Anyone who has ever suffered from disturbed sleep will tell you that sleep is a vital part of our life, probably taken for granted by those who have never experienced problems. Whatever the reason for the insomnia, be it anxiety, bereavement or simply jetlag, it leaves us feeling washed out, with our vitality crushed. We feel unrefreshed, irritable and listless, and as we are not as alert, we are more prone to making mistakes. The main features of insomnia are difficulty falling asleep, an inability to stay asleep, or waking in the early hours and not being able to get back to sleep. Sufferers usually feel frustrated because they feel they should be asleep, and they invariably feel tired and washed out the next day.
Insufficient sleep may have serious repercussions in people of all ages. In children it may cause growth retardation, it can affect the academic performance of adolescents, cause under-achievement in the workplace and contribute significantly to the cause of accidents.
• Nearly four out of ten individuals do not get a regular night’s sleep which affects their alertness.
• One-third of adults experience difficulty falling asleep or remaining asleep.
• Approximately 60 per cent of the elderly suffer from disorders that disrupt sleep, like snoring or sleep apnoea, where breathing ceases temporarily.
• Sufferers are often more tired during the day, not sufficiently alert to even drive a car. Road traffic accidents, for example, have been associated with sleepiness in 27 per cent of cases, and in one study accounts for 83 per cent of the deaths on the road, even more than deaths from alcohol-related accidents.
There are a variety of underlying factors that disrupt our sleep pattern:
• It is thought that in 50 per cent of complaints of insomnia there is underlying anxiety or depression. Stress, tension, grief or fear can all keep us awake.
• Caffeine, found in tea, coffee, chocolate and cola-based drinks, can stimulate us to the point of insomnia.
• Some drugs may produce side-effects which include insomnia, or may induce disturbing dreams which cause us to wake during the night.
• Withdrawal symptoms when coming off certain drugs.
• Alcohol in excess will also produce insomnia.
• Any painful condition e.g. arthritis.
• Any condition that causes you to break your sleep e.g. cystitis or diarrhoea when you need to go to the toilet.
• Day-time napping can prevent us having a sound night’s sleep.
• A cold bedroom, especially for the elderly, could be enough to keep them awake at night.
• Shift work, which involves working some nights and not others is likely to severely disrupt your sleep pattern. We regularly see nurses and air hostesses with problems that relate to their poor sleeping routine, as the menstrual cycle is disturbed by the lack of routine.
• The first step is to exclude the possibility of any underlying cause, especially if there is pain. He should do a physical examination and routine blood screening to check for thyroid problems, diabetes, low iron stores, infection or other serious problems.
• Check to see whether anxiety or depression is keeping you awake.
• Give you instructions about ‘sleep hygiene’ – going to bed at a regular time, not napping during the day, making sure your room is warm enough, that your bedcovers are comfortable, and that there is no external noise to disturb you.
• Reassure you that your problem is likely to be short-lived.
• Prescribe sleeping pills in the very short term to break the pattern of insomnia and re-train you to sleep through the night. • If you are depressed, he may prescribe antidepressants, and in severe cases refer you to a psychiatrist for further investigation and treatment.
• Pinpoint the reason for your insomnia, either by visiting your doctor if you feel it may be a symptom of a medical condition, or by discussing your problems with your partner or a close friend.
• Take concerted steps to sort out the problem to alleviate your worry or anxiety. The problem may take some time to resolve, so you will need some intermediate measures to get you through.
• Eat well. Follow the instructions for The Very Nutritious Diet on page 437. Never miss a meal, and eat wholesome snacks between meals, especially in your premenstrual week if you are menstruating, as your calorie requirements are increased by up to 500 calories per day.
• Never go to bed on a full stomach: eat earlier on in the evening allowing sufficient time for your food to digest. This is more important for older patients or those with digestive troubles.
• Take plenty of exercise during the week, at least four or five sessions, out in the fresh air when possible.
• Learn how to relax your body and mind by practising daily one of the relaxation techniques (see page 29). You can use these techniques before going to bed (or in the night to help you get back to sleep).
• Eliminate the stimulant caffeine from your diet completely, and use alternatives (see page 7). Cut down gradually or you will get a withdrawal headache.
• Cut down on cigarettes if you smoke, or give up completely, as nicotine can act as a stimulant.
• Keep your alcohol consumption to a minimum, especially at night. Many people are under the misconception that alcohol is a hypnotic; it does induce sleep, but as it metabolises it acts as a stimulant.
• In the evening try eating bananas, figs, dates, yogurt or a milky drink. These foods are high in the amino-acid tryptophan which promotes sleep. Eating a grapefruit at bedtime may also help. INSOMNIA 267
• Avoid bacon, cheese, chocolate, and red wine. These foods contain tyramine which increases the release of noradrenaline – a brain stimulant.
• Take a supplement of 5HTP, the precursor to the amino acid tryptophan, which in turn is converted into the neurotransmitter serotonin. 5HTP is much closer to serotonin than tryptophan and it is not dependent on a transport system for entry into the brain.
• Co-factor nutrients that assist the conversion of tryptophan into serotonin should be supplemented for maximum benefit. A B-complex together with the mineral magnesium ensure its conversion to serotonin.
• Protein should be avoided when taking 5HTP because the amino acids in the food competes with tryptophan for transport into the central nervous system. Eat a small carbohydrate snack alongside taking the supplement.
• Take a supplement of magnesium, preferably as amino acid chelate which is better absorbed. Magnesium works by relaxing the central nervous system and promoting uninterrupted sleeping patterns.
• Herbal preparations like valerian have been used for centuries for the natural treatment of insomnia. Several studies have confirmed valerian’s ability to improve sleep quality and alleviate insomnia.
• Passion flower is also a good adjunct which has been widely used in traditional folk medicine for its natural sedative and analgesic properties.
• Make sure that you have a quiet, warm and comfortable environment in which to sleep. Having a good mattress with clean bedding might well help.
• Train yourself to go to bed at a regular time each night, before midnight, but not too early.
• Don’t watch any scary films or upsetting television programmes before going to bed.
• When in bed, don’t think about the day’s activities, try to concentrate on something pleasant, and consciously relax your muscles.
• Cuddle up to your partner if you have one. The warmth of another person can help you get to sleep.
• An orgasm will often induce sleep – so this may be one problem that your partner will be only too keen to help you solve!
• Set your alarm for a regular time, unless you are a shift worker, as this will help you re-establish a routine.
• Instead of lying awake worrying, get up, make yourself a warm drink and read, watch a video or practice some relaxation technique, before returning to bed. This often does the trick and takes the frustration out of the situation.
• Go back to bed when you feel sleepy. Practice relaxing your muscles again and getting your mind to wander to a favourite location (see page 31).
• If you are still awake 10 minutes later, get up again, go to another room, do some more reading or relaxing. Try not to worry or get too frustrated about not being able to sleep, as it is much more tiring than just being awake!
Angela was a 56-year-old teacher with two children. Despite being desperately tired she was unable to sleep. Her health had been so badly affected that she had retired from her job.
‘For eleven years, prior to the menopause, I had heavy periods, headaches and moodswings. My last period was in November 1993. Since then I had suffered with hot flushes, my libido had disappeared, and my vagina was dry. My doctor prescribed HRT which I took for five months, but the side-effects were so severe that I had to stop taking it. I was unable to sleep at all and experienced terrible panic attacks, plus my curly hair went straight and unmanageable. Not being able to sleep seemed to be affecting my brain. I couldn’t retain anything in my mind, and was anxious about everything. I usually play bowls but did not have the energy or the confidence to go to games. I have a super husband and lovely grandchildren, but I couldn’t be bothered with them either. I felt really cheated as I knew I was missing out on life, but I just wanted to be left alone to doze in the afternoon. INSOMNIA 269 A friend recommended that I go to the WNAS clinic, which in desperation I did. I was asked to get my doctor to measure my serum ferritin levels, which is a test to detect low iron stores. Plus I was given a programme which consisted of making dietary changes, relaxation, supplements and exercise. My doctor did find that my serum ferritin was very low, and as a result I was put on a course of iron pills. I followed the programme closely and within a month felt that my symptoms were calming down. I began to sleep for parts of the night, my flushes were calming down and I didn’t feel quite so tired. The next couple of months were hampered a little because I developed diarrhoea. We eventually discovered that I was reacting to the vitamin E and ginseng which were designed to help with the flushes, and when I stopped taking them my bowel settled down. I continued to make gradual progress through the year. I avoid wheat and coffee completely, even decaffeinated which seems to upset me. I feel that I am now back to my old self and have been able to cope well with two family crises that have occurred. I am able to sleep through whole blissful nights again, my social life is restored and so is my sense of humour, and as an added bonus my libido is back. My husband is relieved and we are both very grateful to our friend who suggested we visit the WNAS.’
“ I continued to make gradual progress through the year. I avoid wheat and coffee completely, even decaffeinated which seems to upset me. I feel that I am now back to my old self and have been able to cope well with two family crises that have occurred. I am able to sleep through whole blissful nights again, my social life is restored and so is my sense of humour, and as an added bonus my libido is back. My husband is relieved and we are both very grateful to our friend who suggested we visit the WNAS.”
Angela