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SLEEP"Dreaming permits each and every one of us to be
quietly and safely insane every night of our lives."
- Sigmund Freud Sleep takes up one third of our lives...or at least it should.
Unfortunately, about half of all adults report having difficulty sleeping at
some time in their lives and approximately 10% find themselves tossing and
turning every night in bed. Insomnia is a complaint defined as difficulty falling sleep,
difficulty staying asleep, waking too early and/or non-restorative sleep.
Next-day consequences of lost sleep include fatigue, lack of energy, difficulty
concentrating, and irritability. Insomnia can be acute, lasting from one night
to several weeks, or chronic, lasting months to years. Needless to say, insomnia
can have an adverse effect on occupational and social functioning as well as
adverse effects on health. Lack of sleep diminishes quality of life, pain
threshold, immune function, glucose tolerance, and can worsen anxiety and
depression. Normal sleep is characterized by an alternating pattern of REM
(rapid eye movement) sleep and non-REM sleep. There are five stages
of sleep and REM sleep. These cycles last 90-110 minutes. During REM sleep,
breathing becomes more rapid, irregular, and shallow. The eyes jerk rapidly in
various directions and limb muscles become temporarily paralyzed. Heart rate and
blood pressure increase and males experience penile erections. Dreaming occurs
during this time. As the night progresses, REM stages get longer and deep sleep
gets shorter. People dream about two hours every night. Sleep is governed by
neurotransmitters, hormones and the body’s circadian rhythm.
Melatonin, a hormone produced by the pineal gland, is increased as
darkness falls and is integral to the sensation of drowsiness. One of the major determinants of sleep requirements each night
is age. Newborns require 16-24 hours per day, but by age 2 this need drops to
9-12 hours. Adolescents need 9-10 hours each night and middle-aged adults need
7-9 hours. During pregnancy many women need additional hours of sleep. The
elderly require the least amount of sleep, usually 6 hours per night. People do not adapt to getting less hours of sleep than they
need. Instead they get chronically sleep deprived. Signs of sleep deprivation
include daytime drowsiness, falling asleep within five minutes of "hitting the
sack," and very brief episodes of sleep during the day. Insomnia is caused by the following situations: 1) Emotional
discomfort: stress from work, school, health, family, or current events; 2)
Change in environment or work schedule: jet lag, working a different shift,
sleeping in different places; 3) Disruptions in sleep environment such as
frequent trips to the bathroom, partner snoring, child's needs; 4) Poor sleep
hygiene: eating, smoking, or drinking alcohol or caffeinated beverages too late
in the evening; going to bed at different times each night, staying up late to
cram for exams, etc. Chronic insomnia can be caused by sleep disorders such as
restless leg syndrome or periodic limb movement disorder or sleep apnea.
Behavioral insomnia is a result of excessive worry about being able to fall
sleep. Secondary sleep disorders are due to medical conditions such
as pulmonary disease, asthma and allergies, rheumatologic disorders, depression
and anxiety and hormonal changes. Long term medications may affect sleep if they
are stimulants and taken at the wrong time of the day. Substance abuse
(nicotine, alcohol, illicit drugs) may be another cause. Many of these causes of sleep disorders need medical
evaluation but Often good sleep hygiene is the first step toward improving sleep
and restfulness. Keep these simple
rules in mind: 1) Standardize the sleep time. Our bodies love rituals. 2) Use
the bed for sleep and (intimacy) only!
No reading, watching TV, or listening to the radio in bed. 3) Limit
daytime napping. 4) Reduce or eliminate heavy meals, caffeine, nicotine, and
alcohol near bedtime. Alcohol may make you sleepy but when it wears off there is
a tendency for increased wakefulness and disruption of sleep. 5) Avoid exercise
immediately before bedtime. 6) Minimize noise, light and heat during the sleep
period. 7) Avoid looking at the clock after going to bed. If you cannot fall
asleep within 20-30 minutes of lying down, get up and do something else,
non-stimulating, until you feel sleepy. There are medications for treating insomnia. The most common
over the counter sleep aids contain sedating antihistamines that are convenient
to obtain and use but often have residual daytime drowsiness, and tolerance can
develop within one week. Older
adults taking these medications can develop confusion. There are several
prescription medications to help with sleep – as with all medications, side
effects cost and duration of use need to be individualized. Insomnia can exact a huge economic and personal toll on us if
not recognized and treated appropriately. In addition to sleep hygiene factors
and medications there are other behavioral modification techniques that can be
explored. Evaluation with a sleep study can determine many of the
physiologic causes of insomnia and guide treatment. Discussion with your
healthcare practitioner if advised. "My mind clicks on and off....I try letting one eyelid
close at a time while I prop the other open with my will. My whole body argues
dully that nothing, nothing life can attain, is quite so desirable as sleep."
- Charles Lindbergh
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