Dr. Aadil Jan Shah and Dr. Ovais Wadoo Psychiatrists
Sleep is important for our well-being and optimal functioning. If we are not getting proper sleep, our body struggles, and various problems can occur including tiredness, irritability, problems with concentration and deterioration in overall functioning.
Importance of sleep:
Sleep provides an opportunity for our bodies to recover, revive and repair themselves with some forms of sleep being associated with physical repair (e.g. helping fatigued muscles to recover) and other forms of sleep being associated with psychological repair (e.g. laying down memories, working through anxiety, etc.).
A normal night's sleep has three main parts:
•Quiet sleep: This is divided into stages 1-4. Each stage becomes deeper. Quiet sleep is sometimes called deep sleep.
•Rapid eye movement (REM) sleep: REM sleep occurs when the brain is very active, but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.
•Short periods of waking for 1-2 minutes.
Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. Also, several short periods of waking for 1-2 minutes occur about every two hours or so but occur more frequently towards the end of the night's sleep.
On average, adults cycle through all forms of sleep every 90 minutes. Therefore if a person sleeps for 8 hours, he or she will have five opportunities to repair both the physical and psychological systems. It has been found that 8 hours is the average length of time adults sleep but many studies have shown that people range between needing 4 hours a night up to needing 10 hours or more.
Age influences the balance of the 90-minute cycles. Babies spend the bulk of their sleep time in a dream state since their bodies require very little repair. Older adults, on the other hand, spend a disproportionate amount of their sleep time in physical repair, as aging bodies are more vulnerable to damage.
When emotional distress and worry interfere with sleep patterns, the natural ability of the body to repair itself becomes disrupted. If sleep is disrupted over a long period, necessary physiological and psychological repair cannot take place, which can lead to pain, fatigue, and memory and thinking difficulty.
Insomnia means poor sleep. About one-third of adults do not get as much sleep as they would like. Sleep problems are particularly common in women, children and those over 65. In fact, roughly half of the elderly population complains of insomnia.
The most common causes of insomnia are a big change in daily routine and normal effects of ageing. Other causes can be pain, nausea, need to go to toilet at night time, sleep apnoea or problems with breathing, stress, depression and anxiety, alcohol use, stimulants like caffeine, cannabis, cocaine, amphetamines etc, prescribed medications like 'water tablets' (diuretics), some antidepressants, steroids, beta-blockers, some slimming tablets, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. The disrupted sleep routine can also be due to working shifts or the surroundings not being feasible like bed being too hard or too soft, bedroom temperature not being appropriate, etc.
The different sleep problems people can encounter are:
Insomnia can get better by itself at times but sometimes problems continue for longer, and these problems start affecting your functioning.
When insomnia is ongoing, the most common approach to treatment is to alter sleeping habits.
• Try to go to bed at the same time each day.
• Try to set the alarm and get up at the same time every day.
• Try avoiding any naps during the day time.
Strategies to help with sleep behaviour
• Try to go to bed only when sleepy
• Use the bed only for sleep e.g.; don`t watch TV, eat and use mobile phones or talk on the telephone in bed.
• If unable to sleep within 30 minutes – get out of bed and have a malty drink. Listen to relaxing music, read a relaxing book or watch something boring on TV until you feel sleepy.
• You must teach your body to associate the bed with sleep, not frustration.
• Restrict the amount of time you spend in bed to your usual amount of sleep (e.g. 7 hours) even if you did not get to sleep as well as you would have liked.
Surroundings and Temperature Tips
• Maintain a steady temperature in the room throughout the night.
• Fluctuations in room temperature can cause sleep disturbances.
• Keep the room dark.
• You can raise body temperature by exercising 3 to 4 hours before bed.
• You can raise body temperature by taking a warm bath 20 minutes before bed.
• Sleeping is associated with a decline in core body temperature from a state of relative warmth.
Food and drinks
• Caffeine containing drinks like tea, coffee, cola, etc. should be discontinued 4 to 6 hours before bedtime.
• Nicotine or cigarettes should be avoided near bedtime and upon night waking.
• Alcohol (a depressant) causes awakenings later in the night (though initially may promote falling asleep).
• A light snack may be sleep inducing; a heavy meal too close to bedtime is an interference.
• Making an “effort” to fall asleep will not produce sleep.
• Sleep should not be effortful.
• Avoid mentally stimulating activity just before bed (e.g. action movie, stimulating conversation).
• Relaxation techniques such as visual imagery and the tense-relax skill can help.
Daytime exercise can prove beneficial as it makes your body tired and this can help with sleep.
There are behavioural and cognitive therapies like CBT to help with sleep problems as well. One needs to discuss this option with their GP.
A short course of sleeping tablets can be an option if nothing works. It is suggested to avoid any sleeping tablets and use only if other techniques fail. The sleeping tablets to help could include Z-drugs like Zopiclone, Zolpidem etc. Sometimes benzodiazepines like Nitrazepam, Temazepam etc. are also used for short-term. A doctor can also prescribe antihistamines with a sedative effect. A melatonin supplement is sometimes advised in older people (more than 55 years of age) with persistent insomnia.
Cite this article as:
Aadil Shah, Ovais Wadoo (2016). Sleep Problems.The Beautiful Space-A Journal of Mind, Art and Poetry. October 2016: TBSB107
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The Sleep Council
Helpline: 0800 018 7923
Tel: 0845 058 4595
NHS Choices – your health, your choices
Insomnia: doctor I can`t sleep
By: Adrian Williams
The Insomnia kit: practical advice for a good night`s sleep
By: Chris Idzikowski
Overcoming Insomnia and Sleep Problems
By: Colin A Espie
Klink ME, Quan SF, Kaltenborn WT, et al. Risk factors associated with complaints of insomnia in a general adult population. Influence of previous complaints of insomnia. Arch Intern Med. 1992;152:1634–1637
Morin CM. 2005. Psychological and behavioral treatments for primary insomnia. In: KrygerMH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 4th ed. Philadelphia:Elsevier/Saunders. Pp. 726–737.
NICE: Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia NICE 2004
UMHS 2003, Dr. D. A. Williams and Dr. M. Carey
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