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By Dr Vivian Oputa
Insomnia is a lack of sleep that occurs on a regular or frequent basis which may be chronic or temporary and includes difficulty going to sleep, staying asleep or going back to sleep.

Just about everyone has had occasional sleepless nights possibly due to stress, excessive caffeine or alcohol consumption, heartburn or for no apparent reason. The amount of sleep considered to be enough varies from person to person. The average sleep time is 7 1/2 hours and some individuals do well with as little as 4 hours while others require up 10 hours each night. Insomnia can affect mood, energy level and even health as the immune system is bolstered during sleep. Fatigue leads to impaired mental alertness and concentration which in turn may lead to accidents on the road and at work. Lack of sleep also leads to premature aging as the body works hard during sleep to regenerate itself. A sleep deprived person develops dull sallow skin as well as a dark puffy eye area.


Signs and symptoms of insomnia include difficulty falling asleep at night, inability to get enough sleep at night, waking up during the night, waking too early, waking up tired after a full night of sleep and daytime fatigue and irritability. Insomnia is commonly caused by Stress – which may be as a result of an inability to relax, concerns about work, social life and health as well as excessive boredom; Anxiety;

Depression; use of Stimulants such as antidepressants, antihypertensives, caffeine containing over the counter medications including analgesics, decongestants and diet pills. Insomnia may also be caused by changes in work schedule or enviroment; Long term use of sleep medications which become less effective over time; Painful medical conditions such as fibromyalgia, arthritis and neuropathies; Behavioural insomnia where affected individuals worry about not getting enough sleep and try too hard to fall asleep (affected individuals are usually able to fall asleep when away from their usual sleep environment or are not trying such as when reading or watching TV) and Eating too much late at night which may lead to heartburn and discomfort. Insomnia may be inherited or Age related as after the age of 50 sleep becomes less restful. With age, activity
is diminished which is required to induce restful sleep and health conditions such as painful arthritis and prostatic enlargement lead to restlessness and frequent urination respectively which may disrupt sleep.

Children and teenagers may also have insomnia due to the same factors seen in adults and may in addition suffer from sleepwalking, night terrors and bruxism (teeth grinding).

If insomnia affects daytime function for a month or more, a doctor should be consulted for investigation, diagnosis and treatment. Insomnia may be difficult to diagnose due to its partly subjective nature. Disrupted sleep patterns and daytime fatigue affect individuals differently. After taking a detailed history, your doctor may suggest that you spend a night at a sleep disorders centre where experts can monitor sleep patterns, body movement, breathing, brain waves and eye movement. The downside of this observation is that most people are adversely affected by the laboratory environment leading to even more distorted sleep patterns.

Sleep is very important for optimal health and inadequate sleep adversely affects both mental and physical health.
Individuals with chronic insomnia are more likely to develop pyschiatric problems such as anxiety disorders and depression. This condition may also increase the severity of chronic diseases such as diabetes and hypertension. Several road traffic accidents have been attributed to drivers falling asleep at the wheel as a result of insufficient sleep.

Your doctor may prescribe short term prescription sleeping pills (generally for at most 2 weeks) to help deal with insomnia during periods of stress and anxiety in addition to self help measures. The goal is to develop the abiltiy to sleep without the use of medication as medication may have adverse side effects and lose efficacy when used long term. Some over-the-counter sleep aids contain antihistamines to induce sleep and should be used occasionally as they may lead to daytime drowsiness, difficulty urinating and they also loose effectiveness with repeated use.

Self help measures to improve sleep patterns include adhering to a bedtime and wake up schedule; Avoiding trying to sleep; Exercising regularly about 5 to 6 hours before bedtime and Finding out if medications may cause insomnia. It is advisable to take pain relievers to treat painful conditions; Relax before bedtime by having a warm bath or getting a massage; Avoid naps during the day; Minimise sleep interruptions by creating a quiet environment and avoid excessive fluid consumption before bedtime to prevent frequent urination.

Melatonin is a complementary sleep aid that is marketed to treat insomnia and a variety of medical conditions.
It should be taken for about 2 weeks to determine if there are improvements in sleep patterns. The benefits of this supplement are often xaggerated. The body already produces melatonin and releases it into the blood stream in increasing amounts starting at dusk and tapering off toward the morning hours.


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