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HOW TO GET QUALITY SLEEP AND BEAT
INSOMNIA
by Angelene Fisher Quality sleep is important for the proper functining of the body. It helps people stay emotionally balanced and also plays important roles in memory and learning. In addition to being important for appropriate brain functioning, sleep is necessary for other organ systems to work well, including the body's ability to fight infection. It is critical for growth, especialy in children. However, most people fail to acknowledge the importance of sleep, even though fatigue is a major cause of traffic and industrial accidents. With today’s demanding lifestyles, many people feel they must sacrifice a good night’s sleep in order to get everything done. This lifestyle, with the stress that it entails, may lead to insomnia. People who suffer from sleep disorders, such as insomnia, wish they could have a good night's sleep, but can’t get it. But those of us who are stretching our daytime hours to get more into them may need greater awareness on the impact that the lack of sleep and poor sleep habits have on our health and well-being. Definition of insomnia Insomnia can refer to either difficulty getting to sleep or difficulty staying asleep, or both (Fleming). The National Women’s Health Information Center (http://www.4woman.org/faq/insomnia.htm) defines insomnia as “the perception or complaint of inadequate or poor-quality sleep” because of one or more of the following: difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, and unrefreshing sleep. Problems with sleep are often associated with many conditions, including medical and psychiatric illnesses, as well as use of drugs, alcohol and medications. However, insomnia often simply occurs on its own, and is then referred to as "primary insomnia" (Fleming). Insomnia can be short- or long-lasting. Transient or short-term insomnia (for example the sleeplessness that occurs just before a big test) is very common and is considered a normal stress reaction that typically disappears as the stress passes. It may last from a single night to a few weeks. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent or on and off. Chronic insomnia, on the other hand, refers to sleep problems that have lasted over six months. When stress becomes long-term, or in individuals who are predisposed to insomnia (sleep complaints run in families), the insomnia may become more long-lasting and require treatment (Fleming, National Women’s Health Information Center). Because individuals vary in their need for and their satisfaction with sleep, insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary the patient fills out or from an interview with the patient's bed partner concerning the quantity and quality of sleep. When the possibility of a “primary” sleep disorder like sleep apnea or narcolepsy exists, the patient may undergo specialized sleep studies at a sleep clinic (National Women’s Health Information Center). Incidence Some studies suggest that over 90 percent of people have insomnia at some point. The vast majority of these people have transient insomnia. However, 30 percent of the population may have insomnia that lasts longer (chronic insomnia). Women, the elderly, and individuals with a history of depression are all more likely to experience insomnia. If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely (National Women’s Health Information Center). A recent survey of university students in Utah suggests that students may have a high incidence of sleep problems because of the stress of school. Students who habitually go to bed late and sleep in the next day, the report says, get lower grade point averages than students with early-to-bed and early-to-rise sleeping habits (Zwillich). Causes of insomnia There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following: stress, change in the environment, environmental noise, extreme temperatures, sleep/wake schedule problems such as those due to jet lag or cramming for exams, and medication side effects (National Women’s Health Information Center). Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders, such as depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease, and hyperthyroidism (National Women’s Health Information Center). Chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances. Disrupted sleep/wake cycles may occur with shift work or other nighttime activity schedules. These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place (National Women’s Health Information Center). Sometimes, paradoxically, the habits that people develop to cope with their nighttime sleeplessness delays the return of normal sleep patterns. These problematic habits include napping during the daytime, giving up on regular exercise because of fatigue, or drinking excessive amounts of coffee to promote alertness (Fleming). Therapy for insomnia Treatment for disturbed sleep should be sought when it has lasted more than a few days, and is associated with daytime problems such as mood changes, or difficulty focusing or staying alert. For a doctor to diagnose primary insomnia, all other possible causes of disturbed sleep have to be eliminated first. To do this, the doctor will ask detailed questions, including a sleep history (when and how long you sleep, how you feel before you fall asleep and when you wake up, specific sleep behaviors such as snoring and limb-twitching), as well as a medical and a psychiatric history. A physical examination and certain lab tests may be required (Fleming). Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. For some people who experience daytime sleepiness and impaired performance, the use of short-acting sleeping pills may improve sleep and next-day alertness (National Women’s Health Information Center). If the sleep problem is chronic, the doctor may ask the patient to keep sleep diary. This provides the best information about the actual sleep performance, its night-to-night variability and its effects on daytime functioning (Fleming). Treatment for diagnosed chronic insomnia include identifying behaviors that may worsen insomnia and stopping (or reducing) them, possibly using sleeping pills (although the long-term use of sleeping pills for chronic insomnia is controversial), trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning (National Women’s Health Information Center). Although patients with primary insomnia may never sleep as long as people without this condition, there are a number of effective strategies which can help improve sleep quality and the subsequent day's performance. Fleming suggests treating primary insomnia with stress reduction, good sleep hygiene, or strategic use of sleep-promoting medications and hypnotics. Since falling asleep is a passive process that requires the body and mind to be relaxed, strategies which calm both the mind and body, are very helpful in managing insomnia. Exercise reduces the effects of stress, improves mood, and deepens sleep. Regular, daily exercise completed at least four hours before bedtime usually improves sleep performance significantly. To get good sleep habits, firstly, ensure a relaxing "buffer zone" before bedtime. Stop all work-related tasks 90 minutes before going to sleep. You might relax before bedtime by listening taped relaxation exercises (focusing on breathing and muscle relaxation). Secondly, another technique is “the 20-minute rule." If, after turning the lights out or waking up, you haven’t fallen asleep in 20 minutes, get up and only return to bed when feeling "drowsy-tired." If you get up when you can’t sleep and repeat this throughout the night, the amount of "awake" time during the night will induce a degree of sleep deprivation that will increase sleep pressure the subsequent night. Over time, sleep improves. (Clock watching is an “arousing activity” so turn all clock faces away from you when trying to go to sleep.) A third technique is sleep restriction. It reduces the "awake" time in bed, and increases the depth and quality of sleep. Calculate the average current sleep time from the sleep diary, by subtracting all "awake" time from the total time spent in bed. This amount of time is the new assigned time in bed. Like the "20-minute rule," sleep restriction usually results in a mild degree of sleep deprivation (daytime sleepiness and fatigue), but creates increased sleep pressure at night. Once this begins to occur, increase the allowed time in bed by 10 to 15 minutes. In this way, the time in bed is slowly increased until sleep again becomes disrupted. Then the previous sleep time associated with no awakenings becomes the new sleep time. Drugs, which promote sleep, should only be used under the care of a physician. In selecting a drug, avoid long-acting drugs that would cause daytime sedation. Hypnotics should always be used for the shortest period of time possible and in the lowest dose. Patients with primary insomnia do not have significant psychiatric symptoms. Therefore, unlike patients with anxiety disorders, they should require only occasional use of hypnotics, writes Fleming. The Mayo Clinic Guide to Self-Care, includes the following tips for fighting insomnia, some of which are similar to Fleming’s suggestions:
Managing insomnia will lead to better health. Good sleep will leave people refreshed and more awake. The payoffs for business and industry in fewer accidents and better work habits can be great. Better sleep can lead to reduced amount of sickness and healthier bodies. Also, it has important implications for students. In his book, Sleep Thieves, Dr. Stanley Coren, says I.Q. drops with each hour of sleep lost. The more sleep deprived you are, the lower your I.Q. Adequate sleep is crucial to keeping you functioning at peak performance levels and is very important to students because of the extra stresses of doing well in school, or just getting things done. The Utah study (Zwillich) suggests that students wanting to maximize their academic performance should improve their sleep habits by going to bed earlier and getting adequate sleep. Conclusion Everyone needs different amounts of sleep. Even if you get the right number of hours of sleep, if the quality of sleep is poor, you feel the difference in the morning. Sleep should feel restorative. Sometimes the lack of sleep or poor sleep impairs the ability to perform well and to remember certain things. You are likely to be healthier, more productive, have fewer accidents, and generally feel better if you make the changes needed to your lifestyle so that you can have a restful night's sleep. Bibliography Coren, Stanley. Sleep Thieves. An Eye-Opening Exploration
into the Science and Mysteries of Sleep. New York: Simon & Schuster
Publishing, Inc., 1996.
Fleming, Jon, MD, FRCPC. “Primary Insomnia is a Condition
on its Own.” Medbroadcast.com, 19 January 19, 2001.
Hagen, Philip T., editor-in-chief. Mayo Clinic guide to
self-care : answers for everyday health problems, 2nd ed. Rochester, Minn.
: Mayo Clinic, 1999.
National Women's Health Information Center. “Insomnia.”
The Office on Women's Health, U.S. Department of Health and Human Services,
1998.
Snyderman, Nancy M.D., F.A.C.S. "Wake Up to Good Sleep." drkoop.com, January, 1999 <http://highmark.drkoop.com/family/mens/general/sleep.asp> Zwillich, Todd. “Students Who Snooze Morning Away
Have Lower GPA.” Health News (Reuters Health Information), December 29,
2000.
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