Insomnia and other sleep disorders are common problems that patients present to their doctors.
Sleeping pills are usually not the best solution.
They sedate the brain and by doing so may increase our risk for accidents including falls.
This is particularly risky in the elderly who happen to be the group that is prescribed the most sleeping pills. Sedation may persist into the morning, impairing our judgment and alertness at home, at work and on the road.
The regular use of sleeping pills may result in dependence (when your brain requires a pill every night to fall asleep) and tolerance (when the same dose no longer works and you have to switch to a stronger medication).
Instead, you and your doctor could think of sleeping difficulties as a symptom - a marker for a more significant problem. Together you can treat the underlying cause.
Early insomnia - or difficulty falling asleep - can be due to anxiety, stress or stimulants. Avoid exciting activities (i.e. vigorous exercise and arguments) just before bedtime along with caffeinated drinks.
Reduce unnecessary stress and adopt strategies to manage anxiety during the day. These might include meditation, selfreflection, debriefing with your friends or professional counselling. Moderate exercise earlier in the day is
often helpful.
Middle and late insomnia, such as early morning awakening can sometimes be a symptom of depression. If you are having persistent symptoms, don't hesitate to talk to your doctor. Some medical conditions can interrupt your sleep.
These include bladder problems (such as enlargement of the prostate), congestive heart failure (when individuals feel more short of breath when lying flat) and asthma (wheezing or bronchos pasm that is often worse at night or in the early morning).
Nocturnal symptoms suggest that something more is needed to adequately control the underlying condition.
Nonrestorative sleep can be a sign of a respiratory problem, including obstructive sleep apnea.
If you have significant daytime sleepiness, talk to your doctor. The diagnosis can be confirmed with noninvasive tests.
When doctors talk about sleep hygiene, they don't mean clean pajamas, fresh sheets, brushing your teeth and flossing but rather healthy bedtime rituals.
These include dedicating the bedroom to sleep rather than video games, television and computer work. Reading is fine if it helps your mind to wind down. Avoid big meals, caffeine, alcohol and exercise close to bedtime.
Though many think a nightcap helps their sleep, alcohol is a dirty, twofaced drug. It first sedates the brain (making you feel you can fall asleep right away) and later stimulates (waking you up in the middle of the night). It can contribute to both depressive and anxious feelings.
We now recognize that many sleep problems are related to circadian rhythm disorders. Our brain's daily rhythm can be out of sync with our environment.
Normally, bright light stimulates our brains to be more alert during the daytime and the darkness of night is a signal for sleep.
Shift workers often have difficulty working nights and getting enough sleep during the day.
They need to establish their own winding down rituals soon after the
end of their workdays, putting up thick curtains in their bedrooms to block the daylight and reducing noise during the day.
Exposure to plenty of light for at least 30 minutes after rising can wake up the brain. Consider melatonin to reset your internal clock after discussing it with your doctor.
It seems to work best if taken three to five hours before bedtime.
Sufficient refreshing sleep is an important aspect of your wellbeing, essential for functioning well in all the important areas of your life, and a marker of good health.
Dr. Davidicus Wong is a physician and writer. His Healthwise column appears regularly in this paper. He also posts at davidicuswong.wordpress.com.
