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If you don't snooze you lose (or wired and wide awake)

Date
Wired and wide awake ... why we can't sleep

Wired and wide awake ... why we can't sleep Photo: iStockphoto

Why are so many of us having trouble getting a good night's sleep? Let us count the ways: firstly we are over-caffeinated, we are over-wired and we're overworked.

Being over-caffeinated (coffee, soft drinks, energy drinks, snacks) and over-medicated (prescription and over-the-counter drugs, including alcohol), is wreaking havoc with slumber patterns.

Then being over-wired (video games, web browsing, social media, texting) and overstressed (money, work, relationships, overloaded schedules), is making us too restless to doze off when we should.

Plus we're overworked (longer hours, night shifts incompatible with our biological clocks) and overweight (perhaps a chicken-or-egg deal, as different studies have found that one leads to the other).

And then there's societal pressure, what US sleep expert Dr Mark Mahowald calls "the pervasive, erroneous attitude that sleep is not a biological imperative, that it is negotiable. We have raised sleep deprivation to a badge of honour."

Mahowald is director of the Minnesota Regional Sleep Disorders Center, chief of the Department of Neurology at Hennepin County Medical Center and professor of neurology at the University of Minnesota Medical School.

The effects might outnumber the causes, and are hardly as benign as many of us might think. "Any degree of sleep deprivation will impair performance: behind the wheel, in the classroom or workplace," Mahowald said.

The lowdown:

- Insomnia victims have trouble falling or staying asleep in a setting with adequate conditions for sleep; this becomes chronic insomnia if it lasts more than three weeks. Sleep deprivation is caused by behavioural or situational factors that curtail or mitigate the ability to get enough sleep time.

- Most adults need seven to nine hours of sleep a night. The amount a person needs is genetically determined, Mahowald said. "Some people might need four hours on the short end, up to 10 on the high end. We have absolutely no control over this."

- Anyone who uses an alarm clock "is by definition sleep-deprived," Mahowald said, "because if the brain had received the amount of sleep it wanted, you would have woken up before the alarm went off."

- Larks and owls: "Some people are early to bed, early to rise; others late to bed, late to rise. We have very little control over that," Mahowald said. "So you see a lot of problems when an owl marries a lark and each one thinks the other is being stubborn."

- With sleep deprivation, some glucose metabolism problems might predispose one to diabetes. And if so, a consequence could be heart disease and stroke.

- With insomnia, there is no evidence of long-term physical problems or links to other diseases. But insomnia results in poorer quality of life and work absences and can lead to depression.

- There is some evidence that severe sleep apnea can lead to hypertension, heart problems and a higher risk of strokes.

At different stages of our lives, we're plagued by unique stresses. The good snoozing news: Solutions that go well beyond counting sheep are at hand.


Late teens

- Common stress sources: schoolwork and social pressures.

- This is the stage of circadian rhythm shifts: The ability to fall asleep shifts to later in the night just as the need for sleep increases. This age group has a hard time getting out of bed early and an even harder time attending early-morning classes. That leads to poor attention, concentration and irritability.

- Technology's bite: Young people who are on Facebook or video games late into the night have trouble winding down for bed.

- Caffeine is a huge factor, not only in beverages and "nutritional supplements" but everything from sweets to potato chips, and now inhaled caffeine.

- Obstructive sleep apnea is on the rise among teens, and might be related to the rise in teen obesity.


40-ish

- Common stress sources: work, finances, parenthood.

- Increased work and family obligations abound: Think 5am swimming practices, more early-morning and late-evening meetings at work.

- As many of us age, our biological clocks shift so that we go to sleep earlier and get up earlier. Sleep needs don't change, although sleep might be lighter and more fragmented.

- Many people in this age range who suffer from insomnia are reluctant to seek treatment because they want to avoid sleeping medications. People are increasingly turning to over-the-counter nonprescription agents that have some effect.

- In middle years the risk for intrinsic sleep disorders, including obstructive sleep apnea, increases. Restless-limb syndrome often starts.


70-ish

- Common stress sources: health-related issues and finances.

- Contrary to previous conventional wisdom, aging does not cause poor sleep. It appears that most people experiencing sleep deterioration have another underlying medical cause.

- Pain is an issue for this group. Partly as a result, there's heightened concern with those 70 or older taking a lot of medication.

- Good news, of a sort: We used to see insomnia related to retirement in this age group, but more people are continuing to work later in life.


SOLUTIONS

- Improving sleep hygiene - avoiding late eating and drinking, keeping the room cool and dark, winding down before bedtime - can improve or resolve transient or acute insomnia but probably not chronic insomnia.

- For chronic insomnia, cognitive behavioural therapy is equally as or more effective than medications. Medication often is useful for acute insomnia.

- Naps can help - except when they don't. "We discourage napping when anyone has problems falling or staying asleep at night, which might be an untreated sleep disorder," said Dr Michael Schmitz, who runs the Behavioural Sleep Medicine Program at Abbott Northwestern Hospital in Minneapolis.

"We encourage power naps, 30 minutes or less, when people can't stay awake or will have late-night events."

- See your doctor if: You have had difficulty falling and staying asleep for more than a week. Or if you snore, have frequent awakenings and are reporting sleepiness during the day. Anyone with apnea symptoms should seek treatment.

SHNS

41 comments

  • I can sleep 9 hrs a night no problem, yet I also have a very busy job, do shift work, have lots of financial goals, 3 young kids, drink lots of caffeine in the daytime and moderate alcohol. So it CAN be done !
    Here's a tip : do NOT use the bedroom for anything other than sleep ( or sex ! ). That way, you become wired to going to sleep when you go to bed. People who do work in the bedroom or watch TV or whatever are making a potential big mistake. We refuse to have a TV in the bedroom.

    Commenter
    C
    Date and time
    April 17, 2012, 10:21AM
    • I feel you should definitely start thinking about opening a practice to help insomniacs - your motto being "if i can do it anyone can". I am sure it will be successful as long as it is not put under scrutiny by anyone in the medical field.

      Commenter
      Mynx
      Date and time
      April 17, 2012, 11:30AM
    • Nonsense! I share a room with my husband (shock, horror!) and we do more than have sex and sleep in there. We often lie on our bed and watch shows, read or play cards etc. He sleeps until he's woken and I can hardly get any sleep at all.
      I think that one solution does not work across the board and that every person is unique with our own set of problems and reasons why we do or don't sleep.
      It's probably best to try a range of things and if you're still not sleeping to seek medical help.

      Commenter
      dlh
      Location
      Melbourne
      Date and time
      April 17, 2012, 1:15PM
  • So what, C, you want a medal? Everyone is different, plus people change, I have found as I get older that I do the old waking up around 3am after having a solid sleep and then can't get back to sleep. I was told some of this could be menopause and I know some of it may be stress. You can't help but think stuff when you're wide awake at that hour. Plus I'm a very recurring, vivid dreamer.

    I have found a herbal remedy called Valerian which is really good, I take a couple before bed and have ended up having a great solid sleep and wake up about half an hour before I get up. The vivid dreams seem to have lessened as well, which is a great side effect!

    Commenter
    Ms Patonga
    Location
    Land of Nod
    Date and time
    April 17, 2012, 11:21AM
    • Valerian is great! I find it calms me down and helps quieten my mind so falling asleep is easier.

      Commenter
      aro
      Date and time
      April 17, 2012, 11:54AM
    • I'd add to that pure lavander oil: a few drops on wrists and neck. Very, very good for mild insomnia!

      Commenter
      Donna Joy
      Date and time
      April 17, 2012, 12:08PM
    • You are my sleep twin. I often wake between 3am and 4am and find it hard to drop off. Some nights I'd give almost anything to turn off the dreams for a while as mine are frequent, vivid and often of the being trapped or falling variety.

      Xanax reduces the dreams but makes me drowsy and short-tempered the following day, and Polaramine sometimes brings on vivid but not always unpleasant dreams. I'll try Valerian -- thank you.

      Commenter
      Secret Squirrel
      Location
      Melbourne
      Date and time
      April 17, 2012, 2:30PM
    • I hear you Secret Squirrel! My dreams are often of the "going nowhwere" variety, involving exhausting amounts of missed trains, forgetting where I parked the car, on the wrong bus etc - which I see as being trapped in the one place. Not to mention the recurring "haunted house" dream which I've had for years, so much so that it is getting more annoying rather than scary.

      My uncle once told me to try the exercise whereby before falling asleep, you tell yourself "I am only going to dream of (insert something pleasant) tonight." It can work, but I tend to nod off before i remember to do so!

      I do recommend the Valerian as mentioned - I think because it relaxes you, the dreams tend to lose their intensity. Good luck and sweet dreams!

      Commenter
      Ms Patonga
      Date and time
      April 17, 2012, 3:19PM
    • I need to take Valerian at least 3 hours before going to bed. Even if it soemtimes does not help me sleep, it does help with the waking as it takes away the feeling of grogginess you get with no sleep.

      Commenter
      Blue
      Location
      Bondi
      Date and time
      April 18, 2012, 9:24AM
    • ........ and yet Valerian keeps me awake even more so. go figure.

      Commenter
      OKFJ
      Location
      down by the bay
      Date and time
      April 18, 2012, 10:03AM

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