeper rouses slightly, typically snorts and gasps, then drifts back to sleep almost immediately. In most cases, the person suffering from sleep apnoea doesn't even realize they are waking up. This pattern can repeat itself hundreds of times over every night, leaving the person dogged by sleepiness and fatigue.
How is insomnia diagnosed?
If any of these symptoms sound a bit familiar and you think you have insomnia, the best thing you can do is to talk to your healthcare practitioner. A simple evaluation may include a physical exam, discussing medical history and sleep history. Then you may be asked to keep a sleep diary for a week or two, to keep track of your sleep patterns and assess how you fell during the day. Your healthcare practitioner may even want to talk to your bed partner about the quantity and quality of your sleep and in some cases, you may be referred to a sleep centre for some more advanced tests.
Getting back to sleep
Acute insomnia: In a lot of cases, acute, or short term insomnia may not even require treatment. However, if your insomnia makes it hard to function during the day because you are sleepy and tired, then your healthcare practitioner may prescribe sleeping pills for a limited time.
The rapid onset and short-acting medications that are now available, avoid many of the problems of earlier medications that had continuing side effects like feeling drowsy and groggy the following day. It should be noted though, that some medications may be less effective after several weeks of nightly use. The side effects of sleeping pills and over-the-counter sleep medicines are something that needs to be discussed at length with your healthcare practitioner, as mild insomnia can often be prevented or even cured simply by practicing food sleep habits. (See "Getting into the habit" section below).
Chronic insomnia: The first step of treatment for chronic or long-term insomnia includes treating any underlying conditions or health problems that may be causing the insomnia in the first place. Then, if the insomnia continues, your healthcare practitioner may suggest behavioural therapy or medication. Be aware that most medicines that are used for sleep do have side effects and must be used in consultation with your healthcare practitioner.
Sometimes simple behavioural changes are the most effective way to help you get back in the rhythm of a good night’s sleep. Behavioural approaches to treatment focus on changing the behaviours that may worsen insomnia and focus on learning new behaviours to promote sleep.
Getting into the habit
Good sleep habits are the first step to getting a good night’s sleep.
Try these 10 steps at home:
- Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day because naps may make you less sleepy at night.
- Avoid caffeine, nicotine and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
- Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
- Stress related sleeping disorders may result in teeth grinding which in turn can cause headaches. Sleeping with a dental night guard will eliminate grinding and its effects and potentially assist with the process of sleep.
- Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try ear plugs. Try some essential oils such as lavender in a vaporizer.
- Eliminate and 'white noise' in your room. Turn off the TV and other loud electrical appliances
- Follow a routine to help relax and wind down before sleep such as reading a book, listening to music, or taking a bath.
- If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you fell sleepy.
- If you have trouble lying awake worrying about things, try making a to-do list before your go to bed. This may help you "let go" of those worries overnight.
- Try meditation or relaxation techniques.
Keep sleep in perspective
As you would expect, many people who suffer from insomnia are normally frustrated or annoyed by it. Paradoxically, it's this emotional state that may contribute to keep them awake. It actually helps to stop demanding a set amount of sleep for yourself every night, because having less sleep than you'd like doesn't actually cause any harm. In situations like this you need to be able to allow yourself to fall short of the ideal without getting anxious about it. Sometimes the key to that great night’s sleep is to just relax, be patient and let the sleep you dream of come to you.