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Insomnia

Insomnia is difficulty in getting to sleep or staying asleep. Insomnia contributes to daytime problems such as tiredness, fatigue, excessive sleepiness and feeling unrefreshed upon waking. It is a common complaint, with about one third of people saying they have had insomnia in the preceding year and one in ten people having a chronic problem.

Sleep acts to conserve energy. It is restorative, protective, instinctive, adaptive and is a necessary part of our daily activities so that we can feel refreshed and energetic to deal with life’s changes.

On average people require eight hours’ sleep per day. There are wide variations in individual sleep needs with some people being able to get by on as little as 3 or 4 hours without feeling any ill effects (short sleepers), while others need up to 12 hours sleep per day in order to feel refreshed (long sleepers), Usually, if a person feels well throughout the day, then no matter how little sleep they are getting at night, they are getting ‘enough’.

What happens when you don’t sleep properly?

Not getting enough sleep can mean you don’t sleep for long enough or the quality of your sleep is poor. Quality of sleep can be difficult to establish and sometimes requires further sleep investigations because we often unaware of how well we sleep. For example, small amounts of alcohol and heavy snoring can fragment sleep without you knowing. Sometimes, no amount of extra sleep will compensate for the poor quality.

Nevertheless, sleep deprivation tends to lead to similar problems in most people, Concentration, short-term memory and reasoning are related to the quality and quantity of sleep. People often feel unable to function properly after a poor night’s sleep and complex tasks requiring lateral thinking are affected. Performance of self-placed tasks deteriorates the longer a person suffers sleep deprivation. Boring and repetitive tasks are likely to be most affected and perhaps related to decreased attention during these times.

Accidents may be linked to these changes in your mental state when you are sleep-deprived. For example, the frequency of road accidents increases in the early hours of the morning and the middle of the afternoon - times that correspond with the common patterns of sleepiness throughout the day.

Although sleep deprivation leads to lethargy, there is little evidence that it results in immediate physical damage. On the other hand, feelings of tiredness and fatigue can affect mood state, sometimes leading to irritability, depression and a tendency to become more angry than usual. There may also be a greater tendency to give up on tasks, perhaps related to reduced motivation.

It is important to remember that these symptoms are not always due to a sleep problem and can also be caused by other medical or psychiatric conditions.

Different types of insomnia

True primary insomnia caused by dysfunction of the sleep mechanisms in the brain is uncommon but may develop at any age. Sometimes this is associated with high levels of anxiety and life styles.

On the other hand, Secondary Insomnia is common, often associated with physical illness, chronic pain, substance use or misuse (including alcohol) and psychiatric conditions. Changes in diet, levels of anxiety and depression and the sleeping environment can also affect sleep.

Sometimes other primary sleep disorders such as nightmares or night terrors (especially in children) can also lead to insomnia.

Another cause of insomnia in some people is sleep apnoea. This is a relaxation of the muscles in your mouth which leads to a brief period, which can last for around 10 seconds, when you stop breathing. This will wake you up and the whole process can be repeated several times during the night.

In addition, a person’s normal sleep phase may contribute to insomnia. For example, it is common for adolescents and young adults to have delayed sleep phase, which generally manifests as being a ‘night owl’. The person with a delayed sleep phase does not feel sleepy, until the early hours of the morning but then has to awaken before having had sufficient sleep.

When all medical substance-related psychiatric and other sleep disorders are excluded there is still a group of people who have trouble going to sleep and staying asleep. Often this becomes reinforced by worry and anxiety over their sleep. This is generally regarded as psychophysical insomnia. Contributing factors to this insomnia problem include a racing mind that just won’t shut off and excessive anxiety, worry and agitation over how much sleep is needed and what will happen if ‘not enough’ sleep is obtained.

Constantly checking the clock to see how much time has elapsed and how much time is remaining before having to rise further aggravates the problem. Eventually, too much time is spent in bed awake, leading to the bed and bedroom environment becoming associated with wakefulness and agitation rather than relaxation and sleep.

What is sleep hygiene?

Insomnia will often come and go and requires no specific treatment, but if it persists for more than one week then action is warranted. Good habits, also known as sleep hygiene, are the most powerful factors in establishing and maintaining an effective sleep routine.

Regular exercise (not near bedtime), a good diet without heavy meals or heavy fluid before bedtime, reducing amounts of substances containing caffeine, lowering alcohol intake to a minimum and a comfortable, quiet sleep environment will assist in re-establishing a disrupted sleep pattern.

Try the tips below. If these measures do not lead to an improvement in the insomnia or your feeling of well being after two weeks, seek medical assistance for a more specific treatment approach. Your GP may refer you to a sleep clinic if there is one in your area, although it is likely that most GP’s will be able to help significantly in the first instance.

Tips for better Sleep

• Dealing with tension through self-relaxation skills is important for ‘winding down’ as bedtime approaches.
• If you are a ‘clock watcher’, turn the clock around so that reminders of how long you’ve been awake or how soon you have to get up are not constantly there.
• Establish a regular sleep pattern. Go to bed when feeling sleepy, not by the time on the clock.
• Set a regular rising time every day.
• Exclude reading, eating or watching television in bed until you start getting sufficient sleep and a better sleep pattern develops.
• If sleep doesn’t come after 15 - 20 minutes, get up and practice relaxing in another room until you feel sleepy again, then return to bed.
• Don’t lie down or nap during the day to compensate for the previous bad night’s sleep.

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