Awake at Night?

Insomnia, or the inability to fall asleep and/or maintain sleep is on the rise worldwide, thanks to a host of external and internal factors. Insomnia leads to a wide-spectrum of problems, some of which are immediate, while some manifest in the long run. Insomnia is, however, different from sleep deprivation, or voluntary or forced lack of sleep.

Normal sleep

Sleep is a state of unconsciousness in which the brain is relatively more responsive to internal than to external stimuli. In sleep, the brain gradually becomes less responsive to visual, auditory, and other environmental stimuli during the transition from wakefulness to sleep.

Our bodies have a built-in alarm clock, called circadian rhythm, which tells us when to sleep and when to awake. The circadian rhythm regulates sleep, and other processes like temperature and hormonal secretion, and is located inside the hypothalamus of the brain.

Sleep was earlier thought to be a passive state because of withdrawal of sensory input, but it is now believed to be an active process.

Normal sleep is divided into non–rapid eye movement [NREM] and rapid eye movement [REM] sleep. The stages of NREM are stage I [light sleep], stage II, stages III and IV [deep or delta-wave sleep]. Anything that disturbs this process causes sleeplessness or insomnia.

Sleep patterns in different age groups

A newborn sleeps for up to 18-20 hours. Older children sleep for about 12 hours. Adolescents have difficulty falling asleep, and difficulty in waking up. Young and middle-aged adults manage with anywhere between 5 and 9 hours of sleep. Those above 60 years have difficulty falling into and maintaining sleep, sleep fragmentation and deep REM sleep.

Sleeplessness

Insomnia is characterised by insufficient or poor quality sleep, and night-time or daytime symptoms. Insomnia is very subjective. Someone who sleeps for a long time, but is unsatisfied with respect to sleep quality can be considered an insomniac. Conversely, a person who sleeps less, but has no daytime symptoms, would not be considered an insomniac.

Insomnia can be of various types, and is classified according to the duration, the cause, and severity. Insomnia is called short-term, if it is has lasted less than one month in duration, and long-term or chronic, if it has lasted for more than a month.

This labelling helps us to find a starting point for events that triggered off insomnia, like bereavement, or divorce. Also, the shorter the duration, the easier it is to cure insomnia.

The severity of sleeplessness is determined by the number of nights that a person experiences sleeping difficulties.

Mild insomnia is present for less than three days in a week; it is said to be severe if it lasts more than three days. As far as the cause is concerned, insomnia can be present for a variety of reasons.

Types

Insomnia is of two basic types:

Difficulty falling asleep

• Poor sleep hygiene, habits or behaviours which negatively affect sleep, daytime napping, poor physical exercise, too much light or sound in the bedroom, caffeine drinks, heavy, spicy dinner etc., late in the day
• Psycho-physiological or conditioned causes which include worrying about not being able to sleep, clock-watching, and heightened awareness
• Restless leg syndrome, wherein involuntary movements and sensations of the limbs keep the person awake
• Circadian rhythm disorders, where the body clock is out of sync
• Anxiety and stress
• Use of psycho-stimulant medications.

Difficulty in maintaining sleep or waking early

• Stress and anxiety
• Psychiatric diseases like depression and anxiety
• Diseases like allergies, arthritis, asthma, high blood pressure, heart disease, hyperthyroidism, Parkinson’s disease etc.,
• Pain due to any cause
• Excessive alcohol consumption
• Certain medications
• Habitual snoring and sleep apnoea
• Circadian rhythm disorders
• Environmental disturbances like a crying infant or a sick person at home, night-shifts, jet-lag, noise, mosquito bites etc.,

Things to do

When you want to deal with insomnia in the face, you need to take into account your normal sleep rhythms, your work and family environment, including the use of medications and illnesses, if any.

It is always preferable to try simple lifestyle changes – sticking to a routine for retiring and getting up, reducing day-time napping, avoiding overeating, excessive drinking, caffeine beverages, or taking up a sport or exercise, or relaxing activity like yoga and meditation.

When simple sleep hygiene habits and lifestyle changes don’t give relief, medications may be needed to improve sleep. These medications act on the sleep centres of the brain; they suppress them in order to induce and maintain sleep. Though most of them are safe in prescribed doses, these medications come with their own set of side-effects. Also, overdosing oneself with these medications can sometimes be extremely dangerous, as is combining them with certain medicines, or alcohol. The best thing to do is to take medications, only if required and under medical supervision.

Food as medicine

Food and sleep share an intimate relationship. While overeating and fullness can bloat the abdomen, prevent sleep and increase heartburn, excessive intake of liquids can increase urination, thus reducing sleep.

However, there are also some known foods that can improve sleep; likewise, there are those that can prevent sleep. Foods that promote or prevent sleep are listed in the box. It has been seen that foods, which contain the amino acid, tryptophan, promote sleep. Tryptophan [found in milk] helps in manufacturing the sleep promoting brain hormone, serotonin.

Sleep is a complex phenomenon, linked to too many variables.

One must develop a good attitude to sleep, inviting it, rather than summoning it. A happy optimistic outlook, with the ability to remain in the present, and an attitude of forgive and forget – all these and more go a long way in ensuring healthy sleep habits.