Wednesday, July 14, 2010

10 STEPS TO PEACEFUL BEDTIME By Claire Marketos

10 STEPS TO PEACEFUL BEDTIME
By Claire Marketos

“Sweet dreams, my darling, sleep well, is every parent’s wish for their child. Yet, bedtime can sometimes be a nightmare with youngsters throwing tantrums. If sleep is vital for all of us, why are there so many children who don’t want to go to bed and struggle to fall asleep?

Physical, emotional, and environmental factors all play a part in how easily your child goes to bed and how well she sleeps. You know your child better than anyone else and so it is important to tune into her needs not only at bedtime but during the day as well. Here are some simple guidelines based on what children need to help you make bedtime a pleasure.

DAY TIME AND NIGHT-TIME
In order for your child to develop good sleeping habits, “You must follow the biological forces of sleep. Sleep should happen during night- time hours (the circadian rhythm) and children need to be awake for long enough to be sleepy (homeostatic force),” says Dr. Alison Bentley of The Wits Dial-a- Bed Research Laboratory.

 “It is not fair to insist on a specific bedtime unless your child has been awake long enough for her to get sleepy, emphasizes Dr. Bentley, “You have to take daytime sleep into account.” If your child needs a nap, it should happen early in the afternoon. Toddlers, who fall asleep in the car after 3pm in the afternoon, will not be able to sleep easily at night.

ROUTINE 
 
“The key to getting your child to sleep is consistency, consistency, consistency,” stresses Dr.Irshaad Ebrahim of The Constantia Sleep Centre in Cape Town. “Children of all ages respond to rules and routine, as this provides them with an element of predictability in their life and hence security, and they need this especially when they are tired,” explains Ebrahim. “Bedtime should happen in the same way, at the same time every night, as long as day time naps finish early enough,” Bentley points out.

Children can go to bed later on the weekend and during the holidays, once a bedtime routine has been established, and “both parents clearly and consistently explain that this is a variation from the routine,” stresses Ebrahim. The bedtime ritual you use may vary to the one outlined below. Nevertheless, it should get them to bed calmly and quickly, so that they can sleep for at least 8-12 hours a night.  

When the child begins slowing down and is tired, it is time to start the bedtime routine. Don’t wait too long, otherwise she may get a second wind and then it becomes difficult to get her to sleep. Announce in a firm matter of fact tone, that it’s bedtime. “Time to say goodnight to everyone, brush your teeth, and go to the toilet.” This should take 5-10 minutes. You can make bedtime more fun by telling your child that her favourite teddy is waiting for them to cuddle, or by describing how snug her bed is going to be. A positive tone from you will reassure her that bedtime can be enjoyable.

For the next 10 minutes you can read a story, and your child can have a drink of warm milk. Give her a favourite soft toy or blanket. The bed and its surroundings should be free of any stimulating toys or pictures. Then, sit with your little one and gently stroke her if necessary to help her relax. Do not engage in conversation, say, “We’ll chat tomorrow.” If she keeps chatting say, “Go to sleep now, I’m going to pack things away in the kitchen.” “Make a slight noise,” Ebrahim advises, “to let your child know that you are still there.” Leaving a bathroom light on also makes children feel safe.

If your child comes out of her bedroom, calmly return her to bed. Be firm and reassuring but don’t resort to hitting or shouting, as “this can arouse the child and make them excitable and alert – the exact opposite of what you are trying to achieve,” explains Ebrahim. Sit with her until she is asleep. If you are implementing this routine for the first time, you may have to return your child to bed several times in the first week. Be tenacious, especially if you have to undo bad habits.

REASON
“Why do I have to go to bed now?”
Giving children an explanation of why they need to go to bed helps them to understand the importance of caring for themselves and being healthy. Tell your child: “You are tired. Your body needs to rest so you can grow big and strong, and so you can have lots of energy to play with your friends tomorrow.” Even very young children will listen to your explanation although they may not understand everything you are saying.

Acknowledge their feelings of not wanting to go to bed. “I know you don’t want to go to bed. I know you want to play with your toys. Tomorrow you will have play time again. It is bed time now.” Doing this initially, will relax and reassure your child, and you won’t have to say it every night.

PEACE AND QUIET

In order to sleep well, children need a peaceful environment with positive, calm parents who are in control. Stick to the bedtime routine, and support the parent, who is carrying it out. If you have ideas to make bedtime easier, discuss them with your partner once the children are sleeping. Be creative, and devise a plan together that makes bedtime a joy, rather than a chore.

Stop all stimulating activity including TV, an hour before bedtime, to help your kids calm down. They cannot sleep if they are not calm.

PHYSICAL NEEDS
In order to sleep well, children’s physical needs have to be met. A warm bath and a healthy, sit down dinner, (not in front of the TV), should take place in the hour before bedtime. Avoid sugary and salty foods, or foods which may have colourants and caffeine in them. After dinner, chat, read, or listen to classical music. Rough-and-tumble games with Mom or Dad should take place earlier in the evening.

On the other hand, physical activity during the day is imperative for good rest at night. If your children are sitting in front of the TV all afternoon, they will have more problems falling asleep than if they’ve had a fun day outdoors.
Always check for symptoms of illness which may be preventing your child from resting peacefully. If your child has persistent nightmares and anxiety at bedtime, consult your family doctor, or a child psychologist as there may be underlying issues of which you are not aware.

SECURITY AND SAFETY
You play a significant role in making your child feel safe and secure, which is important if she is to rest peacefully. Be aware of what you say in front of your children, especially when talking about violence. Keep arguments and fights with your partner private where the children can’t hear you. Kids usually blame themselves if there is conflict in the home and may spend many hours at night worrying about how to fix the problem, rather than sleeping.
Talk to your children about concerns they may have, such as the birth of a new sibling, the beginning of a new school year, disputes with friends and exams. Sometimes you may have to initiate chats and bring up topics, even if your child doesn’t tell you what’s bothering her. These conversations should always make the child feel secure. It is counterproductive to create more issues for them to worry about at bedtime.
Take your child’s fears of monsters hiding in her room seriously. Pretend to fight them off “or give them a torch to make them feel a little in control,” recommends Dr. Bentley.

Children should feel comfortable going to bed, so let them help you make their room and bed an inviting sanctuary.

YOUR FEELINGS IMPACT YOUR CHILD’S ABILITY TO SLEEP
“Children are extremely sensitive to their parent’s feelings. They will know from the way you hug them, look at them, and the tone of your voice, how you are feeling.” Ebrahim explains. “If they sense you are anxious, they may cry at bedtime for reassurance. If you allow them to stay up when they cry, they could interpret you actions as caring for them, or that they are not safe in bed. It depends slightly on the emotional situation in which this happens as to how various messages will be interpreted. Not all of the signals from your children relate to how your child is feeling, but how they think you might be feeling as well,”clarifies Ebrahim. 

Give yourself enough time to de-stress before bedtime, and to sit with your child in their bedroom.

MOTIVATION
Having a goal to work towards gives children a sense of accomplishment when they achieve it and it also enhances their self esteem. Find positive ways to motivate your children. Having incentives such as a sticker chart to get them started may help. However, they should learn that sometimes we do things because it is the right thing to do and because it’s good for us. Never reward youngsters with food.

If a child throws a tantrum and resists having to go to bed, understand that she is trying to express her frustration and anger at having to make the change from playtime to bedtime. Acknowledge her feelings with the same exuberance she is expressing them- “You’re cross! You don’t want to go to bed. I understand. Tomorrow you can play again,” while calmly continuing with the bedtime routine.
Praise your children by telling them how proud you are of them when they are successful at bedtime.

LOVE AND COMPASSION
Children need to feel love and acceptance to sleep calmly. Show them patience and compassion when they are tired, and especially if they have been through a life changing experience, such as the birth of a sibling, divorce or death.

During these times, children may need more assurance and attention from you during the day, to help them feel secure at night. In severe cases they may also need play therapy from a professional child psychologist, especially if anxiety persists.  

A child often regresses during difficult times, especially if there is a newborn in the parent’s room, and then it may be necessary for a mattress to be placed in the parent’s room for your older child to sleep on. Give her what she needs and then after several weeks, slowly help her to make the transition back to her own bedroom.

Attention from you is essential for peaceful sleep. If you are away from your child all day, she will want to attach to you from the moment she sees you, and therefore may act out at bedtime to be close to you.
Feelings of guilt should not prevent you from being firm and doing what is best for your child.

FOLLOW YOUR INSTINCTS
Most children who wake at night can be soothed back to sleep quickly. However, Dr Bentley explains “Children who have a very disruptive sleep disorder can wake up to seven times a night and demand either milk or rocking to go back to sleep. This is usually not due to any physical need but rather a behavioural disorder for which you may need professional help.” (See essential signs of seep disorders.)

ESSENTIAL SIGNS OF SLEEP DISORDERS IN CHILDREN:
1. Snoring and associated hyperactivity or sleepiness in the daytime
2. Interrupted breathing while asleep
3. Excessive limb movements in sleep
4. Sleepwalking
5. Sleep/night terrors (not the same as nightmares)
6. Inability to fall asleep, despite adequate parenting

If you feel your child may have a sleep disorder, talk to your general practitioner or paediatrician. 

Chat to your partner and come up with a plan for the middle of the night you both agree on. If junior can climb into your bed without waking you or your partner, it will provide an excellent opportunity for you to all bond and cuddle, especially if you are separated during the day. If you are unable to sleep with junior in your bed, a mattress next to it may be an alternative, or follow the same routine you used at bedtime. Ensure your little one’s room is warm enough. You may want to use a sleeping bag if she kicks her blankets off. Letting her have one of your T-shirts that smells like you to cuddle with can provide solace.

If she has a nightmare or wakes up afraid during the night, gently reassure her that she is safe and that you are there for her. If the nightmares continue speak to your family doctor or a child psychologist. When you say goodnight to your child, remember to always tell her you love her and say: “With a butterfly kiss and a ladybug hug, sleep tight little one like a bug in a rug." A good night to you all.

Useful Contacts: Dr Yacoob Omar Carrim http://zasleep.blogspot.com

Thursday, July 8, 2010

Obstructive Sleep Apnoea (OSA) - SNORING can KILL you

Obstructive Sleep Apnoea (OSA)
Obstructive Sleep Apnoea (OSA) refers to any disorder in which there are breaks or pauses in a person's breathing during sleep. Most people who have OSA also snore, but not all snorers have OSA.. Diagnosing OSA needs to be done in a sleep centre and requires at least one Nocturnal Polysomnogram (PSG), which measures various physiological functions during the stages of sleep. A trained sleep technician monitors the patient continuously during the test. Then, the results are evaluated by a sleep disorder specialist, a diagnosis is made and a treatment plan is proposed.

The most effective means of treating OSA is by Continuous Positive Airway Pressure (CPAP). In this highly effective therapy, a mask is worn over the nose during sleep. Nasal CPAP provides a pressure splint to the upper airway, allowing the person to sleep and breathe normally. The airflow required must be determined through testing during sleep which is done during an overnight PSG.

OSA left untreated is associated with a much poorer long term outcome and increases the risk of cardiovascular, pulmonary and other diseases.

Disruption of sleep caused by frequent interruption of breathing, leading to excessive daytime sleepiness, irritability, memory lapses, inattention, personality changes, poor work performance, increased likelihood of driving and industrial accidents. Dangerously low levels of oxygen can lead to potential heart problems and other health disorders, including: depression, mood changes, memory loss, weight gain, impotency and headaches. Pressure changes in the throat can lead to an irregular heart beat. There is an increased risk of high blood pressure, premature heart disease and stroke.

The Sleep Medicine group of sleep centres provides a fully comprehensive diagnostic and treatment service for patients with OSA including Sleep Studies, Titration, Patient Education and Compliance Monitoring.

Seven-day sleep makeover Written by Hannah Ebelthite, Zest magazine

Getty - Main
We all know what makes for a good night's sleep - sticking to a routine, avoiding stimulants, learning to relax.
But a warm bath, a cup of camomile tea and a sniff of lavender often aren't enough to help us nod off. And unfortunately, next-day grogginess and irritability aren't the only consequences.
Bad quality sleep can suppress your immunity and make you more prone to illness. It may increase your risk of serious illness, too, such as diabetes and cardiovascular disease.
Plus, regularly sleeping fewer than seven hours a night may increase the risk of high blood pressure in women, says a study in the journal Hypertension. And research by the University Of Bristol links sleeplessness with weight gain - the less you slumber, the more appetite-stimulating hormone is released.
But even if you're not troubled by sleeplessness, you may still not be getting the quality of shut-eye you need.
So remedy that now, with our seven-day sleep makeover.

SUNDAY

Do this: keep a sleep diary

Getty - Diary
This will highlight your individual sleep patterns, says clinical hypnotherapist Glenn Harrold, author of Sleep Well Every Night (Orion, £9.99).
'Note the time you went to bed, to sleep, the total time slept, if you woke, what you did, any remedies you took, the last time you ate or drank, and your moods on going to bed and waking. After a week or so, you'll spot the factors that help or hinder your sleep.'

Did you know?

'Research shows that people in the UK get seven and a quarter hours' sleep per night on average,' says sleep expert Dr Neil Stanley of Norfolk And Norwich Hospital.
'But sleep need is like height or shoe size - it's different for everyone. So stop watching the clock and listen to your body instead. If you're alert and happy after six hours, that's fine; if you need nine, that's normal, too.'

Sleep clinic

If you're physically shattered but can't switch off, try spritzing Bach Rescue Night Spray (£8.05, from pharmacies) on your tongue - it's a variation on the classic Rescue Remedy formula, which quietens active minds.
Sunday-night sleeplessness is common, says Dr Stanley. 'It's a combination of not actually needing to go to sleep early, as you've probably had a lie-in and not been particularly active that day, and mental stress caused by thinking ahead to another week of work.'
Harrold suggests the following mindemptying technique: 'Breathe very slowly and deeply in through your nose and out through your mouth for about ten minutes.
'Allow your mind to go blank. Thoughts will still drift into your mind, but don't fight them. Just imagine a computer screen full of data that becomes blank by hitting a keypad. Imagine pressing that keypad, and you'll clear your mind.'

MONDAY

Do this: buy new curtains

Getty - Curtains
'Like most animals, humans are biologically hard-wired to sleep at the onset of darkness,' says Harrold.
'Only when it's dark does your pineal gland release the hormone melatonin, which promotes deep sleep. Even an LED light on an alarm clock or chinks of light under the door are best avoided as you must aim to sleep in complete darkness,' says Harrold.
If you can't eliminate all light, buy an eye mask.

Did you know?

If you haven't exerted yourself during the day, physically and mentally, sleep may elude you at night.
'You lie down and your body says, "what's the point of this? I don't need it",’ says Dr Stanley.
'Research indicates that exercise during the day will help you sleep.' But don’t leave it too late. 'An evening gym session may mean you're too stimulated and hot to sleep well,' he says.
'If you hit the sack at 11pm, say, finish your workout by at least 8pm.'

Sleep clinic

If you fall asleep easily, but wake in the small hours and find it difficult to get back to sleep, then stop trying and do something different. 'Don't just lie there watching the clock,' says Dr Stanley.
'Sometimes just getting up to go to the loo is enough to break the cycle. Or maybe you need to switch on the light and read for ten minutes, or make a drink.'
Just try not to do anything stimulating, such as watching TV. 'The key is to accept you're awake and not to stress out - you'll soon wind down again.'

TUESDAY

Do this: try supplements

Getty - supplements
'B vitamins are essential for sleep and stress relief,' says nutritionist Alice Bradshaw. 'Take a good B complex formula, as the vitamins work best in synergy.'
And if stress and anxiety is the route to your insomnia - or vice versa - try the amino acid L-theanine. 'Studies show it promotes good quality sleep,' says Bradshaw, 'as it's involved in the production of neurotransmitters that have a calming effect akin to meditation.
'Research shows 5-HTP also improves sleep quality.' Try Solgar L-Theanine, £25.85, and 5-HTP, £9.95 (www.solgar-vitamins.co.uk).

Did you know?

Researchers at the University Of Geneva found that people who get a decent quota of sleep perform better in brain and memory function tests.
It's thought sleep helps your brain consolidate experiences and learning, and boosts memory, as connections between nerve cells are strengthened during slumber, which means sleep is vital before an exam or interview.

Sleep clinic

If you're one of the UK’s 15 million snorers, before you reach for the nasal strips and throat sprays, check what type you are.
The British Snoring & Sleep Apnoea Association has a test at www.britishsnoring.co.uk that identifies whether your snoring is caused by an allergy, nose-breathing, mouthbreathing, or is related to your tongue or soft palate. It then recommends appropriate solutions.
In all cases though, avoid alcohol, caffeine and smoking, and lose weight if you need to.
Also, see your doctor - snoring may indicate another, treatable problem, such as nasal polyps.

WEDNESDAY

Do this: de-electrify

Getty - de-electrify
A recent survey by the Sleep Council found that one in three of us makes phone calls or sends texts in bed, while one in five of us goes online, plays computer games or listens to their iPod. But it's definitely not a good idea, says Harrold.
'Studies show that electromagnetic fields (EMFs) from wi-fi, TVs, clock-radios and mobile phones affect sleep patterns in a negative way, stimulating your brain and body as you attempt to rest.'
He advises removing all electrical items from your bedroom with the exception of a daylight-simulating alarm clock (such as the Bodyclock at www.lumie.com).

Did you know?

A study at the University Of Zurich found that using a mobile phone for an hour before sleep increases brain activity, adversely affecting sleep.
'Keep your chats to earlier in the evening, and if you must have your mobile in the room with you, keep it at a distance - not on your bedside table next to your head. Or use a landline phone with a cord,' says Harrold.

Sleep clinic

If you sleep OK but wake up shattered, it may just be sleep inertia - the inability to come round fully after waking.
'For some people, the grogginess lasts minutes,' says Dr Stanley, 'but for others it's up to two hours. Natural daylight and using your body and brain will soon wake you up.'
What about that feeling when you've been dreaming all night and you wake up exhausted? 'The fact is you only remember dreams if you wake during them,' says Dr Stanley.
'So feeling that you have dreamed a lot actually means you've woken several times during the night.'
Dr Stanley also points out that dreams are very real. So if you dreamed you ran a triathlon or were being pursued, for example, your heart rate and breathing would have increased for real - another reason you may feel tired.
'Daytime tiredness may also indicate insomnia - the term refers to sleep quality as well as quantity,' says Dr Irshaad Ebrahim, who is the medical director of the London Sleep Centre.
'You may not always be aware if the sleep you're getting is poor quality. Look to your sleep environment, and ask your partner if you seem restless or noisy during the night.'
Identifying why you feel exhausted is the first step towards solving it.

THURSDAY

Do this: try hypnosis

Getty - try hypnosis
'Hypnosis has a very similar effect on brainwave cycles as sleep,' says Harrold.
'The transition from full consciousness into a hypnotic trance will steadily slow your brainwaves and naturally guide you into a state that's ideal for sleep.' Harrold's book comes with self-hypnosis tips and a hypnosis CD to use before bed or if you wake during the night. Or to find a local practitioner, visit the British Society of Clinical Hypnosis at www.bsch.org.uk.

Did you know?

In a survey by the British Chiropractic Association, about 25 per cent of people blamed their bed for their back pain, and 40 per cent of back pain sufferers said that pain affected their sleep.
Memory foam neck pillows and mattresses such as Tempur (www.tempur.co.uk) relieve pressure on your joints and support the natural curvature of your spine.
In an independent survey, 86 per cent of Tempur customers with back pain said their mattress relieved the pain and gave them a better night's sleep.

Sleep clinic

If you have restless leg syndrome (RLS), you'll experience symptoms such as an itchy, 'crawling' feeling in your legs as bedtime approaches, and involuntary jerking of your legs during sleep that may be enough to disturb your sleep or that of your partner.
'We don't really know what causes this uncomfortable night-time twitching,' says Dr Stanley, 'but if it disrupts your sleep as well as your bedfellow's (who may sustain the odd bruise!), your doctor may be able to prescribe medication for it.'
'Caffeine consumption has been associated with RLS, so avoid it from late afternoon,' says Bradshaw.
Try soporific herbal teas, such as camomile and valerian, instead.
'Magnesium is needed for good muscle function, so supplements may ease symptoms,' she adds.

FRIDAY

Do this: eat right

Getty - eat right
Whether a nightcap or a mug of cocoa is more your style, neither is likely to improve your slumber, says nutrition consultant Ian Marber, founder of The Food Doctor.
'Alcohol may help you get to sleep, but it ultimately disturbs it,' he says.
'Herbal tea or water is better, but remember not to drink too close to bedtime - a full bladder will wake you up later.'
When it comes to food, he suggests similar abstinence.
'You hear about sleep-inducing foods such as turkey, lettuce and carbs, but really the best thing to go to bed on is an empty stomach. You don't need fuel for sleeping and an active digestive system delays deep sleep.
'Try to allow three to four hours between your evening meal and bed.'

Did you know?

In a Sleep Council survey, 41 per cent of us cited lack of sleep as the cause of morning grumpiness. And women feel it more than men - only 14 per cent of us never wake up in a bad mood, compared with 24 per cent of men.
Could that be because 28 per cent of us squeeze in housework between rising and going to work, compared with 5 per cent of men?
'Sleep problems statistically affect both sexes in roughly equal numbers,' says Dr Stanley.
'But in my experience women are more sensitive to and vocal about feeling sleep deprived.'

Sleep clinic

If your sleep is often disturbed by noisy neighbours or traffic, what can you do to lessen your exposure?
'It sounds obvious,' says Dr Stanley, 'but many people "train" themselves to sleep through such disruptions, when it might be more helpful to find ways to eliminate the disruptions.'
So talk to neighbours, fit secondary glazing, wear ear plugs, buy blackout blinds - whatever it takes.

SATURDAY

Do this: stick to your routine

Getty - stick to your
    routine
'Get into the habit of going to bed and rising at the same time, even at weekends,' says Harrold.
'This will help regulate your sleep patterns so you’ll soon become sleepy and wake up naturally at the same time each day.'

Did you know?

A Greek study found that afternoon naps reduce stress levels and your risk of heart attack.
In fact, sleep researcher Dr Sara Mednick, author of Take A Nap! Change Your Life (Workman, £8.99), says a 20 to 90-minute nap before 4pm will increase mental performance and reduce your chance of weight gain by positively affecting your metabolism.

Sleep clinic

If you've tried it all and still can’t sleep, remember that hormones affect body temperature.
'This can result in disturbed sleep at certain times of your cycle, during pregnancy or the menopause. Adjust your environment to remain cool,' says Dr Ebrahim.
'Also, some medication, particularly antidepressants, may affect your sleep, so consult your doctor.'
If you think the cause is medical, ask your GP for help and don't be palmed off with sleeping pills. 
'You can self-refer to a private sleep clinic,' says Dr Ebrahim. 'There, you'll see sleep experts and may spend nights at the clinic for observation.' 
Last updated 15.01.2009
You can contact Dr Yacoob Omar Carrim on zasleep@gmail.com for a direct appointment.

Sunday, July 4, 2010

Is CPAP a Therapy for Type 2 Diabetes?




How Does Apnea Effect Diabetes?

A number of studies demonstrate that between 18 and 36% of Diabetic patients have Sleep Disordered Breathing (Snoring andSleep Apnea). Sleep Disordered Breathing results in intermittent hypoxia and sleep fragmentation, which is a cause of insulin resistance and excessive sympathetic nervous system activity.

Can CPAP Really Lower Glucose Levels?

Researchers from the Scripps Clinic in La JollaCalifornia studied a group of twenty DM patients recently diagnosed with Sleep Apnea. They continually measured BG levels with and without CPAP therapy in a sleep laboratory. The use of CPAP led to an average BG drop from 122mg/dL to 102.9mg/dL (p=0.03).
The findings show that successful CPAP therapy reduces hyperglycemia and stabilizes Blood Glucose during sleep. As a measure of this stability, the median Standard Deviation of sleeping BG markedly decreased from 20 to 13 (p=0.005) after CPAP.

A Call to Screen All Diabetics

As the authors of the study indicate, variability of BG levels is an independent risk factor for mortality and blindness in DM. Much can be gained with effective therapy for Snoring and Sleep Apnea.
CPAP is the most common therapy for SDB. It involves wearing a nasal mask during sleep which is attached by a long flexible hose to a PAP machine. The researchers suggest that physicians screen all DM patients for SDB, and treat SDB as a means of DM management as well as a strategy for disease prevention.

1. Dawson, A. et al. (2008). CPAP Therapy of Obstructive Sleep Apnea in Type 2 Diabetics Improves Glycemic Control During Sleep. Journal of Clinical Sleep Medicine, Vol. 4(6); 538-542.

Saturday, July 3, 2010

voorblad Rapport: As die slaap nie wil kom nie 2010-07-03 12:43

Insomnia - what is Insomnia and why is Insomnia important - what should we do about Insomnia

Insomnia - this remains and justifiably so - one of the top reasons persons seek medical help. This problem is at the best of times resistant to remedies.

Insomnia refers to repeatedly difficulty in falling asleep or staying asleep, waking up too early, and or feeling unrefreshed the following day.  If you have had difficulty falling asleep or had woken repeatedly at night but could function normally the next day, indicates that you have had sufficient appropriate sleep.

You do not have to sleep for eight hours or fit a social norm of sleep. You have to sleep the amount of time that is just right for you. All of us are different.

Some of us believe that we can abuse our sleep patterns by working all day and night - with a minimum of sleep and not get enough sleep. These people will soon realise that sleep is rigid and is madatory for survival. The birds, insects, animals, fish and all that is created needs to sleep - yes this includes all of us - inclusive of man and beast. Dolphins are fortunate to sleep with one brain hemisphere at a time - the other half of the brain remains awake to keep swimming.

The only being that does not have to sleep is God himself - "slumber does not seize him nor sleep" and "there is none like unto him." For us simple  mortals we will have severe problems with every system of our bodies and mind if we deprive ourselves of sleep.

There are those that are short sleepers and require less sleep than average - the function perfectly well on 5 to 6 hours of sleep.  These short sleepers are few and far between. For the average Joe we have to sleep on average 8,15 hours - a SA high school metric student requires 9 hours sleep!

Epidemiology and importance: Insomnia is known to affect 58% of western adults.

People that do not get sufficient appropriate sleep run the risk of having impaired cognition, memory, attention, and ability to plan , execute and follow up. They usually appear more irritable, more aggressive, and develop an underlying anxiety (more than depression). They perform poorly in their daily tasks - in whatever they choose to do. They have more motor vehicle accidents than average. Some suggest they have the same number of accidents as alcoholic drivers - I hope the authorities are reading this.

Definition of Insomnia
Insomnia is defined by time - there are 3 basic types:

  • Transient: Insomnia that lasts for less than a few weeks
  • Intermittent: Recurring transient insomnia
  • Chronic Insomnia: Insomnia that occurs for most nights for more than one month
Insomnia may be classified according to when it causes trouble: Recalling the definition of insomnia we may divide sleep into sleep onset insomnia, sleep maintenance insomnia and early morning awakening.

  • sleep onset insomnia, occurs when a person has trouble falling asleep in the first place
  • sleep maintenance insomnia, when a person wakes up at night and cant go back to sleep and 
  • early morning awakening - waking up too early in the morning. 

One may also get a combination of the above - mixed insomnias.

The time that it takes for the average South African to fall asleep differs - on average it takes people 7 minutes to fall asleep but you may require 20 to 30 minutes to fall asleep. The key question is are you able to function the next day, do you feel restored after sleep.

If you dont feel restored or you cant stand your inability to fall asleep or maintain sleep then its time to seek help from a Sleep Medicine Specialist.

How would I recognise an Insomniac? 
Apart from those with underlying medical and psychiatric problems that need a sufficient appropriate diagnosis by their medical service provider there is a spectrum of Insomniacs -
The first are those that do all the right things to get ready for sleep and feel ready for sleep but just cant fall asleep.

The next are those that have no trouble falling asleep but are parting or working all night - burning the candle on both ends thinking that sleep is for the dead - they are of the mistaken belief that sleep is like a soccer ball that can be kicked about without any implication on their long term health.

There are also those that are being kept awake by the environment - the husband snoring, the wife with the restless moving legs, the sleep talking and sleep walking bed partners, a child with night terrors.  We must never forget the nursing mothers that sacrifice their sleep for the suckling babes in the middle of the night (Breast remains best).

So who gets insomnia?
Anyone can get insomnia but these are the groups that have the highest risk of getting insomnia:

  • Elderly persons - the older you are, the more likely you are to have insomnia. One third of persons greater than 65 have insomnia.
  • Worriers: Those that are prone to anxiety are more likely to have insomnia.
  • Women have a slightly higher incidence of insomnia
  • Psychiatric disorders: those that have psychiatric disease such as anxiety, depression really do need the assistance of a registered psychiatrist.
  • Physical disorders: Pain, heart disease (cardiac disease)
  • Alcohol abuse and drug abuse: Alcohol induces sleep but does not allow you to have the deep stage 3 and 4 slow wave sleep required to restore the body or the REM sleep required to file the information for the day.
  • Certain Jobs - the more repetitive jobs that required less mental engagement had more difficulty falling asleep - as if the brain protests compelling you to use it before it will allow you to rest. If you dont use your brain - it will not allow you to sleep.
Insomnia may be caused by changes in the environment, physical medical causes, and psychological causes.

  • The changes in the environment may be a change in routine, and sudden change in the weather or poor sleeping conditions.  
  • My patients that have illness be it the flu or a serious heart, lung, kidney or stomach problem have worsening insomnia. Those that suffer the most are those with chronic pain conditions. Medication given by homoeopaths and doctors may cause change in the wake sleep cycle. 
  • Changes in hormones - menstruation, pregnancy, menopause and hot flushes really cause havoc in my female patients sleep.
  • Caffeine and smoking: Tea, coffee, coke and dark chocolate are stimulants that keep most patients awake - patients should not consume caffeine 6 hours before bedtime.  You should have your last cigarette four hours or more before you sleep. 

I still wonder how James Bond managed to smoke, have alcohol and still look refreshed.

There are a number of psychological causes for Insomnia :
  • Anxiety
  • Depression
  • Stress
  • Worry about sleep 
SO WHAT SHOULD I DO IF I HAVE INSOMNIA?
  • Don't lie there - get out of bed and do something else - if you are not sleeping you should not be in your bedroom. 
  • Keep a constant schedule: remember dont change your waking time no matter what time you go to bed
  • Exercise early - Do not exercise at night
  • Avoid napping if you an insomniac - remember daytime napping improves performance if you are not an insomniac
  • Sterilise the bedroom: the bedroom must be free of the TV, the Blackberry,the cell phone, the iPhone, Books, the alarm clock - the bedroom is only for sleep and sleeping with your partner.
  • Quit smoking
  • No alcohol
  • No tea, coffee and chocolate
  • Restrict your sleep: if you feel you only sleep 4 hours a night out of the eight hours you lie in bed than restrict your sleep to to the 4 hours that you need - this will improve your sleep efficiency. Use only the time you need to sleep.
  • Reduce environmental distractions.
  • Stop all over the counter supplements and medication for sleep unless prescribed - there is little evidence that using non-prescribed medication works - why waist your money and risk you health with these drugs or supplements - if they are proven not to work. If insomnia remains a problem than contact your health care provider that will direct the treatment at the underlying cause of the insomnia.
Medications of you must:

There are 3 classes of drugs that are approved for the treatment of Insomnia:
  1. The Benzodiazepines - these work in an undirected manor on the brain - and may allow you to have sleepiness the next morning.
  2. The non-benzodiazepines - The "Z" drugs - zolpidem and zaleplon. These act with the benzodiazepine receptor of the brain. Their advantage is the rapid absorption and lack of active metabolites, and low risk for side effects. 
  3. Melatonin - this has some interesting promise when used alone or in combination with the other approved sleep drugs. Melatonin is a naturally occurring hormone that is secreted by the pineal gland and controls the day night cycle in the brain - the circadian rhythm. Melatonin does not put you to sleep, but gets your night time hormones ready for sleep and in the event that you are asleep - makes your sleep more efficient. Please ensure that the melatonin that you buy is from a regulated pharmaceutical manufacturer - that apply the highest standards of quality or you may not be getting the melatonin you paid for as I have come to see with my SA patients.
  4.  Herbal remedies: Although there are very few studies proving the value of herbal treatments - Valerin and Keva are the most commonly promoted herbal remedies.  
MOST EFFECTIVE TREATMENT
Prescription medication with behavioural treatments work best in combination. Cognative Behavioural therapy  appears to be the most effective behavioural therapy. Sleep hygiene is imperative, limiting or controlling stimulus at bedtime. 

Remember Insomnia is not a way of life - you need to seek appropriate medical help from your health care provider. 

Dr Yacoob Omar Carrim
Sleep Medical Specialist 
Zuid Afrikaans Hospital
zasleep@gmail.com
http://zasleep.blogspot.com