Insomnia

This is a condition in which a person is unable to obtain enough sleep. It is important to remember that there is a wide range of "normal" sleep requirements (from 3-10 hours in adults), and also that insufficient sleep may lead to illness.

Insomnia can be due to many causes. Stress, anxiety, depression and some psychiatric problems can cause insomnia. It can be treated with relaxation therapy, improved sleep habits or medication. Alcohol and other drugs can distort the normal sleep pattern, resulting in an ineffective or poor quality sleep. Stimulant drugs, tobacco, tea, coffee or chocolate can all impair one's ability to fall asleep. Conditions such as asthma, heart burn, angina, and pain may occur at night and can result in insomnia. When no cause for insomnia is obvious, then it may help to keep a sleep diary recording day and night events, including activities, meal times, going to bed and going to sleep times. Occasionally a sleep sudy is required.

Methods to treat insomnia are geared at:

1. Treating any underlying medical condition, such as angina, asthma or heartburn, if one is present and causing the insomnia.
2. Providing stress management with relaxation therapy and possibly medication.
3. Improving sleep habits or adopting "sleep hygiene" measures such as:
   • avoid tobacco, alcolol, tea, coffee, chocolate for at least 4 hours before sleep;
   • improve the sleep environment - achieve low noise (eg. with ear plugs, if necessary), and a comfortable stable room temperature;
   • get out of bed at the same time each morning regardless of how tired you might feel and have a regular time for going to bed;
   • relax before sleeping by reading, listening to music, having a warm bath before bed;
   • avoid naps during the day; and
   • spend limited time in bed - only for sleep.
4. Take regular exercise.
5. Eat a small snack before bedtime.
6. If all else fails - avoid trying to sleep and distract yourself, for example by reading a book or listening to music.

There are a number of other approaches to insomnia under active investigation at present. One of these, for example, is the use of bright light therapy to delay or advance sleepiness in people with insomnia dur to a shift in the phasing of their sleep (circadian) rhythm. Another is to delay the time of going to sleep by a few hours each night gradually pushing the time of sleep forward to a more "normal" time. These treatments are helpful in some people but need to be under the supervision of a doctor specialising in sleep disorders. Similarly the use of hypnotics or sleeping tablets should only be for limited periods and under careful medical guidance.