Sleep: The secret to sleeping well and waking refreshed. Prof. Idzikowski Chris

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СКАЧАТЬ result of untreated short-term insomnia. It can last for months, and, in rare cases, years. It is a long-term problem that often recurs.

      Sleeplessness and insomnia

      It may be better to use two words: ‘sleeplessness’ for the times that sleep is impossible, but you know why; and ‘insomnia’ for the times that you do not know why you cannot sleep. Some reasons for sleeplessness include:

      • lifestyle (work, shifts, caring for an invalid, children)

      • poor sleeping environment (noise, uncomfortable mattress, etc.)

      • stress (bereavement, divorce, etc.)

      • a poor diet

      • stimulants, medicines and drugs

      must know

       Using sleeping pills

       Prescription of sleeping pills costs the UK about £22.4 million per year. About 15.5 million prescriptions are written. Taking sleeping pills has been shown to increase the risk of road accidents (last year there were 32,220 serious injuries and deaths on UK roads).

      As a general rule, a good way to find out if you have true insomnia is to ask yourself if there is any obvious reason for your sleeping problems. If not, and you have had the problem for a few weeks, then you are likely to be suffering from the condition.

      Diagnosing insomnia

      Insomnia can develop from sleeplessness, and often patients will know when their sleep problems started but cannot understand why they have not gone away. Psychiatrists rarely diagnose insomnia but when they do the following conditions must be met:

      • The time it takes to get to sleep must be more than 30 minutes. Total sleep time during the night is usually between three to six hours. The sleep may be unrefreshing.

      • The problem must occur three or more nights a week.

      • The insomnia causes major problems in daytime functioning (socially, at home, at work).

      • It must have lasted for three months or longer.

      • There are no environmental, lifestyle, medical or psychiatric causes for the problem.

      The role of Nature

       Understanding when our bodies are working against us can sometimes be half the battle when trying to understand why we can’t sleep. Here are some of the natural factors that can affect sleep.

      must know

       Women and sleeping

       Polls carried out in the USA by the National Sleep Foundation found the following:

       • Almost three out of four women get less than eight hours’ sleep a night.

      • Sleep is disturbed for 2.5 days on average during the menstrual cycle.

      • More women complain of sleep problems during menstruation (71 per cent) than during the week preceding menstruation (43 per cent).

      • Sleep-disrupting conditions such as anxiety and depression are twice as likely to occur in women than in men.

      Gender

      It is a sad fact of life that you are more likely to have sleep problems if you are a woman. The reason for this is partly due to the female bodily cycles. Much of women’s lives is governed by the sex hormones oestrogen and progesterone, and hormonal fluctuations, as in the menstrual cycle, pregnancy and the menopause, can severely affect sleep either directly, or through their effects on anxiety and general mood. Pre-menstrual women commonly report sleeping difficulties in the week before their period starts, but even women who don’t suffer from pre-menstrual symptoms can still take longer to fall asleep, wake more often and feel less refreshed after sleep during the second phase of their cycles. Sleep disturbances also become more common during the menopause, when women report waking up more often at night and feeling more tired during the day.

      Studies on the effects on sleep of Hormone Replacement Therapy (HRT) and oral contraceptives have shown that these hormones have direct effects on the brain. Oestrogen has widespread effects on mental performance, mood, movement coordination and pain. However, the monthly fluctuation of oestrogen and progesterone impacts on cognitive function, mood, appetite and temperature, as well as the sexual organs and breasts, making it more difficult to work out how they affect sleep directly.

      There is evidence to suggest that women’s role in society may affect their sleep even more than hormonal changes. The added pressures many women face of juggling stressful jobs with their roles as mothers and wives can often pose an intolerable burden, exacerbated by the fact that many women ignore their fatigue.

      Age

      Ageing can greatly affect sleep, with the number of hours declining as you get older. While a young adult will sleep on average for 7-8 hours, by old age this will go down to about six. Quality of sleep is affected too. Stage 4 sleep is reduced, and the proportion of REM sleep, which makes up abut 50 per cent of baby sleep, will, in the latter stages of life, go down to 15-20 per cent. Although the cause may be inevitable, there are still steps you can take to improve the situation (see Chapter 4).

      General constitution

      Your sleep is more likely to be poor if your general health is poor, even if you are not suffering from a specifically sleep-related disorder (see Chapter 6). Conditions such as heart disease, general breathing problems and arthritis can make it difficult to get comfortable at night, and will almost certainly have an impact on your sleep. Consult your doctor if this becomes an issue. For many people emotional issues and character make-up may come into play.

      must know

       Adult sleep A recent US National Sleep Foundation survey looking at the relationship of sleep problems in adults aged between 55-84 found:

      • Nearly one in four adults had at least four medical conditions.

      • Depression, heart disease, pain and memory problems were most associated with insomnia.

      • Ninety per cent of those that did not have any medical condition thought their sleep quality was good or excellent. This went down to 78 per cent if they had 1-3 medical conditions, and 59 per cent if they had four or more conditions.

      • Obesity, arthritis, diabetes, lung disease, stroke and osteoporosis were more likely to be associated with other sleep problems (e.g. snoring, restless legs).

      The role of diet

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