A good night's sleep is vital for a healthy body, therefore, when patterns of sleep become disrupted there may be significant deterioration in health.
It is quite common and perfectly normal to experience some difficulty in sleeping at times of increased stress. These stressors can be unpleasant experiences, such sitting exams, the death of a loved one or supposedly pleasant events, such as getting married or starting a new job. This type of sleep disturbance usually settle down of its own accord once the stressful situation has passed.
Talking through problems with a friend, family member or GP can often dispel these temporary stresses and help to improve sleep patterns. It is also useful to try not to become anxious and stressed about not sleeping; remember that a lack of sleep over a short period is not harmful. Anxiety about not sleeping adds to stress levels and worsens sleep patterns.
If talking about these problems does not work for you, there are a number of relaxation techniques that can assist with the management of stress, e.g. yoga, meditation and exercise. If sleep continues to be disturbed, with adverse effects, then consult your GP or other health professional. He/she may think it appropriate to use a hypnotic medication, such as diazepam (Valium), for a short period of time.
As these medications are physically and psychologically addictive for some individuals it is important to only use them as directed by your doctor and to avoid using them every night (use for four nights out of seven to minimize the development of tolerance). The body can quickly become tolerant to them and the medication may cease to work without an increase in dose - which is the way in which dependence and addiction develop.
Sleep & mental health
Sleep disruption is very common and persisten problems tend to indicate mental health issues. Sleep problems are often part of the diagnostic criteria for many psychiatric illnesses. In people who have had an episode of depression, mania or of a psychosis, sleep disruption can be seen as an early warning sign that things are going wrong.
It is important for the individual to pay attention to his/her body in these instances and to look at methods of improving sleep patterns. It is advisable to discuss the problem of sleep disturbances with a GP or mental health professional.
Sleep disturbance can be associated with depression (especially the early morning waking pattern), anorexia nervosa, panic disorder, generalized anxiety disorder, post traumatic stress disorder, mania (typically a decreased need for sleep) and schizophrenia (a reverse sleep pattern can occur and the high level of stress and anxiety associated with being acutely psychotic may also disrupts sleep).
Alcohol and other drugs have a major impact on the quality of sleep, especially if these are used on a daily basis. Often people use them to help them sleep but the quality of sleep is poor and unrefreshing and this can become a dangerous habit, carrying the risk of becoming psychologically dependent on the substances, and in turn, causing damage to physical and emotional health.
Alcohol, for instance, will produce a period of unconsciousness which is different from normal sleep and which rarely lasts for more than 3 or 4 hours. The person then wakes up in a state of rebound increased alertness - in which further sleep is difficult, if not impossible.
Panic attacks occurring regularly in the morning on wakening may be a sign of regular sedative use or alcohol consumption the night before with the panic emerging as a rebound phenomenon as sedation wears off.
Types of sleep problems
Below are different types of sleep problems and associated patterns of sleep disturbance:
- Increased sleep (hypersomnia). Seen in some organic/physical illnesses and also in about 15% of cases of depressive illness. May also occur in schizophrenia.
Decreased sleep: difficulty getting to sleep (initial insomnia); common in states of tension, anxiety and pain or if overworked or overtired.
May also occur as a side-effect of certain medications. o waking up through the night (middle insomnia); common in depression, post traumatic stress disorder and in anxiety states - also in states of pain. o waking up earlier in the morning by at least an hour (early morning waking). This is common in depressive illness.
Decreased need for sleep associated with lots of energy
- Very typical of hypomania or mania and also seen in heavy users of amphetamine or cocaine.
Unrefreshing sleep
- This can also occur in depression but certain physical problems can be associated with this problem. If a person wakes feeling un-refreshed, is sleepy and tired during the day and snores loudly at night in sudden violent snorts after a period of not breathing, he/she may have a condition called sleep apnea.The muscles that normally hold the airway open during sleep become lax and fall in on themselves causing blockage to regular breathing, hence sleep apnea (i.e. a sleep pattern where breathing is regularly blocked, resulting in the brain being repeatedly deprived of adequate oxygen). In people who are overweight or who smoke, there is an increased risk of sleep apnea. It is important that this condition be diagnosed and treated because the impact of repeatedly depriving the brain of oxygen can have serious long-term effects.
Drugs & sleep
Almost all drugs or unnatural chemicals and even foods and herbs will affect sleep. Sometimes, using substance to help sleep can be beneficial in the short-term, although in most instances using anything unnatural to help sleep will eventually become useless or simply create more problems.
Prescribed medications for a physical or psychiatric illness can also disrupt sleep. If a person has just started on the medication, chances are that the body will become used to it and the sleep patterns will improve.
As a general rule, using substances for short-term gain creates long-term pain. There are certain situations where particular food, herbs and medications can fix fundamental problems with sleep. In such cases, this will usually be due to readjusting an imbalance, which allows sleep patterns to return to normal.
Some drugs or chemicals that are known to cause sleep disturbance are listed below:
- Alcohol
- Nicotine (patches & smoking)
- Marijuana
- Caffeine
- Decongestants
- Benzodiazepines
- Antidepressants
- Antipsychotics
- Thyroxine
- Hormones (including contraceptives & other female and male hormones)
- Theophylline (chemically similar to caffeine - often used for respiratory conditions)
- Antihypertensives
Things to do to improve sleep ('Sleep hygeine')
Establish a regular routine before going to bed. This helps to let the brain and body know what is about to happen up and brains/bodies respond well to such pre-sleep routines.
- Take a look at your overall lifestyle and stresses
- Consider your level of physical activity
- Make sure your diet is good and you eat consistently well
- Go to bed and get up at the same time each day
- Avoid sleeping in on the weekend
- Use your bedroom only for sleep
- Avoid taking a nap during the day
- Drink less right before bed
- Drink less coffee and tea or other stimulants
- Reduce or stop drinking alcohol
- Be careful with sleeping drugs
- Open your blinds so that light enters your bedroom
- Darken or dim your lights at night to stimulate sleep
- If you can't get to sleep after 30 mins consistently, do something for 10-20 minutes outside your bedroom and then try again.
