GET A GOOD NIGHT’S SLEEP
Most people have trouble sleeping some of the time, and some people have trouble sleeping most of the time. Insomnia is clearly a widespread problem.
Body’s need for sleep varies widely from person to person, ranging from as little as four hours to a much as ten.
New- born babies spend up to 18 hours a day asleep and young adults average seven to eight hours, but older people tend to sleep only 5-7 hours at night, often because they take daytime naps. If they insist on climbing into bed at 11pm and satisfy there until 7am, they are apt to spend a lot of hours in bed awake and worrying about it.
The quality as well as quantity of sleep changes with age. Older people spend more of the night in the light sleep and report fewer dreams when they wake up. Their sleep is often fitful and punctuated by frequent awakenings. So much of the insomnia that people battle so hard against is really he normal change in sleep patterns that occurs with age.
Sleeplessness is not usually caused by a dripping tap, a barking dog or a room that’s too hot or too cold. Those are simple things you may notice while lying awake. But no all insomnia is an illusion, of course. Most people suffer temporary periods of sleeplessness resulting from grief, worry, tension, stress, depression or other psychological problems.
Sometimes diseases such as congestive heart failure may result in nocturnal shortness of breath and contribute to sleepless nights. Frequent night time urination because of prostrate enlargement is common among older men.
Irregular bedtimes can result in sleeplessness too. The body becomes “programmed” for sleep at a certain time and resists it at other times. If you go to bed much earlier or later than usual, you may find that your body sticks to the established sleeping routine-waking up early, for example, even if you fell asleep late. Shift workers are common victims of this ype of resistance, as are people who jet across time zones.
Caffeine, a stimulant found in coffee, tea and cola, can cause or aggravate insomnia. Its effects may last up to 7 hours in susceptible individuals. So even a late afternoon coffee break might take its toll. Certain drugs can also ruin a good night’s sleep, including some used to fight depression, and appetite-suppressants prescribed by doctors. Some over- the counter medications such as the decongestants used in cold preparations, are central nervous system stimulants and may contribute to wakeful nights.
Man people turn to pills to get a good night’s sleep, and prescribed soporifics can help the insomniac fall asleep sooner, stay asleep longer or both. But most lose some or all of heir effectiveness after a few weeks of use, an effect known as “tolerance”.
Even if an insomniac realizes that the sleeping pills aren’t helping any longer, its not easy to give them up. Long term use can lead to psychological dependency and increasing the dose can even lead to addiction. Abrupt withdrawal can lead to jitteriness, nervousness and more insomnia.
Ironically, insomniacs may find themselves confronting a new variety of sleeplessness called “drug withdrawal insomnia”. Sleeping pills generally reduce the time spent in dreaming sleep. Their withdrawal triggers, in most people a surge, or “rebound” of dreaming time.
Dreaming becomes intense, sleep often becomes disturbed and nightmares may disrupt sleep further. The patient may then go back on the pills- and the cycle repeats. The drug, at that point is worthless except for staving off withdrawal symptoms.
Some type of sleeping pills are more troublesome than others. Barbiturates are particularly hazardous in large doses. They are used to commit suicides more often than any other chemical agent and have been responsible for accidental deaths when used with alcohol. The barbiturate withdrawal symptom is especially dangerous if the drug has been abused; sudden abstinence that can be fatal.
Barbiturates also tend to depress the breathing center, a serious consideration for people with respiratory difficulties. And barbiturates can interfere with the activity of other drugs including certain heart drugs derived from Digitalis.
Most of the alternative drugs are not much better. Their safety margin is no much wider than barbiturates; they produce tolerance, dependence and withdrawal as often as barbiturates; and an overdose may even harder to treat.
However, two alternatives to barbiturates appear to be more rational choices. Choral hydrate, used more than a century ago, has relatively few side effects and doesn’t disturb sleep patterns as much as barbiturates. Bu tolerance and physical dependence can occur and gastric irritation is common if the pills are taken on an empty stomach.
Another alternatives is flurazepam(dalmane), in a class of drugs called benzodiazepines, which lso includes the minor tranquillizers diazepam(valium) and chlordiazepoxide(librium). They cause fewer changes in the sleep pattern, and their withdrawal symptoms can be milder. The have no effect on respiration in the doses used to promote sleep, but they can depress respiration when used with alcohol.
Some insomniacs prefer alcohol to lull them to sleep. But like most sleeping pills, it effectiveness is short lived and more and more alcohol must be downed as nights go by. Alcohol also reduces the time spent in dreaming during sleep.
A malted milk drink at bedtime is another popular way of trying to beat mild insomnia. It’s certainly safer than alcohol and recent research confirms that it just might work.
Milk, liver, nuts and a few other foods contain enough of amino acid L-tryptophan to have a similar effect. Preliminary studies have shown that in normal sleepers and mild insomniacs L-tryptophan taken as a drug reduces he time it takes to all asleep and lengthens the total sleeping time. But more studies are essential to establish its effectiveness and long term safety.
Whether or not you take sleeping pills or other sleeping aids, experts offer a number of suggestions to help you sleep better:-
- Don’t drink beverages containing caffeine after the middle of afternoon. Caffeine can make it hard to fall asleep.
- Avoid daytime napping, particularly an after dinner snooze. Daytime sleep can cut down on sleeping time at night.
- Take exercise everyday. Physical activity can be conductive to longer, deeper sleep. Sexual activity can be an effective soporific for some people.
- Establish a routine including a regular time to go to bed and to wake up. Once the body “programmed” into a daily sleep-wake cycle, sleep is easier to attain.
- Establish a regular bedtime ritual for the hour or two before retiring such as taking a warm bath, reading in bed or anything else you find relaxing.
- If you’re not sleepy, get out of bed. Tossing and turning and worrying about falling asleep can only make our insomnia worse.
- If insomnia lasts for several weeks and doesnt respond to these measures, consult a doctor.
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