BN Doctors’ Lounge: Insomnia

Insomnia
In our rapidly-paced Naira chase, sleep might seem like a distraction for some, or may be simply difficult for others. It is likely that most, if not all of us have at some point suffered from the effects of poor or inadequate sleep. Sleep is important for normal cognitive and motor functions. Our organs and body systems are refreshed, rejuvenated, renewed and recharged when we sleep. Much like any machine or processing unit, our body systems need a good shut down after a day’s work.
Sleep needs vary from person to person and with age. On the average, children generally need about 8 to 9 hours of sleep every night, 6 to 8 hours for adults and it’s normal for the elderly to catch about 6 hours of sleep.

Insomnia is trouble falling asleep or staying asleep through the night. The medical designation for insomnia is DIMS – Difficulty Initiating or Maintaining Sleep.

It is quite normal to experience a few days or a couple of weeks of poor sleep once in a while, either due to crazy work deadlines, exams (who invented that by the way), or just a rough patch of anxiety and worrying due to life events. Alarm signals buzz a warning of chronic insomnia when poor sleep persists for about 3 weeks or more.

The control of the sleep cycle is by higher centres in the brain. The pineal gland is a pea-sized structure in the brain which produces melatonin- the body’s own sleep chemical, and is primarily responsible for the body’s circadian rhythm (body clock). In dim light or at night time, snooze signals are sent to the brain and melatonin levels rise, reaching a peak between midnight and 2a.m, with a dramatic drop at dawn.

Causes of Insomnia
When insomnia occurs as a result of anxiety, depression or losing sleep due to timed commitments, without any real medical issue, it is primary insomnia. Co-morbid or secondary insomnia on the other hand, usually stems from a host of factors such as trauma, certain illnesses, medications, narcotics, chronic pain, chronic cough or even an itch.
Things like sleeplessness following jet lag, a stretch of night-shift duty or a fun weekend of back-to-back outings would be transient primary insomnia.

Common causes of insomnia are:
• Physical or emotional stress
• Anxiety
• Depression
• Medication such as some pain meds, blood pressure meds and weight-loss pills(most contain stimulants like amphetamines)
• Drugs like caffeine, nicotine and alcohol
• Medical conditions like UTI requiring frequent trips to the loo, thyroid disease, gastric reflux disease, sleep apnoea, chronic pain and many other conditions
• Irregular sleep schedule
• Excessive daytime napping
• Dependence on sleeping pills
• Learned insomnia (concerned about wakefulness)

All of these are possible causes and you probably now see where the problem lies. Once the underlying cause is identified and addressed, you’ll be on the cruise to sleepville.

How do I know I have insomnia?
It’s pretty easy.- Do you have difficulty in falling asleep at night? Do you have difficulty staying asleep at night? If the answer to either or both questions is yes, then you’re probably suffering from insomnia. Since people are very poor judges of their own sleep quality and quantity, a heuristic guide that always works when patients can’t give me a straight answer is to assess by asking:
How do you feel the next day? Are you tired, groggy, with poor concentration and generally cranky?

With insomnia you awaken feeling un-refreshed and this takes a toll on energy levels, mood and productivity throughout the day. It results in slower reaction time while driving and thus a higher risk of accidents. On the long term, it predisposes to serious medical conditions such as obesity, depression, hypertension, diabetes and heart disease. Insomnia causes a drop in immunity and reduced cell-mediated response to infections.

So, if your answer yet again is in the affirmative, then you have to see a doctor!

How Can My Doctor Be Certain I Have Insomnia?
In addition to asking you a few questions, your doctor will have you fill out a questionnaire to assess your sleep-wake pattern. You may also be asked to keep a sleep diary, which basically involves you noting down some things about your sleep, the morning after.
The doctor will assess you for underlying causes, to rule out any serious medical conditions.
Only in severe and cases would special tests with monitors be needed. These will check your brain waves, breathing, eye movements and body movements while you sleep.
But on the whole, diagnosis is mostly clinical, without any fancy tests.

Can It Be Treated?
Changing your sleep habits and addressing any underlying causes of insomnia can be all that is needed to restore healthy and restful sleep in most people. This involves a combination of sleep hygiene practices, stimulus control, relaxation techniques and cognitive therapy. Only in some cases will sleep aid meds or sleeping pills be prescribed. And these have many adverse effects, can lead to addiction, and are generally not for long term use.

Tips for a Refreshing Night’s Rest
• Reduce caffeine – cut out food, medicines, or drinks that contain caffeine (including cola drinks).
• Do not smoke within six hours before bedtime (you should quit actually!).
• Do not drink alcohol within six hours before bedtime (alcohol might make you snoozy but the overall quality of sleep is poor with alcohol).
• Do not have a heavy meal just before bedtime.
• Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful).
• Try to get into a routine of wakefulness during the day, and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well.
Therefore:
o No matter how tired you are, do not sleep or nap during the day if you have insomnia.
o Use your bed and bedroom for sleeping (and sex) only – not for reading, eating, watching TV or working on your computer or other such devices (reading blogs in bed is a no no!).
o Switch off the light out as soon as you get into bed.
o Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in – even after a poor night’s sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have gotten used to in the week.
• The bedroom should be a quiet, relaxing place to sleep:
o It should not be too hot, cold, or noisy.
o Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.
o Make sure the bedroom is dark with good curtains to stop early morning sunlight.
• Mood and atmosphere – try to relax and wind down with a routine before going to bed. For example:
o A refreshing bath, some light reading, and a glass of warm milk – this is a natural sleep aid which triggers the production of melatonin.
o Do not do anything that is mentally demanding within 90 minutes of going to bed.
o Some people find playing soft music is helpful at bedtime, and playing the same sequence every night might help with creating a sleep routine. Try a player with a time switch that turns the music off after about 30 minutes.
• If you cannot get off to sleep after 20-30 minutes – then get up. If you can, go into another room, and do something else such as reading or watching TV rather than brooding in bed. Go back to bed when sleepy. You can repeat this as often as necessary until you are asleep.

In a Nutshell
If you’ve had difficulty falling asleep or staying asleep on most nights for three weeks or more, then you must seek help. Don’t stay awake wondering whether or not your slumber troubles are indeed insomnia (that would be a hilarious irony).
Make sleep a priority, get your 6-8 hours of sleep per night, every night, and address sleep issues before they become serious or chronic. And remember, you can never really pay off your ‘sleep debts’; in fact there’s no such thing. Sleep is not a bank. That you can go on with little sleep for days and pay back at weekends is an urban myth. Your body might not be so forgiving. So, get cosy and bring on the zzzzzz.
Sweet dreams……..

Did You Know?
If it takes you less than 5 minutes to fall asleep, then you’re most likely sleep deprived. The average normal time between hitting the bed and falling asleep is about 10 minutes.
___________________________________________________________________________________________________
Annette Bazuaye is a Medical practitioner, writer, researcher and UN Millenium development ambassador. She holds a Bachelor of Medicine, Bachelor of Surgery from the University of Benin, and a Master of Science in Global health from the University of Oxford. She is committed to preventive medicine, health literacy and community development.