We regularly see patients who are having issues sleeping and it can be intensely frustrating and upsetting if you are having difficulty getting off to sleep (insomnia).
Sleep is complex thing and there are many reasons why somebody may be suffering with insomnia. In this piece we will try to go through a few of them and hopefully come up with a few solutions you may not have thought of, or indeed new ways to approach an old problem.
The basics of sleep
There are 3 parts to sleeping and we tend to cycle through these three parts 3-4 times each night. Quiet sleep, REM sleep & short waking periods. The middle part is REM sleep and this is when dreaming occurs. We usually don’t remember our ‘wake’ periods unless they last longer than a couple of minutes.
Every night, we have about 4-5 periods of quiet sleep and these alternate with 4-5 periods of REM sleep. The short ‘wake’ periods occur every 2 hours or so and increase in frequency the closer one gets to waking up.
This is a useful graphic, with thanks to patient.co.uk:
‘I can’t sleep doctor…..’
We are all different and some us like 10 hours sleep and some of us can’t sleep beyond 6 hours!
‘I can’t sleep’ can mean a number of things. It could mean difficulty getting off to sleep, waking during the night or too early in the morning or not feeling rested and refreshed after a night’s sleep.
Not sleeping well can lead to irritability, low mood, poor work performance, poor general concentration or a poor outlook on life.
What are the causes of insomnia?
- Medical conditions such as sleep apnoea, restless legs, indigestion, hot flushes or depression. These are usually best treated by going to your GP. Occasionally you may need investigations or treatments for these. On occasion, no medical cause for insomnia may be found.
- Medications. Sometimes it can take your body time to adjust to a new medication and your sleep may suffer for a few days as a result. Steroids, anti-depressants, medicines that contain caffeine or beta-blockers (used for certain heart conditions mainly) may affect your sleep.
- Depression & anxiety are common psychological issues that can affect your sleep.
- Stress is a huge cause of insomnia and may be related to family issues, work problems etc and often sleep will not recover until the root problem is addressed.
- Transient issues such as jet lag, a new baby in the house, a new bed, a new bedroom or a lack of heating can affect your sleep.
- Noise from the street, from inside your house, from a partner (snoring!!) or a neighbour can contribute to insomnia.
- Stimulants, legal and illegal such as caffeine, alcohol, nicotine or ecstasy, cocaine and ‘legal highs’ will affect your sleep.
- Screen time, i.e spending too much time on your tablet, computer, games console or phone.
What can I do for myself?
If you feel you have a medical condition that is affecting sleep, or we have given you a medication that may be causing insomnia, it is worth talking to us.
Handling stress, reducing screen time, reducing caffeine intake and going to bed on time are practical ways to intervene. Exercise can also help, as can ensuring that your bedroom is a quiet, comfortable place with minimal ambient noise from elsewhere in the house.
Should I take a sleeping tablet?
Occasionally we will advise this for you for up to a week to help get your sleep back in tune. We may also recommend it for lifestyle reasons-exam stress, upcoming wedding, fear of flying, recent bereavement, etc.
There are significant risks associated with taking sleeping tablets, however.
They are addictive, you can build a tolerance to them quite quickly and they are largely only designed to be used for a short period. Stopping them may lead to withdrawal symptoms.
Insomnia is a complex issue and before you talk to your GP it is worth considering what you can do for yourself first of all. Sleeping tablets are not always the answer and the commonest causes we see are usually stress and lifestyle related. If you would like to talk to one of the team about insomnia or think you have a medical issue that is affecting your sleep you can of course call us on 01-8461335 or 01-8038881 for an appointment, or you can e-mail us on firstname.lastname@example.org.
This post was prepared by Dr. Niall