Insomnia - the inability to sleep, or to sleep satisfactorily - is the
most common sleep disorder. It varies from restless or disturbed sleep to
difficulty in falling asleep, to a reduction in the usual time spent sleeping.
In the extreme, it may involve complete wakefulness.
Requirements for sleep vary
widely. Most adults need the traditional seven or eight hours of sleep a
night, but some adults are "short sleepers" and function well on
only three or four hours. Many people overestimate the amount of sleep they
need and underestimate the amount they actually get during a restless night.
Generally there is no need for concern, even if an unbroken night's sleep is
rare. However if loss of sleep impairs a person's ability to function well
during the day, it might indicate a problem.
ROLE OF SLEEP
The mechanism that induces sleep is not known. In the dark, the pineal gland
in the brain secretes a hormone called melatonin, which is thought to induce
sleep. Exactly why sleep is necessary for good health and efficient mental
functioning is unknown. We do know that sleep consists of two very different
states: rapid-eye movement (REM) sleep and non-REM sleep. In REM sleep, the
eyes move under the closed lids, the heartbeat quickens and all body processes
speed up. Dreams occur during REM sleep and sexual arousal is common, even if
the dreams themselves are not sexual in content. Periods of REM sleep last
about 20 minutes and occur four or five times during the night. They alternate
with longer periods of non-REM sleep, when body functions slow. Non-REM sleep
has four stages. During the deepest stages (3 and 4) it is hard to arouse a
sleeper. As the night goes on, the periods of non-REM sleep become
progressively lighter. Stage 4 sleep is felt to be restorative. During this
time the body repairs itself, utilizing a hormone called somatostatin. Lack of
stage 4 sleep is believed to be important in chronically painful conditions
such as fibromyalgia.
Insomnia can take various forms: difficulty falling asleep (sleep onset
insomnia), difficulty staying asleep, and early wakening. Sleeplessness is
common during pregnancy, especially in the later weeks. The elderly typically
sleep lightly and fitfully.
Physical situations can
complicate sleep patterns: the need to urinate frequently, leg cramps, painful
conditions such as arthritis, symptomatic asthma or other medical problems and
restless legs syndrome can all interfere with both sleep onset and sleep
maintenance. Social situations can disturb sleep, too. Arguing, watching
exciting programs on television late at night, consuming excessive caffeine or
alcohol or eating a large meal close to bedtime, vigorous exercise less than
six hours before retiring may disturb sleep patterns.
In the majority of insomnia
cases, however, the core problem is emotional. Anxiety and internalized,
unexpressed anger are common causes of sleeplessness. Depression is also
implicated in insomnia, waking in the early morning is common in some
depressed individuals. People may clock many hours of sleep time, yet continue
to feel fatigued due to poor sleep quality.
Paradoxically, insomnia may
result from the use of a sedative prescribed to relieve it. Some people,
especially the elderly or people with certain occupations, develop an inverted
sleep rhythm: drowsiness in the morning, sleep during the day, and wakefulness
TREATMENT FOR INSOMNIA
There are a number of ways to help yourself fall asleep more easily.
Establish a bedtime
"ritual" composed of environmental cues which tell your body
that it is now time to rest: go for a stroll an hour or so before bedtime,
take a warm bath or drink a glass of warm milk (milk contains an amino
acid that is converted to a sleep-enhancing compound in the brain).
Sexual intercourse has a
relaxing effect for many people.
including muscle-relaxation exercises and meditation, may be useful.
If insomnia is persistent,
consult a doctor. Often, reassurance that the problem results from normal
anxieties or from a treatable physical disorder relieves distress and helps
restore a normal sleeping pattern. Treatment of underlying stressors or
alteration of living habits is necessary if one or the other is causing
insomnia. Above all, it is important to create a situation that is appropriate
for sound sleep.
HELP YOURSELF SLEEP BETTER
Many sleep problems can be overcome by simple, common sense measures. These
Cut back on coffee, tea,
and other sources of caffeine, especially in the evening.
Avoid alcoholic drinks in
the late evening. Alcohol may help sleep onset, but cause early morning
Avoid eating a large,
late-evening meal - and heavy, fatty foods before going to bed.
Take a walk or perform mild
exercise such as yoga or Qi Gung before going to bed.
Don't use your bedroom as a
place to work.
Have a warm milk drink
before going to bed. Milk products contain an amino acid precursor that
boosts serotonin in the brain.
Take a warm (NOT HOT) bath
(not a shower) before going to bed.
Avoid naps if they
interfere with your normal sleep pattern.
If unable to fall asleep
within 20-30 minutes of lying down, get up and do something else until you
feel sleepy. This way your body does not associate your bed with
Exercise during the day.
Drugs may be prescribed when the cause of insomnia includes a particularly
stressful situation (i.e., bereavement or the loss of a job) or a pain from
some physical condition, or if a person's efficiency and sense of well-being
are seriously impaired by sleeplessness. Hypnotic (sleep-inducing) drugs
should never be combined with even a small amount of alcohol, a sedative that
enhances gastrointestinal absorption of the drugs and compounds their effects.
Always follow your doctor's specific instructions for treating insomnia.
Alcohol consumption may cause initial drowsiness, but this is usually followed
by sudden wakefulness after the alcohol is metabolized. It may be more
difficult to get back to sleep than it was beforehand.
Nearly half of all Americans have some kind of sleep disorder, with insomnia
being the most common. Worry, anxiety, unconscious tensions, and major or
minor health problems can all affect the quality of sleep. Simple
tension-reducing measures, such as a warm bath or moderate exercise, often
help restore normal sleeping patterns. If they do not, and insomnia becomes a
chronic problem, seek medical help. Sleep-inducing medications should be
considered a temporary solution when great emotional stress, considerable
physical pain, or prolonged sleeplessness seriously affect the quality of a
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