Why are sleep problems so common?

Sleep can be disrupted easily for many of us as it requires

progressive relaxation in order to take place. Therefore anything that

raises our adrenaline levels, or causes us to worry, can interfere with

the natural process of sleep. Some people seem to be able to 'switch off'

the day's worries and can sleep in any environment. For others, sleep

seems to be much more delicate.

 

Sleeping pills - a real 'Insomnia Cure'?

 

When you haven't slept for days, the thought of 'sweet oblivion' is

extremely attractive, and who can blame those of us who choose a fail-safe

option like a sleeping pill? In the long run however, they can lead to

more problems. Sleeping pills impair quality of sleep and often have other

side-effects such as anxiety and disorientation.

 

So what can be done about insomnia in the long-term?

 

When a person has chronic insomnia it is almost as if they have 'forgotten'

how to sleep properly, or that they have become

 

conditioned to responding to the sleep situation (i.e. bedtime) with anxiety

or irritation instead of relaxation. What often needs to happen in these

circumstances is a 're-training' of the mind and body in achieving the

state necessary for sleep to occur.

 

The difficulty with sleep is that the harder you try to sleep, the less

likely it is to happen. This means we need to approach it in a different

way. Rather than going directly for the goal, we need to 'set the scene'

so that natural sleep processes can take place by themselves.

How Much Sleep Is Enough?

Animal studies suggest that sleep is as vital as food for survival. Rats, for example, normally live 2–3 years, but they live only

5 weeks if they are deprived of REM sleep and only 2–3 weeks if they are deprived of all sleep stages—a timeframe similar to death due to starvation. But how much sleep do humans need? To help answer that question, scientists look at how much people sleep when unrestricted, the average amount of sleep among various age groups, and the amount of sleep that studies reveal is necessary to function at your best.

When healthy adults are given unlimited opportunity to sleep, they sleep on average between 8 and 8.5 hours a night. But sleep needs vary from person to person. Some people appear to need only about 7 hours to avoid problem sleepiness whereas others need 9 or more hours of sleep. Sleep needs also change throughout the lifecycle. Newborns sleep between 16 and 18 hours a day, and children in preschool sleep between 10 and 12 hours a day. School-aged children and adolescents need at least 9 hours of sleep a night.

The hormonal influences of puberty tend to shift adolescents’ biological clocks. As a result, teenagers are more likely to go to bed later than younger children and adults, and they tend to want to sleep later in the morning. This sleep–wake rhythm is contrary to the early-morning start times of many high schools and helps explain why most teenagers get an average of only 7–7.5 hours of sleep a night.

As people get older, the pattern of sleep also changes—especially the amount of time spent in the deep sleep stages. Children spend more time than adults in these sleep stages. This explains why children can sleep through loud noises and why they might not wake up when they are moved from the car to their beds. During adolescence, a big drop occurs in the amount of time spent in deep sleep, which is replaced by lighter, stage 2 sleep. Between young adulthood and midlife, the percentage of deep sleep falls again— from less than 20 percent to less than 5 percent, one study suggests— and is replaced with lighter sleep (stages 1 and 2). From midlife through late life, people’s sleep has more interruptions by wakefulness during the night. This disruption causes older persons to lose more and more of stages 1 and 2 non-REM sleep as well as REM sleep.

Many older people complain of difficulty falling asleep, early mornnoting awakenings, frequent and long awakenings during the night, daytime sleepiness, and a lack of refreshing sleep. Many sleep problems, however, are not a natural aspect of sleep in the elderly. Because older people are more likely to have many illnesses that can disrupt sleep, their sleep complaints often may be due, in part, to illnesses or the medications used to treat them. In fact, one study found that the prevalence of sleep problems is very low in healthy older adults. Other causes of some of older adults’ sleep complaints are sleep apnea, restless legs syndrome, and other sleep disorders that become more common with age. Also, older people are more likely to have their sleep disrupted by the need to urinate during the night.

 

Some evidence shows that the biological clock shifts in older people, so they are more apt to go to sleep earlier at night and wake up earlier in the morning. No evidence indicates that older people can get by with less sleep than younger people.

 

Poor sleep in older people is linked to excessive daytime sleepiness, attention and memnotory problems, depressed mood, and overuse of sleeping pills.

 

Despite variations in sleep quantity and quality, both related to age and between individuals, studies suggest that the optimal amount of sleep needed to perform adequately, avoid a sleep debt, and not have problem sleepiness during the day is about 7–8 hours for adults and 9 or more hours for school-aged children and adolescents. Similar amounts seem to be necessary to avoid further increasing the risk of developing obesity, diabetes, or cardiovascular disorders.

 

Quality of sleep is as important as quantity. People whose sleep is frequently interrupted or cut short may not get enough of both non-REM sleep and REM sleep. Both types of sleep appear to be crucial for learning and memory—and perhaps for all the other restorative benefits of healthy sleep, including the growth and repair of cells.

Many people try to make up for lost sleep during the week by sleeping more on the weekends. But if you have lost too much sleep, sleeping in on the weekend does not completely erase your sleep debt. Certainly, sleeping more at the end of the week does not make up for the hampered performance you most likely had at the beginning of or during that week. Just 1 night of inadequate sleep can adversely affect your functioning and mood during at least the next day.

 

Daytime naps are another strategy some people use to make up for lost sleep during the night. Some evidence shows that short naps (up to an hour) can make up, at least partially, for the sleep missed on the previous night and improve alertness, mood, and work performance. But naps don’t substitute for a good night’s sleep. One study found that a daytime nap after a lack of sleep at night did not fully restore levels of blood sugar to the pattern seen with adequate nighttime sleep. If a nap lasts longer than 1 hour, you may have a hard time waking up fully. In addition, late afternoon naps can make falling asleep at night more difficult.

Do You Think You Have a Sleep Disorder?

At various points in our lives, all of us suffer from a lack of sleep thatcan be remedied by making sure we have the opportunity to getenough sleep. But, if you are spending enough time in bed and stillwake up tired or feel very sleepy during the day, you may have a sleepdisorder.

One of the best ways you can tell if you are getting enough goodquality sleep, and whether you have signs of a sleep disorder, is bykeeping a sleep diary, to record the quality and quantity of your sleep; your use of medications,alcohol, and caffeinated beverages; your exercise patterns; andhow sleepy you feel during the day. After a week or so, look overthis information to see how many hours of sleep or nighttime awakeningsthe night before are linked to your being tired the next day.

This information will give you a sense of how much uninterruptedsleep you need to avoid daytime sleepiness. You can also use thediary to see some of the patterns or practices that may keep youfrom getting a good night’s sleep.

 

You may have a sleep disorder and should see your doctor if yoursleep diary reveals any of the following:* You consistently take more than 30 minutes each night to fallasleep.

* You consistently awaken more than a few times or for long periods of time each night.

* You take frequent naps.

* You often feel sleepy during the day—especially if you fall asleep at inappropriate times during the day.

 

Your Sleeping Posture

Your sleeping posture can also have a very significant effect on how deep you sleep.

If you sleep on your back or on your side, you should be fine. However, if you sleep

on your front, or need to lie on your front to fall asleep; this could have some serious

repercussions on your sleep and your back!

Sleeping on your front puts unnecessary pressure on some of your vital organs, like

your stomach, liver, and intestines. You'll also put a lot of strain on your neck and

your back, which makes your sleep very un-restful, and often is a major cause of

back problems. Whenever you're sleeping in a position that puts unnecessary

pressure on your body, it makes it harder for you to sleep deeply.

How Sleep Apnea Manifests Insomnia

The clinical definition of a sleeping disorder is a disruptive pattern of sleep that may include difficulty in falling or staying

asleep, falling asleep at inappropriate times, excessive total sleep time, or abnormal behaviors associated with sleep.

There are four basic categories that each sleeping disorder can be put into: insomnia, hypersomnia, sleep disruptive

disorders, and basic trouble with adhering to a normal sleep pattern. Some symptoms of having a sleeping disorder are:

difficulty in falling asleep, daytime drowsiness, loud snoring, fatigue, depression, anxiety and lower leg movements during

sleep.

Sleep apnea is a common disorder in which a person's breathing stops during sleep for 10 seconds or more, sometimes

more than 300 times a night.

There are two main types of sleep apnea. The first is Obstructive Sleep Apnea which may represent the stoppage of

breathing due to a mechanical blockage of the airway. The second is Central Sleep Apnea which appears to be related to a

malfunction of the brain's normal signal to breathe.

Some of the symptoms of sleep apnea may include restless sleep, loud and heavy snoring which is often interrupted by

silence and then gasps, falling asleep while driving or when the person is at work or at home while watching TV, morning

headaches, loss of energy, trouble concentrating, and mood or behavioral changes.

Snoring is usually associated with apnea. Snoring is defined as noisy breathing one occurs during sleep when the flow of air

through the airways is blocked or when the airways vibrate during breathing.

Several factors tend to make people snore: nasal congestion, being overweight, smoking, drinking alcohol before bedtime,

and sleeping on your back. Sleeping pills, painkillers and other drugs that cause drowsiness can also make snoring more

likely.

Because a person is not able to sleep well or not get good nights sleep, some doctors are now conducting research to see

how Apnea manifests insomnia since both interferes with the daytime functioning o f a person. Some causes which still

have to be confirmed are the certain medicines available in the market to treat such disorder; medical conditions, excess

stress, or poor sleep habits can all affect the quality of your sleep.

To check if a person has a sleeping disorder, a diagnosis is made by a physician specially trained in sleep medicine. After a

physical examination of the upper airway and an interview with lots of questions, if it the tests have determined that the

patient has a sleeping disorder, one will have to undergo a polysomnogram (sleep test). Most sleep centers and labs

monitor 16 different sleep parameters including EEG, EKG, eye movement, chin movement, air flow, chest effort, abdomen

effort, SaO2, snoring and leg movement. Each parameter serves to help the physician make a correct diagnosis.

Test are conducted in a sleep room much like a motel room. A technician will paste electrodes at certain points on your

head, face, body and legs. Those electrodes will be hooked to monitoring equipment that will record the entire night study.

Most patients do not experience anxiety or difficulty in going to sleep. The patients in most case are extremely sleepy and

will be asleep in just a few minutes.

Once a correct diagnosis has been made, the doctor may recommend a variety of treatments available for those that suffer

from sleep apnea, including medications, behavioral therapy, and, in extreme cases, surgery.

Although over-the-counter sleep aids may be helpful it is not advisable to use these products on a regular basis. These

sleep aids don't eliminate the problem but only provide temporary relief and may become less effective after a few days of

use.

Doctors however often recommend a prescription device called a continuous positive airway pressure (CPAP) device for

patients with sleep apnea. During sleep, the patient wears a mask that fits over the nose. The mask is attached to an air

compressor adjusted to blow enough air through the nose to keep the airway open. If a CPAP device doesn't help, then

surgery on the upper airway may be the last resort.

By developing good sleeping habits, one may be able to break the pattern of sleeplessness without needing other therapies.

Good habits include going to bed and waking up at a regular time, eliminating naps, and avoiding stimulation from exercise

or caffeine shortly before bedtime. Relaxation techniques and changes in diet can also help some people.

 

Reduce Worry/Anxiety

Perhaps you're someone whose mind is always busy. Do you think about the events of your day as you wind down for the evening? Do you worry about

your family, your job, your finances, and what tomorrow will bring?

Sometimes it's difficult to empty your mind of all these details long

enough to fall asleep. This can lead to tossing and turning as your mind fights

sleep.

There are several ways that you can reduce the worry about situations

and events in your life long enough to allow you to rest and fall asleep. The

key is finding a process that works for you. The goal is to clear your mind and consciously realize that tomorrow is the time to tackle problems and tonight is the time to sleep.

One technique you can try is the practice of writing down all your worries and concerns before you retire for the night. Keep a notebook available for just this purpose.

List in point form those things that you are worrying about. Make note of which of these items you can deal with tomorrow. Have a decisive plan of action for what you are going to accomplish tomorrow.

This will make you feel positive that tomorrow you will take care of certain items on your "worry list".

Make a separate list in your notebook that contains only those things in your life over which you have no control. Firmly tell yourself that these items are beyond your power.

Once you have completed your two lists it is time to close the notebook and repeat to yourself that you will not think of these worries until tomorrow.

If, during the night, you find yourself thinking about any of the items in either list make a mental note to catch yourself and sternly remind yourself that the covers of the notebook are closed and cannot be opened.

Another technique for keeping daily anxiety and worry out of your thoughts while you try to fall asleep is to keep a daily diary.

Make sure to include all your worries and fears in your diary along with the events of the day. The goal here is to actualize your feelings in writing so

that you can be free of them in the evening.

The act of physically writing is the key here to acknowledging that you are worried while at the same time giving yourself permission to rest and deal

with these feeling tomorrow.

You can reduce the effects that worry and stress can create for your

body by using some of the other methods for achieving relaxation described in this book.

You may want to consider a combination of soothing music and yoga to

clear your mind. Or perhaps reading quietly will keep your mind from

wandering back to the stressful thoughts you had during the day.

Once again, the goal here is to relax and prepare you for a night of restful sleep.

 

The Interrelationship of Depression and Insomnia

Insomnia is a sleeping disorder characterized by any of the following: a) light, interrupted sleep that one is still tired upon

waking up, b) not being able to sleep, even if fatigued, c) lack of sleeping hours.

Insomnia can be classified into three types based on the length of time it affects an individual.

Transient insomnia lasts only a few days and is usually due to changes in living or working conditions, which may be minor

or traumatic.

Short-term insomnia, or acute transient insomnia, lasts for less than three weeks and has similar causes as transient

insomnia.

Chronic insomnia, on the other hand, is more complex. This condition is characterized by one of the following: a) light,

interrupted sleep that one is still tired upon waking up, b) not being able to sleep, even if fatigued, c) lack of sleeping

hours.

Based on the causes, chronic insomnia may be considered as primary or secondary:

* Primary chronic insomnia - when the insomnia is not caused by any physical or mental imbalance.

* Secondary chronic insomnia - may be caused by physical and mental conditions, such as depression, or emotional and

psychiatric disorders.

Since insomnia is just a symptom of an underlying disease or an imbalance, evaluating the cause of insomnia is very

important before prescribing any medication.

Depression is the most common cause of chronic insomnia, especially in the elderly.

A study shows that depressed elderly patients, if they suffer from insomnia, have a tendency to be depressed for over a

year.

Another study shows that even without a history of depression, if an elderly patient suffers from insomnia, they have a high

risk of being depressed. This is usually observed in women.

It has been proven that insomnia can affect ones' lifestyle negatively. Once this happens, the person starts to worry.

Worrying, then causes depression.

Depression is an emotional condition characterized by sadness or misery. Although many have experienced this at one

time, clinical depression is a mood disorder characterized by feelings of sadness, anger or frustration affect daily life for an

extended period of time.

Another interesting relationship between depression and disrupted sleep is that some medications used for depression can

cause insomnia. This is because these medications are used to make the patient more energetic, that at times, these make

the patient anxious.

The new anti-depressants that have stimulant effects include Prozac, Paxil, Zoloft and other serotonin-reuptake inhibitors.

Serotonin-reuptake inhibitors are substances that prevent the reabsortion of substances in the kidney. During the

biological elimination process of substances taking place in the kidney, some substances are reabsorbed in the kidneys,

thus, prolonging the effect of such substances.

With the presence of serotonin-reuptake inhibitors, serotonin is not reabsorbed and is continued to be eliminated from the

body.

Serotonin is an important monoamine neurotransmitter that plays a large role in depression, anxiety and bipolar disorders.

Some serotonin is converted by the pineal gland, the pea-sized gland at the center of the brain, into melatonin. Melatonin

is a hormone that helps regulate the sleeping and waking cycles.

In addition to the prescribed medications to treat insomnia, a patient may also practice the following procedures to combat

insomnia.

* Control exposure to caffeine, alcohol and nicotine.

These three substances are known to disrupt one's normal sleeping patterns.

* Maintain regular sleeping time and waking time.

This would help in maintaining the circadian rhythm thus minimizing the effects of fatigue caused y insomnia.

* Regular exercise is good for the body but this shouldn't be done late in the afternoon or early in the evening.

This is because exercise tends to start-up the body. If the body has gained more energy by the end of the day, this can

prevent one from being able to sleep at night.

* Go to be only when about to sleep. Reading or watching TV in bed is discouraged or to be avoided.

When the mind is conditioned that the bed is for sleeping, once one goes to bed, he or she can readily get some sleep.

* Eat meals regularly.

Meal intake affects biological activities due to increased blood blow to the stomach.

These pointers may be helpful in managing conditions associated with insomnia. Still, some situations require sleeppromoting

medications prescribed by a medical specialist.