Sleep Disturbance

 

In my last article I wrote about the subject of sleep deprivation and whilst many people do not readily recognise this problem, those that have disturbed sleep are instantly aware of it and its effects on their health.

A natural sleep patten for an adult is usually 7-8 hours sleep waking naturally and remembering some parts of their last dream. As the depth of sleep varies it may not be unusual to have a short period of wakefulness in the night but this will normally only last for minutes.

Factors known to improve sleep are physical exertion during the day, the practice of sleep hygiene allowing the mind to relax before sleep, and freedom from unsolved problems. A carbohydrate meal containing pasta, rice or potatoes in the evening also helps sleep as does an active sex life.

Disturbance of sleep is caused by a number of problems which can be classed as physical, emotional and a range of stimulants and environmental factors.

A common physical cause of disturbed sleep is pain. Often neck and back pain caused by nerve compression are tolerable during a busy day but the increased tension placed on the nerves becomes apparent at night. We as doctors often see people with back pain and neck pain, often associated with poor sleep. Neck pain in particular is often associated with the increased use of computers at work and poor sleeping positions. The use of medications and physiotherapy and attention to the work environment helps with these problems.

Pain is often caused by arthritic joints that have been used during the day and again medications and physiotherapy can help, in severe cases surgery and joint replacement can remove pain and aid sleep

Men as they get older often have disturbed sleep caused by the need to pass urine, this is usually due to the natural prostatic enlargement that comes with age. In general this should not occur before a man is in his late 50’s. It is however wise to check the size of the prostate and perform a chemical test for cancer on all men over 50 and certainly on those under 55 that have the need to pass water at night. An active sex life and the oil present in pumpkin seeds helps to maintain a healthy prostate gland. Such problems are not so common in women but can be associated with gynaecological conditions so help should be sought.

Emotional problems cause by far the greatest number of sleep problems that we as doctors see in our clinics. In general two patterns exist. Firstly there is the problem of insomnia - the inability to go to sleep, whilst this can be caused by a range of stimulants which should be excluded, it is usually caused by the effects of ongoing emotional problems that remain unsolved and whilst suppressed during the day enter our consciousness just before sleep and then keep us awake. Physical exercise can help with this problem so we are physically tired when we go to bed but more important is to try to reach some solution to the problems we have and gain some control over them. Often a psychologist or counselor can help patients with such problems.

Occasionally habit, such as listening for an ill child or relative, causes insomnia or its cause is unknown. In such cases a short course of hypnotic (sleeping tablets) can be helpful for some 10 days but their general use should be avoided due to their addictive properties.

The second problem is that of disturbed sleep and early morning waking. Typically the patient enters sleep quite easily and then wakes at any time between 0230 and 0430 and finds it difficult to return to sleep until perhaps an hour or so before they are due to wake. They then wake feeling extremely tired. Such sleep patterns are commonly seen in patients who are depressed and such problems improve with the use of anti-depressant drugs which restore a natural pattern of sleep by increasing serotonin and noradrenaline levels in the brain. Less commonly depressed patients experience the ability to sleep at all times, a condition called hypersomnia. Unfortunately many depressed people turn to alcohol to help their problems which considerably increases their sleep disturbance.

Among the stimulants causing disturbed sleep alcohol is common and any consumption of over 50ml before sleep it tends to cause disturbed sleep some 2-3 hours after an initial deep sleep. Strong coffee has a more immediate effect causing stimulation and insomnia. The snoring of a partner often causes disturbed sleep, and such snoring can usually be helped by decreasing alcohol consumption and loosing weight. Occasional severe snoring can cause a condition of sleep apnoea in which the brain becomes starved of oxygen and the patient wakes up, this condition may be serious and advice should always be sought. Whilst the stimulus of noise often prevents us from sleeping it rarely wakes us when we are asleep although we can incorporate it into our dreams. For parents with young children disturbed sleep is common with children both crying in the night and coming to their parents bed. Education and advice about childcare before the birth of the child can minimise such problems and babies can often sleep through the night from 8 weeks old with minimal disturbance to their parents.

So the doctor presented with the problem of poor sleep may find many causes and differing treatments, however in general disturbed sleep is amenable to treatment and many people can benefit from such help

Wednesday, 03 November 2010

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