A very popular topic amongst individuals is sleep. More than 240 women registered for the “Insomnia and other disorders” talk given by Dr. Brandon Miller at a previous Healthy Woman Ladies Night Out. When he asked how many women in the room have had insomnia, almost all of them raised their hand.
Miller pointed out that centuries ago, sleep was thought of in positive terms, as described by Shakespeare and other poets. With the invention of the light bulb in the 19th century giving people longer days, sleep took on more of a negative connotation. He quoted Thomas Edison as saying, “Sleep is a waste of time.” Miller said, “Sleep was seen as an enemy that got in the way of productivity.”
He also said that humans spend one-third of their entire lives sleeping. All mammals, as well as insects, sleep. Unlike humans though, most animals can go to sleep with just half their brain at one time. This makes it possible for dolphins to surface every five minutes to breathe even while sleeping, and for ducks to sleep with one eye open to watch for predators.
He explained that terrestrial animals are able to burrow underground to protect themselves, so their entire brains can go to sleep at once.
Sleep allows humans to rest, heal and learn; it helps the brain to organize important memories, “clears your mind and gets rid of unnecessary info,” Miller said.
Most adults need seven to eight hours of sleep but problems with sleeplessness are very common. Miller said he sees three to four patients a day with insomnia, which causes “impaired daytime function.” People with insomnia have difficulty initiating and/or maintaining sleep or have poor quality sleep.
Miller also said that insomnia is not defined by the number of hours one sleeps as sufficient sleep varies from person to person, but is it the most common sleep complaint. Symptoms include irritability, anxiety, depression, and reduced motivation and energy.
More than half of adults have had it, with twice as many women as men experiencing insomnia. The causes of sleeplessness include stress, financial difficulties, chronic pain, anxiety, depression, medical conditions, mental health problems, neurological disorders and illness. Additional causes are poor sleep habits, shift work, and other sleep disorders including circadian rhythm disorder, restless leg syndrome and sleep apnea.
Besides alcohol, caffeine/chocolate and nicotine/nicotine patches, there are many common drugs that can cause insomnia including decongestants, corticosteroids and antidepressants.
People who suffer from chronic insomnia are at twice the risk of auto accidents and make increased errors. People who sleep five hours or less a night also have a 50 percent increased risk of developing diabetes.
Other consequences of insomnia, he said, are a decrease in mental performance and functioning, inability to accomplish daily tasks, mood disturbances and interpersonal difficulties at home and work.
To cope with sleeplessness, Miller recommended keeping a sleep diary or log in which is noted the times at which one goes to bed, falls asleep, wakes during the night, gets back to sleep, wakes up and gets out of bed in the morning as well as when naps are taken, if any, during the day. The log can help in finding and treating underlying disorders and causes.
Other treatments for insomnia include relaxation therapy (contracting and relaxing muscles from head to toe), and stimulus control (go to bed only when sleepy/using bed only for sleeping).
He stressed that good sleep hygiene is also important. That entails establishing a regular sleep schedule (going to bed and getting up at the same time every day), getting exposure to daytime bright light every day, exercising daily, dealing with worries before bedtime (setting a worry time earlier in the evening to write down everything that is troublesome) and plan for the next day before bedtime. These steps will help alleviate some of the problems and their accompanying stress that keep people awake at night. Removing clocks from the bedroom and using a dimmer light when getting up during the night can also help one get back to sleep.
According to Miller, there are many kinds of medical treatments; some are sedative-hypnotic medications such as benzodiazepines which should never be mixed with alcohol, may cause morning sleepiness and affect driving safety, job performance and decision making. Non-benzodiazepines have fewer side effects, work more on the sleep center of the brain, are short acting, cause less hangover sedation in the morning and can be taken for a longer period of time.
Antihistamines can contain pain relievers, should not be taken every night and have the side effect of daytime sleepiness. Miller said melatonin is a hormone produced by a gland in the brain and it is not helpful to people with insomnia although it may help those with sleep phase syndrome (an internal clock problem). A diet supplement, it is not FDA regulated.
Miller said alternative treatments that have some supporting evidence of helpfulness are acupressure, tai chi and yoga. There is mixed support for acupuncture and L-tryptophan while little support for the usefulness of massage, aromatherapy and herbal medications like valerian.
More information on insomnia, its causes and treatment, can be found at www.sleepfoundation.org.