QUESTION: I am struggling with tiredness, cannot sleep properly and am constantly restless. I am terrified of becoming addicted to sleeping tablets and hear that there are many side effects involved. Are there health risks (to what I am experiencing), and why is this so difficult to shake off?
I desperately need your help as I am feeling out of control and my girlfriend wants to leave me. She says that I am grumpy all the time and have changed a lot. Who should I see ?
ANSWER: This is a major problem for thousands of people who struggle with sub-optimal performance due to poor quality sleep. At the core of dealing with insomnia lies a basic understanding of sleep architecture, as well as the risks and complications of sleep deprivation.
What we do know about sleep is that different people function differently on the same amount of sleep.
Ever notice how some loved ones or colleagues just look like they have been hit by a train in the morning? Also, the phenomenon where you wake up on some days and feel totally unco-ordinated and clumsy, dropping things and tripping over objects.
Many describe it as having a “zombie” brain that struggles to get going.
What is normal sleep?
The average amount of sleep needed for most people to function is between six and nine hours a night.
Science shows that at least seven hours of sleep a night can boost creative processes in the human brain.
There are three main parts to normal sleep:
* Quiet or non-REM (rapid eye movement) sleep: this is divided into stages one to four, with each stage becoming more deep. Quiet sleep is sometimes called deep sleep.
* REM sleep: this occurs when the brain is very active. The eyes move rapidly behind closed lids, while the body remains limp. Most dreaming occurs during REM sleep.
* Short periods of waking for between one and two minutes.
The normal architecture of sleep cycles is represented by 4 to 5 periods of quiet sleep which alternate with 4 to 5 periods of REM sleep.
In addition, several short periods of waking for 1 to 2 minutes occur about every two hours or so, but occur more frequently towards the end of the night’s sleep. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer, and you are more likely to remember them.
Sleep and children
It is interesting to note that one of the major challenges for new parents is when their children struggle to connect with their individual sleep cycles.
In other words, when children wake up during light sleep due to a noise or an environmental factor like heat or light in the room. The advice is to introduce familiarity in forms of a pet blanket or soothing toy to give consolation when they awaken for short periods.
Think of how you would feel if you fell asleep in a car or on your parent’s chest and woke up a while later in a dark unknown room.
What is insomnia ?
Insomnia refers to poor or bad quality sleep.
Up to 33 percent of adults struggle with bad sleeping patterns and don’t get an adequate amount of sleep.
When we use the term poor sleep we mean:
* Difficulty falling asleep.
* Waking up too early.
* Waking for long periods in the night.
* Feeling exhausted after a night’s sleep.
* Excessive tiredness in the daytime. This in turn, leads to reduced concentration, irritability and generally poor performance.
Symptoms of insomnia can include:
* Sleepiness during the day.
* General tiredness.
* Irritability and mood changes.
* Problems with concentration or memory.
What to do and where to start
You need to have a good sleep diary of your habits when visiting the doctor.
Note the frequency of insomnia, possible activities and associated conditions as well as your diet and medicines used during these times.
Generally, a two-week diary can help a great deal.
Check in with your parents or guardians about their sleeping habits, as well as some history around your childhood sleeping patterns. Primary insomnia does exist in families. This means there is no obvious medical cause for the insomnia.
Secondary Insomnia is the term used for poor sleep due to a medical condition or due to medication.
This means that a thorough physical examination by your medical practitioner is essential.
In addition, special investigations may include some blood tests, looking at chemical hormones in the blood like cortisol or thyroid hormones, as well as sex hormones.
Further testing often requires a Multiple Sleep Latency test, which is conducted in dedicated sleep laboratories, aimed at analysing brain wave function and correlation with observations like pulse, oxygen saturation and movements associated with sleep.
This can be a useful diagnostic tool.
Brain imaging is sometimes done to exclude structural brain lesions.
As you can imagine, one doesn’t start with all these tests immediately.
Often an experienced clinician will pick up on possible insomnia triggers by taking a well directed history.
Experience in the field is absolutely crucial to get to the root cause as soon as possible.
Treatment
Treatment plans should be clear and well directed with a time constraint to evaluate progress.
The cornerstone of good management must include good sleep hygiene. These are the habits around establishing a good downtime routine and controlling the influencing factors in the environment a bit better, but you need to understand their role to remember to practice this.
Medical treatment involving sleeping tablets to sedate and sustain sleep is useful, but controversial and dangerous in the wrong hands and with certain personalities who show addictive traits.
Sleeping meds can act as a crutch that prevents us from dealing with the cause of our insomnia.
There is a use for medicines in establishing sleep cycles which can assist with mood disorders and stress coping mechanisms.
* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues. He features on 567CapeTalk.
If you have medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen.
The advice in this column does not replace a consultation and clinical evaluation with a doctor.