“I just can’t sleep.” At a conservative estimate, 10 per cent of the population voices this complaint to friends, relatives or busy practitioners. But the condition is seldom taken seriously, especially by those who sleep soundly, and sleeping tablets are prescribed as a temporary panacea.
The sleep requirements of individuals vary, with infants and children sleeping 16 to 20 hours a day, adults (till 60) seven to eight hours and senior citizens approximately six hours. Some people get by on just four hours a day. The deepest and most refreshing kind of sleep diminishes with age, with the result that sleep in people over 60 becomes fragmented, with brief awakenings. A common misconception is that constant daytime drowsiness or early-morning awakening is a part of aging. Actually, older adults sleep less because of an inability to sleep, and not because their sleep requirement is reduced.
Insomnia is present if there is difficulty in falling asleep, frequent or early awakening, daytime drowsiness, inability to function efficiently, absenteeism, inadequate performance, poor concentration and dysfunction in the workplace. Other symptoms are tension headaches, stomach upsets and constant worry about not getting enough sleep. It can be acute or chronic.
Everyone has a normal sleep-wake rhythm, and this may become disturbed with “shift” work, frequent late nights, or travel to different time zones.
Medical conditions like hyperthyroidism, the restless leg syndrome, bronchial asthma and hot flushes (menopause) can disturb sleep. An urinary tract infection or an enlarged prostrate can necessitate frequent trips to the toilet, particularly at night. Pain because of arthritis or a peptic ulcer can keep a person awake.
Many prescription drugs, antidepressants, heart and blood pressure medications, allergy medications, stimulants (Ritalin) and corticosteroids cause insomnia. Some of these medications are prescribed. Others, (like cough suppressants containing pseudoephedrine) are over-the-counter (OTC) medications. Some herbal weight loss products contain thyroid extract, ephedrine or caffeine. They too can keep a person awake. Antihistamines may initially sedate, but they can increase your night-time loo visits.
An alcoholic beverage before bedtime may appear to lead to good sleep, but it produces early awakening and reduces restful sleep.
Caffeine, present in tea, coffee, chocolate and cola, is a stimulant that produces mild exhilaration and prevents sleep. Do not drink coffee or tea after lunch if you find sleeping difficult. Colas have a similar effect.
Nicotine is a central nervous system stimulant found in cigarettes, beedis, chewing tobacco and snuff. Using these products within an hour of bedtime will compromise sleep.
Psychological problems like grief, anxiety, depression and unresolved stress prevent sleep. The unsettled conflicts and images prey on the mind, preventing sleep.
Exercise will contribute to good sleep but only if done 3-4 hours before bedtime. Exercise releases stimulatory chemicals from the leg muscles and it takes 3-4 hours for the chemicals to be removed from the body.
Hunger can keep you awake. So having a light snack with warm milk (which contains the sleep inducer tryptophan) at bedtime is a good idea. A heavy meal on the other hand will make you feel bloated, uncomfortable and may cause acid regurgitation. All this contributes to insomnia.
To tackle insomnia, try correcting all these factors. Exercise regularly for 40 minutes a day and combine it with yoga and meditation. Try to visualise your problems (financial, familial) as images instead of figures. Remove all distractions (computer, television) from the bedroom. If you cannot fall sleep in 30 minutes, get up and read a book. If nothing works, you can go to a sleep laboratory to rule out sleep apnea and do a test called a polysomnography (overnight sleep study). This is expensive and offered only at a few centres.
Popping pills should be the last resort. Many sleeping tablets are addictive and habituating, requiring higher doses for the same effect. They can produce severe allergic reactions, or cause confusion, memory loss and bizarre behaviour. If the insomnia is due to depression, psychiatric help and antidepressants may cure it.
If you’re having trouble falling asleep, wake frequently once you do fall asleep, or wake up earlier than you want to, try acupressure. Just maintain the pressure for a minute on the spirit gate, which is below the little finger at the wrist or the inner gate, which is two-and-a-half finger widths below the wrist at the centre.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org