Insomnia – Reasons and cures

Close-up of alarm clock on night table

For some this is only a brief problem. For others however, insomnia can become a severe, ongoing struggle. Chronic insomnia can have a negative impact on your quality of life and your physical and mental health.

What is normal sleep?

Normal sleep is defined as the amount and quality of sleep required to be fully alert and functional the next day with normal levels of alertness, concentration, attention, and stability of mood.

How much sleep is necessary?

The exact amount and timing of sleep can vary from individual to individual and still be called ‘normal’ as long as the above requirements are met. For example, some people can be fully functional on 6 hours sleep per night (this is unusual) while other needs 9 hours of sleep per night.

How does one know one has a sleep disorder?

Some obvious signs of sleep disorders are: (1) failure at work, in school or at home because of sleep problems, (2) problems falling asleep while driving or during other periods of high risk that require full vigilance, (3) injury occurring to self, others, or property during sleep, but outside of the sleeper’s conscious awareness.
There are some simple tests or rating scales which can be self-administered that will give an indication of whether a sleep disorder is likely present.

 What rating scales are available?

The following Rating scales are simple, short, and free on the web:
Epworth Sleepiness Scale (a score > 10 indicates abnormal degrees of sleepiness)
Insomnia Severity Index (a score > 14 suggests at least a moderate degree of insomnia)
Disturbing Dreams and Nightmares Severity Index (a score > 10 indicates a significant degree of problems with nightmares)

 What effect does alcohol have on sleep?

Drinking alcohol will usually speed the onset to sleep, but a few hours later, as the alcohol is metabolized, sleep will become progressively disturbed. This is related, in part, to the suppression of rapid eye movement sleep (REM) in the first portion of the night while blood alcohol levels are high, then a rebounding return of REM sleep in the second half of the night as blood alcohol levels approach zero, a highly activated state characterized by dreaming, high brain metabolism, and faster ‘wake-like’ brain rhythms. This highly activated state, when accentuated by middle of the night alcohol withdrawal, will lead to middle of the night awakenings, early morning awakening, and the perception of restless sleep. This negative impact on sleep can paradoxically lead to more alcohol consumption to offset the induced sleep problem. During periods of abstinence, about 50% of alcoholics will have insomnia problems that extend months into their recovery. Unfortunately, persistent insomnia is a confirmed risk factor to returning to drinking alcohol, suggesting that managing insomnia during abstinence should be a target to prevent alcohol relapse.

Are there dietary or behavioural changes that can improve sleep?

The most useful behavioural and dietary changes that can be made to improve sleep are the following:
-severely limiting or abstaining from all caffeine
-severely limiting or abstaining from all tobacco
-severely limiting or abstaining from all alcohol, even if alcoholism is not a problem
Rising at the same time every day
No naps if you have insomnia
Never stay in bed more than 8 hours if you have insomnia
Make sure that the lights in your home are very dim for the last 2 hours before bedtime (severely limit “screen time” with smart phones, iPads, etc.)
Never monitor your progress during the night by watching the clock

What causes insomnia?

1) Medical causes:
• Nasal/sinus allergies
• Gastrointestinal problems such as reflux
• Endocrine problems such as hyperthyroidism
• Arthritis
• Asthma
• Neurological conditions such as Parkinson’s disease, strokes, Alzheimer’s disease
• Chronic pain
• Low back pain
2) Medications that can cause insomnia:
• Decongestants (pseudoephedrine)
• Diuretics, especially if taken in the evening
• Appetite suppressants (sibutramine, phentiramine)
• Amphetamines
• Metielphenidate
• Antidepressants (bupropion, fluoxetine)
3) Insomnia also may be the result of withdrawal from:
• Benzodiasepines
• Alcohol
• Antihistamines
• Amphetamines
• Cocaine
• Marijuana and other addictive drugs
4) Underlying sleep disorders:
1. Restless legs syndrome
A neurological condition in which a person has an uncomfortable sensation of needing to move his or her legs which can lead to insomnia.
Symptoms are typically worse in the later part of the day, during periods of inactivity, and in the transition from wake to sleep, which means that falling asleep and staying asleep can be difficult. An estimated 10 percent of the population has restless legs syndrome.
2. Sleep apnoea
– pauses in breathing and a drop in oxygen levels.
– A change from non- REM stage IV sleep to the very light stage phase I sleep ensues.
– This causes a person to wake up briefly but repeatedly throughout the night. It can lead to daytime sleepiness.
5) Psychiatric disorders:
• Mood disorders
• Anxiety disorders
• Substance abuse
• Psychotic disorders
6) An Unhealthy Lifestyle:
Can create insomnia on its own (without any underlying psychiatric or medical problem), or it can worsen insomnia caused by another problem.
Working at home in the evenings makes it hard to unwind, and makes you feel preoccupied when it comes time to sleep. The light from a computer could also make the brain more alert.
Taking naps in the afternoon. Short naps can be helpful for some people, but for others they make it difficult to fall asleep at night.
Sleeping in later to make up for lost sleep. This can confuse the body’s clock and make it difficult to fall asleep again the following night.
Shift working (working irregular hours). Non-traditional hours can confuse the body’s clock, especially if the work schedule changes periodically.
7) Food and Beverages:
& Caffeine is a stimulant.
Most people understand the alerting power of caffeine and use it in the morning to help them start the day and feel productive. Caffeine in moderation is fine for most people, but excessive caffeine can cause insomnia. Caffeine can stay in the system for as long as eight hours, so the effects are long lasting. Food or drinks with caffeine should be avoided close to bedtime.
& Alcohol is a sedative.
It can make you fall asleep initially, but may disrupt your sleep later in the night.
& Nicotine is also a stimulant and can cause insomnia.
Smoking cigarettes or tobacco products close to bedtime can make it hard to fall asleep and to sleep well through the night.
& Heavy meals close to bedtime can disrupt your sleep. The best practice is to eat lightly before bedtime. Eating too much in the evening, can cause discomfort and make it hard for the body to settle and relax. Spicy foods can also cause heartburn and interfere with sleep. Meals low in fibre and high saturated fat are associated with lower quality sleep, while higher levels of sugar leads to more wake-ups.
8) Hormonal and other body chemistry changes:
• Menopause
• Pregnancy
• Age above 65y.

What treatment is available?

• Sleep habit and behavioural modifications (Sleep hygiene) for optimal long-term results – may correct the problem without medication
• Medication
• Treatment of underlying sleep disorders, psychiatric disorders and medical conditions

• Go to bed at the same time each day
• Get up at the same time each day
• Get regular exercise each day, not close to bed time
• Spend some daytime outdoors in natural light
• Make the bedroom restful: quiet, dark, comfortable temperature
• Use your bed only for sleep and sex
• Relaxation techniques i.e. yoga, breathing
• Drink warm milk before bed: high levels of Tryptophane in milk which helps induce sleep
• Understand your sleep need

• Exercise just before going to bed
• Engage in stimulating activity (electronics) close to bedtime
• Drink caffeine containing drinks in the evening
• Go to bed too hungry or too full
• Nap in the evening before you go to bed
• Stay in bed when you are awake
• Share your bed with children or pets
• Look at the clock all the time
• Smoke
• Use alcohol to help you sleep or rely on sleeping tablets to help you sleep


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In Memoriam – Clive Ramsbottom