Insomnia, is your sleep restful?

Insomnia is here defined as unsatisfactory sleep. With insomnia there may be slowness to fall asleep, or/and sleep is broken up into short sessions, is broken into less than full cycles, and too early awakening may occur. The broken sleep results in fatigue, unrestedness, and reduced alertness during the day. The condition can occur as a separate complaint without a concurrent physical ailment, or it is the secondary effect of another ailment. However, without seeking completeness, a few physical conditions are referred to that extend insomnia beyond being a single sympton complaint.

A primary chronic insomnia is an obstructive sleep apnea. Firstly, in sleep muscles relax and this includes the muscles controlling the pharynx and epiglottis, and, in some persons, sleep in the supine position causes the epiglottis to fall back and close the airway completely. The automated breathing drive is not adequate to handle the breathing effort required and the anoxia awakens the individual. For these insomniacs, with short night naps, unrestedness, daytime fatigue and sleepiness is their lot. These individuals never get a full cycle of sleep throughout the night. There are five EEG patterns, stages, described for a full cycle.

These individuals are working under reduced mental alertness, with daytime grogginess and fatigue and irritability. Food is a common stress reliever and obesity is part of obstructive sleep apnea syndrome. If you are some one overweight, thats snores perssistantly, and wake up frequently with a loud breath, then get checked out medically. You are encouraged to get help for chronic obstructive sleep apnea. Pain is another cause of sleep interferance, but the management of it is not here discussed. Frequency of urination at night, nocturia, interferes with sleep. Insomnia may occur from excessive fluid intake, water, coffee, tea, liquor, if imbibed untimely will result in nocturia. If polyuria is due to prostatic obstruction, or from polydipsia due to hyperglycemia, then medical attention is required. If lying flat leaves you mildly short of breath and you sleep better sitting consult a doctor.

If with your insomnia you have significant changes in mood, whether elation, worries, or of feeling blue and are low in energy, seek medical counsel for these. Consider whether you need treatment for depression or/and anxiety.

Now let's consider a few vignettes.

I have heard and read that you should turn off the sounds and lights in the bedroom when you go to bed, and I ascribe to it. But, I once read an article on baby sitting, and, this was the setting. A couple with a baby, hire a babysitter, who arrives late and whom the child has not met before, and on arrival the parents hand the child over and give the instruction to place the child in the bed, put off the radio , put out the light and close the door. Compare this to being hijacked, then placed into a dark quiet room and told to go to sleep. This child, no doubt, will have cried itself to sleep.

It begs the question why were lullabys and cradles invented?

There are several relevant observations of note here. I submit that when asleep total blackness and total silence will favor non-arousal from sleep. But, an abrupt drop off of all sounds and lights is not the most efficient way to go to sleep. The mind is not like a motor that can be instantly turned off as by a switch.

I have found falling asleep in church easy, and have had my mind balk at shutting down, when in anticipation of a short night, I went to bed early. And, after a longer series of poor nights it is easy to acquire a negative reaction to your bedroom, and as soon as you get to it your system goes into red alert.

I find the little ear plug speaker, is reasonably inobtrusive to a partner, is helpful to crowd out other thoughts, and with the right choice of material and volume is soporific. My wife reads till she is sleepy.

Are you having enough daytime exercise? A tired body is prerequisite to good sleeping. It may be necessay for you to add a planned exercise program to rest well. Vigorous exercise requires a cool down of many hours to phase out the alertness effect of it. If you are napping too much during daytime inactivity, take a short walk instead of the nap.

In driver education we are warned not to keep our eyes fixed to a point ahead on the road, as this is hypnotizing, and you want to stay awake. With a converse situation were you are wanting to fall asleep, then focusing the mind on a single action, should facilitate shutting it down. Hence, counting sheep to fall aseep is advocated. I tend to lose my concentration, and so the process is too slow for me.

INSOMNIA NOTES:

Pre-bedtime relaxation. Meditation, Yoga, etc. Daytime exercise to the point of tiredness improves sleep. Too much day time napping interferes with good night time sleep. A vigorous workout should precede going to bed by four hours or more. Avoid caffeine and other stimulants from about six hours before bedtime. Be regular about when you go to bed. Use the bedroom only for sleeping and what suits. Warm milk and honey! It is worth a try. Herbals! Worthy of trial. Counting sheep? Start an hour before going to bed.

Treatments: