Battling Insomnia: I Can’t Sleep!

 

Health Corner

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With Dr Sithabiso Alice Dube.

 

So what do you do when you can’t sleep? Update your Facebook status? Count non-exisiting sheep? Go through that day’s text messages? Or write that article you’ve been meaning to get started on – like I am doing right now? Well, the news is that all three suggestions are a bad idea if you are struggling with sleeplessness. The likely answer is a change to your daily routine – and then hopefully you can hit the pillow looking forward to a long, refreshing slumber.


 

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Most adults have experienced either sporadic or chronic insomnia at one time or another. Insomnia can result from inadequate quality or quantity of sleep but it is not a stand-alone diagnosis, rather a symptom with an underlying cause. “I go through phases where I am not able to sleep for weeks. It’s usually when I’m going through a stressful period at work or in my relationships,” says Rudo Tigere, a 28-year-old chemical engineer from Pretoria who rightly pins the cause of her sleeplessness on stress. “Sometimes I take sleeping pills but I haven’t done so in a while and I’ve heard one must not take them for extended periods.”

Some people fall into a high-risk group which makes them susceptible to insomnia. Geraldine Nwachukwu, a 31-year-old copywriter from Nigeria, had trouble sleeping when she got pregnant. “Maybe it’s because I was always worrying,” she says. Indeed pregnant women are one of the groups at high risk of insomnia. Other groups include women in menopause, travellers, shift workers, the elderly, adolescent and young adult students, drug abusers and alcoholics.

Among adults, insomnia affects women more often than men. The incidence tends to increase with age and is typically more common in people in lower socio- economic groups.

A myriad of things can cause insomnia. These can be divided into situational factors, medical or psychiatric conditions, or primary sleep problems. Your daytime habits, sleep routine, and physical health may also play a role. Causes of short-term insomnia also include jet lag, excessive or unpleasant noise, uncomfortable room temperature, acute or surgical illness or hospitalisation and withdrawal from drugs, alcohol, sedatives, or stimulant medications. This highlights one of Rudo’s underlying problems: taking sleeping pills on and off. In the long run sleeping pills can actually cause sleeplessness.

Sleep disorders put people at risk of other conditions, too. Most commonly, chronic insomnia can lead to high blood pressure and diabetes. There is also evidence that it increases the risk of heart attack. The good news, however, is that most cases of insomnia can be cured with changes you can make on your own – without relying on sleep specialists or turning to prescription or over-the-counter sleeping pills.

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Be bright with light

The glare from mobile phones, computer screens and the flicker of the television screen can keep you awake. Make sure your bedroom is quiet and dark to ensure a good night’s sleep. Blackout curtains or eye mask heighten this effect. In addition, the brain produces the hormone melatonin to help regulate your sleep-wake cycle. As melatonin is controlled by light exposure, not enough natural light during the day can make your brain feel sleepy, while too much artificial light at night can suppress production of melatonin and make it harder to sleep.

You need to ‘prepare’ your brain for sleep to help naturally regulate your sleep-wake cycle. Increasing light exposure during the day by taking breaks outside in sunlight, or removing sunglasses when it’s safe to do so, for example, can help fight insomnia. You also need to limit artificial light at night. To boost melatonin production, use low-watt- age bulbs, cover electrical displays in your bedroom, avoid bright light and turn off television and computer screens at least one hour before bed.

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Matters medical

Physiological causes of insomnia span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. Some of the most common medical conditions that can trigger insomnia include chronic pain syndromes, night-time angina (chest pain) from heart disease, acid reflux disease (GERD), chronic obstructive pulmonary disease (COPD) suffered by long-time smokers, degenerative diseases such as Parkinson’s disease and Alzheimer’s disease and even brain tumours, strokes, or trauma to the brain.

People with these conditions will often be kept awake due to the pain and discomfort. Medical treatment of the disease in such cases can often cure the insomnia.

Loneliness

A recent US study showed that loneliness is linked to sleep disruption: people who scored themselves high on loneliness were also the ones whose monitored sleep patterns were most fragmented.

According to the American Academy of Sleep Medicine, “The relationship between loneliness and restless sleep appears to operate across the range of perceived connectedness.” One theory is that lonely people don’t sleep as well as those who feel more connected to others. Loneliness could also be associated with poor health. These emotions are linked to feelings of anxiety, stress and depression.

Loneliness was defined in the US study not as social isolation but perceived social isolation, which reflects the difference between what a person wants and what they actually have in their social connections with others.

Alcohol and stimulants

Medications for asthma and colds, antihypertensives, and some anti-depressants can cause insomnia. The prescription varieties of these medications may contain stimulants. Further stimulants to avoid are nicotine and caffeine.  And do not be fooled by alcohol’s sedative effect either! Alcohol is associated with sleep disruption and creates a sense of non- refreshed sleep in the morning.

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