Insomnia
Sleep is something that most people take for granted. It is not something we give much thought to, unless we cannot sleep, and then it can become a big problem. It is quite likely that most people will have difficulty sleeping at some time in their lives.
The problem may not last very long. It may be the result of worry or excitement, and after a short time we return to our normal sleeping patterns. We need sleep to keep healthy in body and mind. If we don’t get enough sleep, we can become ill.
What is sleep?
There are two recognisable types of sleeping:
Rapid Eye Movement (REM) sleep
Rapid eye movement (REM) sleep is the stage of sleep characterized by rapid movements of the eyes. During this stage, the activity of the brain is quite similar to that during waking hours. Most of the vividly recalled dreams occur during REM sleep. It is the lightest form of sleep, and people awakened during REM usually feel alert and refreshed. REM sleep is so physiologically different from the other phases of sleep that the others are collectively referred to as non-REM sleep.
During a night of sleep, a person usually has about four or five periods of REM sleep, which are quite short at the beginning of the night and longer at the end. It is common to wake for a short time at the end of a REM phase. The total time of REM sleep per night is about 90-120 minutes for an adult. However, the relative amount of REM sleep varies considerably with age. A newborn baby spends more than 80% of total sleep time in REM mode, while people over 70 years old spend less than 10%.
Non-REM sleep
During this stage of sleep, the brain is less active, but you may move around more. During this stage of sleep you physically recover from the previous day’s activity, and hormones are released to enable this. There are four recognised phases of non-REM sleep:
- Relaxation of muscles, slower heartbeat and reduction in body temperature. This is the precursor to light sleep.
- In light sleep we can still be woken easily without any feelings of disorientation.
- In ‘slow-wave’ sleep blood pressure falls. During this phase some people may talk in their sleep.
- Deep ‘slow-wave’ sleep is the fourth phase in which we are difficult to wake. If we are disturbed and woken in this phase, we become confused and disoriented.
We alter from REM to non-REM sleep about five times throughout the night, with dreaming occurring more toward the morning.
During a normal night, we may also have short periods of waking. These last just a few minutes and happen every couple of hours. We don’t always realise this is happening. We are more likely to remember being awake if we feel anxious or there is something else disturbing our sleep, for example noises outside. These periods of being awake often feel much longer than they really are. So it's easy to feel that we are not sleeping as much as we actually are.
How much sleep do we need?
The amount of sleep we need mainly depends on how old we are.
- Babies sleep for about 16-18 hours each day.
- Older children require 9 or 10 hours a night.
- Most adults need around 7-8 hours sleep each night.
- Older people need the same amount of sleep, but will often only have one period of deep sleep during the night, usually in the first 3 or 4 hours, after which they wake more easily. We also tend to dream less as we get older.
There are also differences between people of the similar ages. Most of us need 7-8 hours a night, but a few people can get by with only 3-4 hours a night. There is normally no benefit in sleeping more than 7-8 hours each night.
What if I don't sleep?
It's easy to worry when you can't sleep. The occasional night without sleep will make you feel tired the next day, but it won't harm your physical or mental health.
However, after several nights without good sleep, we start to find that:
- we feel tired all the time
- we ‘nod off’ during the day
- we find it difficult to concentrate
- we find it hard to make decisions
- we start to feel depressed.
This can be very dangerous if we are driving or operating heavy machinery. Many deaths are caused each year by people falling asleep while driving.
Lack of sleep may also make us more vulnerable to high blood pressure, obesity and diabetes.
Sleep problems in adult life
Sleeping too little (Insomnia)
You feel that you are not getting enough sleep or you don't get a good night's rest. There are many simple reasons for not sleeping well such as noise, or the temperature of your bedroom is too hot or cold. There can be more serious causes, however
- emotional problems
- difficulties at work
- anxiety and worry
- depression - you may wake very early in the morning and not be able to get back to sleep
- thinking over and over about day to day problems.
Can medication help?
People have used sleeping tablets for many years, but we now know that they:
- don't work for very long.
- don’t provide the right kind of sleep so they leave you tired and irritable the next day.
- lose their effect quite quickly, so you have to take more and more to get the same effect.
- may cause addiction. The longer you take sleeping tablets, the more likely you are to become physically or psychologically dependent on them.
- there are some newer sleeping tablets (Zolpidem, Zalpelon and Zopiclone), but these seem to have many of the same drawbacks as the older drugs, such as Nitrazepam, Temazepam and Diazepam.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, you should only change your medication after discussing it with your doctor.
In some cases, antidepressant tablets may be helpful.
Over the counter medication
You can buy remedies at your chemist, without the need for a prescription. These products may contain an anti-histamineas found in medicines for hay-fever, coughs and colds. These can work but they may make you sleepy during the following day If you use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - your body gets used to the medication, so you need to take more and more to get the same effect. Consult your doctor before taking any medication for a long time, especially if you are taking any other types of medication. Never take complementary or herbal medicines if you are already taking prescription medecines without consulting your doctor.
Psychological Treatments
Cognitive Behavioural Therapy (CBT) has been shown to be helpful. It involves looking at unhelpful ways of thinking that can make you more anxious, and so interfere with your sleep. Find out more about CBT and the forms of treatment and self-help programs available.
Practising ‘ Sleep Hygiene’ – by which we mean ensuring that your evening routine is conducive to sleep – and ways to relax and clear your mind are also very helpful to some people.
Shift Work and Parenthood
You may have to work at night and stay awake when you would normally be asleep. If you only have to do this from time to time, it can be quite easy to adjust. It is much more difficult if you have to do this more often. Shift workers, doctors and nurses working all night, or nursing mothers may all have this problem. They find themselves sleeping at times when they ought to be awake. This is similar to jet lag, where rapid travel between time zones means that you find yourself awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early, at the same time every morning. It doesn't matter how late you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
Sleeping too much
You may find that you often fall asleep during the day at times when you want to stay awake. The commonest reason is not getting enough sleep at night. However, you may find that you are still falling asleep in the daytime even after a week or two of getting enough sleep at night. Sometimes, a physical illness can be responsible - diabetes, a viral infection, or a thyroid problem. There are other conditions which make people sleep too much:
Narcolepsy (Daytime sleepiness)
There are two main symptoms:
- you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
- you suddenly lose control of your muscles and collapse when you are angry, laughing or excited - this is called cataplexy.
You may also find that you:
- can't speak or move when falling asleep or waking up - (Sleep Paralysis)
- hear odd sounds or see dream-like images (Hallucinations)
- "run on auto-pilot" - you have done things, but can't remember doing them,
- wake with hot flushes during the night.
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin. Treatment consists of taking regular exercise and having a regular night time routine. Depending on the pattern of your symptoms, medication may be helpful - an antidepressant or a drug which increases wakefulness, such as Modafinil.
Sleep Apnoea (Interrupted Sleep)
You snore loudly and stop breathing for short periods during the night. This happens because the upper part of your airway closes. Every time you stop breathing, you wake suddenly and your body or arms and legs may jerk. You are awake just for a short time before falling off to sleep again. This often happens several times during the night. So, you feel tired the next day, often with an irresistible urge to go to sleep. You may also have a dry mouth and a headache when you wake up in the morning. It is more common in:
- older people
- the overweight
- smokers
- those who drink a lot of alcohol.
Sometimes, the problem is noticed more by their partner than by the sufferer. Treatment usually involves correcting the parts of your lifestyle that may be making the problem worse - cutting down smoking and drinking, losing weight, and sleeping in a different position. If your apnoea is very bad, it may be necessary to wear a Continuous Positive Airway Pressure (CPAP) mask. This fits over your nose and supplies high pressure air to keep your airway open.
Self help organisations:
The Sleep Council
www.sleepcouncil.com;
tel: 01756 791089.
Promotes the benefits of sleeping well. Provides information leaflets on
sleep and beds.
British Snoring and Sleep Apnoea Association
2nd Floor Suite, 52 Albert Road North, Reigate, Surrey RH2 9EL
www.britishsnoring.co.uk;
tel: 01732 245638; e-mail: info@britishsnoring.co.uk
Helps snorers and their sleeping partners worldwide.
National Sleep Foundation
www.sleepfoundation.org
American website with information on sleep and sleep disorders
Narcolepsy Association UK (UKAN)
UKAN, 50 Culvert Street, Newent GL18 1A
www.narcolepsy.org.uk;
tel: 0845 4500 394; e-mail:info@narcolepsy.org.uk
Promotes the interests of people with narcolepsy and encourages better
understanding of the illness.