Insomnia - Sleep Disruption
Insomnia is reported at least once during a lifetime usually for the normal reasons of excitement, stress, consumption of alcohol and coffee and more. Recurring complaints of difficulty to fall asleep, multiple awakenings and a short sleep duration are classified as Chronic Insomnia. A third of the population reports difficulty in falling asleep or multiple awakenings from time to time. Over 50% of the 65 years old and above population reports difficulty in falling asleep or little sleep altogether. The frequency of patients who are treated with sleeping drugs is age dependable, rising with age, and makes about 10%-20% of the general population.
People who suffer from insomnia usually report of one or few of the following symptoms: Difficulty in falling asleep, inconsistent sleep, little sleep, tiredness during the day, fidgeting during the day, and poor concentration and memory.
Insomnia has a lot to do with the disruption of the awakening mechanism and/or a change in the sleep timing mechanism. (Production of Melatonin). Different aetiologies that contributes disruptions in those mechanisms are: stress, high alertness, anxiety and/or feeling down with or without a connection to other chronic illnesses, a change in lifestyle - work, living arrangements, grief and more. In elderly people insomnia is connected to reduced levels of Melatonin, infrequent physical workout, morbidity, chronic illnesses and the intake of different drugs. The group of drugs that is notoriously known to disrupt the sleep mechanism consists of steroids, Beta blockers, statins, pain killers, anti congestion, antidepressant and more. In children and adolescents the disruption of sleep regulation and Melatonin is common.
When the insomnia is disruptive to the daily routine and/or is lasting for over a month it is recommended to seek medical help. The diagnosis procedure will include an inquiry regarding the sleeping routine, a sleeping diary and an actigraph check (mobility meter) and if the doctor suspects pulmonary disease or other different sleep disorders a sleep test in the sleep lab will be conducted. This test will include parameters of breathing, heart rate and position. Today one can also use free apps that are medically recognised (such as SleepAPPnea) to identify sleep apnea and assess its effect on insomnia and quality of sleep.
Quality of sleep is something that can be upgraded in most of those who seek help. It is advised to avoid medicine and upgrade your sleep by cognitive behavioural treatments while maintaining the guidance for right sleeping habits.
Relaxation techniques,hypnosis, Tai Chi, Qigong, acupuncture, maintaining a diet and food supplements such as Melatonin are all known to have a good success in regulating sleep. Sleeping drugs are recommended only when absolutely necessary. It is recommended to use the drugs for a limited time while acquiring non-medical tools to restore a better sleeping routine without drugs.
As mentioned before a good sleeping routine is the aim. it is important to use the bed for sleeping purposes only (and/or sex). If you stay awake it is advised to get out of bed and come back to bed a half an hour later. IT is encouraged to adopt good habits that encourage sleep such as: Getting in and out of bed at regular times preferably towards 11:00 p.m., Keeping a calm quiet environment and a full lights out. 4 hours prior to getting to bed a light physical activity (walking, Tai chi, Qigong and such) for 20-30 minutes. 3 hours prior to getting to bed take a hot shower. 2.5 hours prior to getting to bed have a light meal. A 30 minute relaxation and calming techniques right prior getting into bed would be advised.
During the day it is recommended staying awake as much as possible. Drink nonalcoholic and decaffeinated drinks.
It is important to remember that insomnia is NOT FATE. With the right treatment which is not based on drugs it is possible to help most of those who reach out for help in the long run.
Dr. Naveh Tov MD PhD
Head of Pulmonary unit, Bnei Zion Hospital
Specializes in Internal Medicine, Pulmonary diseases and treats Insomnia for 25 years
Practices acupuncture, studies and teaches Tai Chi and Qigong
Co-developer to different apps to treat insomnia such as: Quit Snoring, Sleep APPnea Aware.
Clinic address: 29 Yigal Alon, Haifa. 12 Ramat Yam, Herzelia. Phone: 04-8268826
Webpage: HYPERLINK "http://www.navehmed.com" www.navehmed.com
Facebook: Dr. Nave Tov - snoring, sleep apnea, insomnia
* Translated by Roni Kalir
This post is also available in: Hebrew