Sleep is a naturally recurring state characterized by reduced or absent consciousness. It is observed in all mammals, all birds, and many reptiles, amphibians, and fish. The purposes and mechanisms of sleep are only partially clear and are the subject of intense research.
Sleeplessness or insomnia is often a symptom of several physical and mental disorders. It is characterized by persistent difficulty falling asleep and staying asleep. Insomnia often causes functional impairment.
There are different types of insomnia. One classification is as transient, acute, or chronic.
Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired performance – are similar to those of sleep deprivation.
Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function.
Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include fatigue of body and mind.
In many cases, insomnia is a symptom of another disorder, or side-effects from medications, or a psychological problem. Consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders by the British Association for Psychopharmacology says: “Approximately half of all diagnosed insomnia is related to psychiatric disorders.”
Non-pharmacological strategies are superior to hypnotic or sleep inducing medication for insomnia because these medicines becomes less and less effective as the individual continues to take them. In addition, dependence or addiction can develop with rebound withdrawal symptoms developing upon discontinuation. Hypnotic medication is therefore only recommended for short-term use, especially in acute or chronic insomnia. Non pharmacological strategies however, have long lasting improvements to insomnia and are recommended as a first line and long term strategy of managing insomnia. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions, sleep-restriction therapy, patient education and relaxation therapy.
Stimulus control therapy is a treatment for patients who have conditioned themselves to associate the bed, or sleep in general, with a negative response. As stimulus control therapy involves taking steps to control the sleep environment, it is sometimes referred interchangeably with the concept of sleep hygiene.
Cognitive therapy for insomnia
A recent study found that Cognitive Therapy for Insomnia is more effective than hypnotic medications in controlling insomnia. In this therapy, patients are taught improved sleep habits and relieved of counter-productive assumptions about sleep. Common misconceptions and expectations that can be modified include:
(1) Unrealistic sleep expectations (e.g., I need to have 8 hours of sleep each night)
(2) Misconceptions about insomnia causes (e.g., I have a chemical imbalance causing my insomnia)
(3) Exaggerating the consequences of insomnia (e.g., I cannot do anything after a bad night's sleep)
(4) Performance anxiety after trying for so long to have a good night's sleep by controlling the sleep process.
Observe fifteen-point sleep hygiene
- Fix a bedtime and an awakening time. Do not be one of those people who frequently change bedtime and awakening time. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
- Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
- Avoid alcohol. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.
- Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate.
- Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
- Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.
- Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Make sure this is not a source of your problem.
- Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.
- Block out all distracting noise, and eliminate as much light as possible.
- Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.
- Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
- Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
- Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
- Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
- Get into your favorite sleeping position. If you don't fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.
Sleeplessness and Television Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. At the appropriate bedtime, the TV should be turned off and the person should go to bed. Some people find that the radio helps them go to sleep.