Getting a good night's sleep is critical to feeling refreshed
during the day, but unfortunately not everyone is able to get
the sleep they need. Different factors can contribute to lack
of sleep: a noisy bedroom, stress or illness. When the
problem persists help should be sought. Experts can suggest a
wide range of treatment options, including finding ways to
change bedtime behaviors, and in some instances,
medication.
Getting a good night's sleep is an important part of a
healthy lifestyle, but for many Americans that restful break
is hard to achieve.
Probably more than half of all Americans experience a sleep
problem at some time in their lives. Somewhere between 9 and
17 percent of the adult population will experience chronic or
more ongoing difficulties with their sleep.
We know that insomnia affects older people more than it does
younger people. It's more often reported in women, and it may
be associated with certain medical or psychiatric
conditions.
A poor night's sleep can mean more than just tossing and
turning. People with insomnia often complain of impairments
in intellectual abilities like attention, memory or
concentration, impairments in their mood, feeling depressed
or irritable or anxious, and impairment in their ability to
function in the workplace, at home or even at school.
Insomnia can manifest itself in a variety of ways.
Insomnia as difficulty sleeping during the night can occur at
any point during the night, really. Although some people will
have mainly difficulty falling asleep, other people will have
mainly difficulties because of frequent awakenings during
sleep. And in many cases, people will just have difficulty
returning to sleep once they have awakened in the middle of
the night.
But what is a good night's sleep? The answer is different for
everyone. The amount of sleep is not defined by a certain
number of hours, because different people need different
amounts of sleep. There are certainly short sleepers and
there are long sleepers. But the thing that categorizes
adequate sleep is that the person's able to remain awake and
to function well during the day.
Many sleep problems are temporary, usually caused by a
particular event or poor sleep environment. Transient
insomnia is defined as something that lasts less than two or
three weeks. And it's usually a problem that occurs in the
context of some other stress in the person's life, whether
it's a stress in terms of their life situation, problems at
work, problems in their family or perhaps a stress in terms
of a medical problem, an acute medical illness.
Chronic or more persistent insomnia can result from several
factors. Virtually every chronic medical illness can cause
insomnia. Things that cause pain, things that impair our
ability to move at night, things that cause difficulty
breathing are common examples of medical conditions that may
be associated with insomnia.
Psychiatric conditions of just about any sort can also be
associated with long-term insomnia. The most common example
is clinical depression, but certainly people with serious
anxiety disorders including panic disorder, generalized
anxiety disorder, those can also be associated with
insomnia.
A number of specific sleep disorders can also cause chronic
insomnia, among them sleep apnea and restless leg
syndrome.
Sleep apnea is a condition in which the individual stops
breathing during sleep. Generally speaking, there can be two
reasons for that. One is that there's an obstruction
somewhere in the airway that prevents breathing. The other is
that the brain stops giving signals to breathe to the lungs
and the breathing apparatus.
Restless leg syndrome is a neurological disorder
characterized by uncomfortable feelings in the legs at night.
Individuals with restless legs usually complain of creepy,
crawly feelings or the need to move their legs at night. And
very commonly, they will have repeated jerking movements in
their legs that further disrupt sleep.
Sleep specialists have learned that many people suffering
from insomnia often need help breaking bad habits.
Sleep hygiene is really the development of good sleep habits.
This refers to doing things like going to bed at the same
time every night, getting up the same time every morning, no
matter what happened the night before. For most people,
avoiding daytime naps, avoiding stimulants such as caffeine
and nicotine, avoiding alcohol just prior to bedtime are
important. Although it's a sedative, alcohol can truly
disrupt sleep. Both going to bed too hungry or too full can
disturb sleep.
Not surprisingly, the best environment for sleep is one
that's quiet, dark and sealed off from any light. All of
those factors can certainly disrupt our sleep.
People who use nonpharmacologic therapies often report that
they work very well for them. They experience a subjective
sense of improvement in their sleep. One of the problems with
behavioral therapies or nonpharmacologic therapies for
insomnia is they often take time to work, and patients don't
want to wait. They're suffering. Their lives are impaired,
and they want some immediate relief.
For many, relief is found with both over-the-counter and
prescription medications. In years past, many doctors were
concerned about offering a prescription medication to their
patients. They were rightly concerned about problems of
tolerance, dependence, misuse of the prescription and adverse
effects. But the newer medications that are available now
have offered real alternatives to the older class of
medications, effective and safe alternatives which now offer
physicians an opportunity to prescribe something that they
know is effective for sleep.
Whatever the strategy, it's vital to recognize the
problem.
2004 Dr. Reuven Bruner. All Rights Reserved. Contact him at:
POB 1903, Jerusalem, 91314, Israel; Tel: (02) 652-7684;
Mobile: 052 2865-821; Fax: (02) 652-7227; Email:
dr_bruner@hotmail.com
