“O sleep, O gentle sleep, nature’s soft nurse, how have I frightened thee, that thou no more wilt weigh my eye-lids down and steep my senses in forgetfulness?” — William Shakespeare
One of the most frequent complaints we hear from patients is “I just can’t sleep at night.”
Some statistics on sleep deprivation and insomnia in the United States show nearly 25 percent of the population reporting occasional sleep deprivation, while at least 10 percent report long-term insomnia.
Sleep deprivation is sleepiness experienced by a patient that depends on quantity, quality, and timing of sleep. Importantly, sleep deprivation is voluntary. If a person had enough time to sleep at night, comfortably and uninterrupted, then that person should not be sleep-deprived.
Insomnia is defined as difficulty in initiating or maintaining sleep, or waking up too early with the addition of regular poor-quality sleep. Due to the impaired sleep, daytime activities are significantly affected.
Insomnia is often involuntary, as the patient has the opportunity for adequate sleep.
The causes of insomnia are many. They can be broadly classified into groups depending on the factors that contribute to insomnia.
Medical conditions causing insomnia include pain that keeps one awake at night, urinary frequency, difficulty breathing at night, nighttime coughing, reflux or heartburn and medication side effects.
Psychological conditions include anxiety, increased stress and depression. Lifestyle-related factors that over-stimulate the mind include intake of caffeine, tobacco or alcohol, eating close to bedtime, frequent daytime napping and erratic work schedules or shift work.
Environmental factors include too much light, especially for those working at night, and too much noise.
The causes for insomnia are many. Therefore, treatment depends on the cause.
Medication prescriptions should not be the first or even the second line of treatment for insomnia and sleep deprivation, but unfortunately they often are. Sedating prescription medications are a band-aid or quick fix to a problem that is often caused by an underlying factor. For the best long-term results, it’s best to treat the underlying factor.
In addition to identifying and treating the underlying condition, you might try improving your sleep hygiene.
Avoid stimulants such as caffeine, tobacco, and alcohol in the late afternoon and evenings. Eat your last meal at least two or three hours before bedtime, and don’t go to bed hungry. Avoid late-night snacking. Maintain a regular sleep pattern. Adjust the bedroom environment to allow for quality uninterrupted sleep.
Regular exercise helps improve sleep. The recommended average amount of sleep for adults ranges from seven to nine hours in a 24-hour period, with longer sleep times for children and teenagers.
Other non-pharmacologic methods may include working on relaxation techniques, stimulus control, behavioral therapy and light therapy.
Sedatives of any kind, prescription or over-the-counter, should be used only after underlying problems have been addressed, and if non-pharmacologic methods are ineffective.
Talk with your doctor or healthcare provider to see what’s keeping you awake and if there is an underlying problem that needs to be corrected.
This article was written for general information purposes and is not meant to substitute the personalized care of your doctor. Please see your doctor before making any significant lifestyle or medication changes.
For more information, visit these Web sites:
• Centers for Disease Control and Prevention – www.cdc.gov
• National Sleep Foundation – www.sleepfoundation.org