| Do you get a good night sleep? Tips to obtain a refreshing sleep Navin Jain, MD, Sleep Specialist (Published in Healthy Living 2006) You went to bed at ten o’clock at night and now it's three o'clock in the morning, and you can't sleep. You stare at the clock, aware that the alarm will go off in a few hours, but you just can't sleep. You know you have a busy day ahead and need to be rested, but you can't sleep. No matter how hard you try, you can't sleep. Or, you become very anxious when you are ready to go to bed becuase you know that you won’t be able to get a good sleep similar to poor sleep on other nights. You also start thinking about what happened during the day and what you have to do next day. You look at the clock and are upset that night is almost over and you haven’t fallen asleep. If you fit in one of these patterns, you may have INSOMNIA. Insomnia is the inability to initiate sleep and/or maintain sleep resluting in inadequate or poor quality sleep, and feeling of tiredness, lethargy during awake hours. Final awakening that occurs much earlier than desired time (waking up consistently at 4 AM while you would like to wake up at 7 AM) is also a type of insomnia. Sleep is a basic necessity of life. It is as important to our health and well-being as are air, food and water. When we sleep well, we wake up feeling refreshed, alert and ready to face daily challenges. Insomnia is inability to initiate sleep and/or maintain sleep resluting in experience of inadequate or poor quality sleep and feeling of tiredness, lethargy during awake hours. Most insomniacs have poor quality sleep, and do not feel refreshed after sleeping. Persistent insomnia has a major negative effect on feeling of well being. One has a sense of fatigue during awake hours, a poor mood, anxiety, stress, less vigor, poor concentration, and less ability to complete tasks. They have greater tendency to suffer work related or traffic accidents. Many individuals with insmonia also have a higher tendency to develop depression, including a major depressive episode. A recent epidemiologic data analysis suggested individuals with reduced total sleep time < 5 hours were more obese as compared to individuals who were getting 7-8 hours of sleep every night. One possible mechanism involve suppression of leptin due to sleep deprivation, and this in turn prevent suppression of apetite and hence weight gain and obesity. According to the National Institutes of Health, insomnia affects more than 70 million Americans at some point in their life. Direct costs of insomnia, which include dollars spent on insomnia treatment, healthcare services, hospital and nursing home care, are estimated at nearly $14 billion annually. Indirect costs such as work loss, property damage from accidents and transportation to and from healthcare providers, are estimated to be $28 billion. For a long time it was thoght that Insomnia is a manifestation of underlying disorder, but current research indicates that Insomnia may be a disorder by itself. Insomnia may be caused by other medical conditions (pain, acid reflux and heartburn, restless legs syndrome, asthma and emphysema, certain medications, withdrawl from some medications). Once insomnia begins, certain situations and habits may perpetuate it. Fortunately, there are many things you can do to improve your sleep. The first step requires some detective work. You'll need to examine your diet, exercise patterns, sleeping environment, personal habits, lifestyle and current concerns. As you begin to see the connection between them, you can develop your own good sleep plan. Keep in mind that good sleep doesn't always just happen. If you've been sleeping poorly for some time, you may have fallen into some bad sleep habits that reinforce your problem. Here are some tips to help you sleep better if you suffer from Insmonia: At night: · Establish a regular bedtime routine and a regular sleep-wake schedule. That means getting up at the same time every day of the week irrespective of the time you went to bed, and not sleeping in late on weekends or your days off. Do not stay in bed to make- up for lost sleep or beyond your regular wakeup time · Don't spend too much time in bed. Your time in bed should be about the same as the amount of time you can actually sleep during the night. You can't force yourself to sleep by spending more time in bed. Go to bed only if you are sleepy. · If you can’t fall sleep within 20-30 minutes after going to bed, get out of bed and do something (reading), but do not stay in bed and try to force yourself to go to sleep. · Do not read or watch television while laying in bed. Use your bed for purpose of sleeping and sex only. · Do not eat a heavy meal before bed time. This may cause heartburn and indigestion, and may lead to sleep disturbance. · Do not drink too much liquids before bedtime, as this may interrupt sleep because you may have to go bathroom. · Create a sleep-promoting environment that is quiet, dark, cool and comfortable. Avoid sources of noise to help promote sleep. Consider ear plugs, heavy curtains, rugs, or soft music to help with noise if necessary. Mattress quality may affect your sleep quality as well. · Do not keep the bedroom temperature too hot. · Keep your clock away from you. In fact, you should set your alarm and then hide the clock so that you are not looking at it several times during the night and developing anxiety about diffciulty in falling asleep. During the Day · That afternoon cup of coffee seems like a good idea at the time. The same drink can prove an enemy of restful sleep. Coffee contains caffeine, as do many teas, chocolate and cola drinks. Caffeine is a stimulant, which means it has an alerting or wake-up effect. For some people, a small amount of caffeine early in the day can cause problems falling asleep ten to twelve hours later. It is best to avoid caffeine-containing drinks and foods within six hours of bedtime. Nicotine is a stimulant as well and should be avoided for several hours before going to sleep. · Dinnertime wine may be a fitting celebration but may be a reason for poor sleep. Alcohol is often thought of as a sedative: a calming drug. However, while alcohol may speed the beginning of sleep, it actually increases the number of times you awaken in the later half of the night. If your sleep isn't restful, alcohol (beer, wine, hard liquor) may be the cause. Skip the nightcap and see if your sleep improves. · Exercise, but not within three hours before bedtime. · Avoid naps, particularly in the late afternoon or evening. · Strong light similar to sunlight is the most powerful regulator of our biological clock and promotes wakefulness. The biological clock influences when we feel sleepy and when we are alert. During sleep, bright lights can disturb your sleep. Keep your bedroom dark (consider light-blocking shades, lined drapes, even an eye mask) so light doesn't interfere with your passage to slumber. There are several treatment options available for insomnia, ranging from self therapy to behavioral therapy to the use of prescription medicines, or a combination of the therapeutic options. Behavioral therapy includes Stimulus Control, Sleep Restriction and Cognitive therapy. Stimulus control trains people to use their bed and bedroom for sleep and sex only. Persons with insomnia are encouraged to go another room and engage in a relaxing activity until they are sleepy and ready to return to bed. Sleep restriction therapy limits the time individual spends in the bed, and helps makes that time as efficient as possible for sleep. Cognitive therapy (CBT) is conducted with a therapist who helps the patient with attitudes and beliefs that may contribute to poor sleep. Cognitive and behavioral therapy is as important as medications and is probably preferred treatment for chronic insomnia. According to Dr. Edward Stepanski, director of Sleep Disorders Center at Rush University Medical Center in Chicago, there aren’t enough people trained to do CBT. An online version of cognitive and bahavioral therapy for insomnia is available at http://cbtforinsomnia.com/ . This is six week self guided program in which participants can access for upto two years after signing up, and costs $35.00. There are several over the counter (inclding Melatonin, Tylenol PM) and prescription medications (Restoril, Desyrel, Halcion, Ambien, Sonata, Lunesta) that promote sleep. Most medications are recommended to be used for short periods only. There is some concern that one may develop dependence on these drugs if used for prolonged periods. However, newer hypnotics have been shown to have less dependence likelihood, and can be taken for prolonged periods (6 months – 1 year) if needed. Medications are probably best used when you suffer from insomnia for short periods. If your sleep problem persists, there may be an underlying cause that can be successfully treated or controlled once properly diagnosed. Contact your physician or sleep disorder specialist in your area. If you suffer from Insomnia, you may be eligible to participate in a clinical research trial currently being done at St. Vincent Mercy Sleep Disorders Center. You may call 419-251-0591 for further information. You may want to get more information on insomnia from web site sponsored by American Academy of Sleep Medicine: www. SleepEducation.com. Any sleep related questions can be directed to him by e-mail at toledosleepdoc@gmail.com. Tips for Helping Insmoniac to a Good Night's Sleep · Just Say No...to Caffeine, Nicotine and Alcohol? · Establish Regular Wake Up Time (same time even on weekends) · Do not spend excessive time in the bed · Avoid excessive food or drink before bedtime · Keep room temperature cooler · Avoid sternuous exercise before bedtime · Avoid exposure to bright light for several hours before bedtime · Reclaiming your bed for sleep only · Avoid Naps |
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