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June 27, 2006 Middle Park Times |
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Insomnia Can Have A Variety of Reasons |
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As the most recent heat wave swept through Grand County , I found myself tossing and turning at night instead of sleeping. I watched the clock tick each new minute, unable to fall asleep, but I was determined to continue to try and force myself to sleep. The next morning I was tired and groggy, and ready to fall asleep in several meetings during the day (well, more sleepy than usual for a meeting).
Insomnia encompasses not only inability to start or maintain sleep, it also includes having disturbed sleep cycles which lead to daytime fatigue even after sleeping for eight hours. Insomnia is extremely common in our society today -- one out of every three people transiently experience insomnia during their lives, and one out of every ten people have insomnia chronically. There are three types of insomnia: transient, short-term, and chronic. Transient insomnia occurs for less than 1 week, short-term insomnia occurs for 1 to 3 weeks, and chronic insomnia occurs for longer than 1 month. Factors that can put people at a higher risk for insomnia include age (older suffer more than younger), gender (females suffer more than males), lower socioeconomic status, being divorced or widowed, recent stress, depression, drug abuse, and alcohol abuse.
What is sleep? In order to understand problems with sleep, we need to understand what defines “normal” sleep. The answer seems obvious, since we are all so familiar do it, but sleep is not as simple as you might think. Why do we sleep? No one actually knows. Among the many theories are: sleep is allows the mind and body to rest and replenish themselves; sleep lowers metabolism leading to increased life span; sleep may even be a leftover from the days when avoiding detection by predators would be best served by the immobilization that occurs with sleep.
Sleep consists of several different states and phases. The lightest stage of sleep, the one we enter when first falling asleep, is called Stage 1 and accounts for only 2-5% of sleep time. This stage of sleep is not believed to provide any benefits. Stage 2 accounts for most of the time spent in sleep, approximately 45-50%. Again, this stage is not believed to provide any benefits to the individual. Stages 3 and 4 account for 20% of total sleep time and are termed “deep sleep”. These deep-sleep stages are thought to provide the “restorative” effects (e.g. alertness and energy levels) that people experience after normal sleep. The final sleep state is Rapid-Eye-Movement (REM) sleep and accounts for the remaining 25-33% of total sleep time. REM sleep is thought to help the brain form long-term memories and total loss of REM sleep has been shown to result in death in test animals. Normal sleep architecture does not actually occur in the numerical order of stages, but is a comprised of four to five “cycles” that last 90-120 minutes. Each cycle varies depending on when they occur during the total sleep time, with the first cycle going in order from Stage 1 to Stage 4, and the second cycle from Stage 2 or 3 to REM sleep. The last two cycles consist of alternating between Stage 2 and REM sleep.
So, what causes insomnia? There are many causes for transient / short-term and chronic insomnia. Transient and short-term insomnia can be caused by a change in sleeping environment, change in time zones, change in work shifts, excessive noise, uncomfortable room temperature, stressful live events, short-term medical problems, and use of certain medications. Change in sleeping environments (e.g. different bed, different location, etc) is the most common cause for transient insomnia. Change in time zones most frequently occurs with long-distance air travel that crosses multiple time zones within a short period of time (especially from west to east), but can occur with even the shift from daylight savings time. Insomnia can also occur when switching between day- and night-work shifts. Emotional upsets, such as divorce, death of a loved one, job loss, public speaking, or legal troubles can give almost anyone insomnia transiently. Surgery or illness can lead to short-term insomnia that corrects with improved health. Medications and drugs can disrupt the normal sleep architecture leading to insomnia, and include beta-agonists (albuterol, theophylline), beta-blockers (metoprolol, propranolol, pindolol), steroids, thyroxine (Synthroid, Levoxyl), stimulants (cocaine, methylamphetamine, amphetamine, methylphenidate, ephedrine, pseudoephedrine), caffeine (as little as 1-2 cups of coffee a day), tobacco |
(cigarettes, pipes, and snuff), and alcohol (since it blocks deep and REM sleep leading to fatigue after sleep).
Chronic insomnia is usually caused by medical or mental issues. Medical causes of insomnia include heart failure, heart disease / angina, COPD, obstructive sleep apnea, asthma, peptic ulcers, gastric acid reflux, rheumatic diseases, menopause, pregnancy, Lyme disease, AIDS, or chronic fatigue syndrome. Additionally, damage to the brain or chronic pain syndromes can lead to insomnia and are common with strokes, Alzheimer’s disease, Parkinson’s disease, brain tumors, traumatic brain injury, peripheral neuropathy, and headache syndromes. Mental illnesses that can lead to insomnia include post-traumatic stress disorder, schizophrenia, bipolar disorder, depression, and anxiety. There are several diseases that are specific to defects in the sleep architecture and include fatal familial insomnia, narcolepsy, circadian rhythm disorder, sleep state misperception, restless leg syndrome (RLS), periodic limb movements in sleep (PLMS), altitude insomnia, and central sleep apnea.
So, what should you do if you have transient or short-term insomnia? The best approach is to practice proper “sleep hygiene”. Sleep hygiene is the environment and state of mind you practice during the day and just before trying to sleep in order to get to sleep. Typically, medications should not be used to treat transient or short-term insomnia since they do not address the underlying issue, but merely cover it up until the issue is too big to cover up anymore. There are ten easy steps to practice good sleep hygiene and break the cycle of transient or short-term insomnia. They are: 1) sleep only as much as you need to feel rested (e.g. don’t over sleep and avoid daytime naps), 2) keep a regular schedule (same time to bed and time to awake each day), 3) avoid forcing sleep (don’t go to bed until you are tired), 4) exercise regularly for at least 20 minutes each day (preferably 4-5 hours before bedtime), 5) avoid caffeine after lunch (both drinks and foods), 6) avoid alcohol near bedtime (e.g. no nightcaps), 7) avoid tobacco products at night (nicotine is a stimulant), 8) eat enough at dinner to keep you satisfied at bedtime (e.g. don’t go to bed hungry), 9) keep bedroom “sleep-ready”, and 10) deal with worries or other issues before bedtime (e.g., don’t go to bed upset or worried about an issue).
So, what is meant by keeping the bedroom “sleep-ready”? It means to use the bedroom for sleep and sex only. Do not watch T.V., pay bills, talk on the phone, argue with others, or participate in hobbies while in the bedroom. Your mind and body needs to recognize the bedroom as the place for sleep not for other daily activities. Additionally, “sleep-ready” means keeping the bedroom temperature comfortable and the room should be dark during your entire sleep time. Why shouldn’t you drink alcohol before bedtime, since it makes a person feel tired? Alcohol is a depressant and will put you to sleep, but it plays havoc with the normal sleep architecture and prevents deep and REM sleep states, the only two types of sleep states that help you feel rested upon waking. How can you stop worrying about the next day’s activities before you go to bed? The best approach is a “wind-down” period approximately 30 minutes before your bedtime. Some people like to write down a list of issues and plans to deal those issues for the next day, some like to read a short story, some mediate, some like to take a warm bath or listen to music. Whatever it is that relaxes you, make sure that you practice it whenever you are not tired before bedtime. Additional advice for sleep-hygiene includes not lying awake in bed tossing and turning. If you can’t fall asleep within 30 minutes, get up and try to do an activity that is relaxing to you until you are tired. Do not sleep past your normal wake time, even if you started your sleep time late (awake time is critical in giving you a good next night’s sleep). If you are tired even though you do not have trouble falling and staying asleep, then try adding 1-2 hours of sleep each night; chronic sleep deprivation is the most common cause of tiredness in adults and is due a choice by the person to spend less hours asleep then their body and mind needs – usually from lifestyle issues.
If you have chronic insomnia that does not improve with the above suggestions, then please visit your health care provider. You may have a serious underlying medical problem that needs to be addressed before you can return to your normal sleep pattern |