Sleeplessness and poor sleep (insomnia)

Many people at some point in their life may find it difficult to sleep or continue sleeping. It causes a lot of discomfort and may increase stress.

You have insomnia when you have difficulty falling asleep, difficulty staying asleep, or both. It can last for a few days, weeks or months.
You can manage insomnia by changing your behaviour towards sleep.

Depending on the cause of your insomnia, you may need treatment to prevent complications.

If you have insomnia, you may experience one or more of these symptoms:

• You may feel sleepy during the day time and awake at night.
• You may be unable to sleep at all.
• You may wake too early and find it difficult to get back to sleep.
• You may feel tired or feel like you need more sleep, after sleeping as usual.
• You may feel stressed more than usual.

Insomnia is often caused by stressful life events or trauma, travel and work that disrupts your normal sleep patterns, poor sleep hygiene, medicines (like antidepressants and water pills for high blood pressure), mental health disorders, medical conditions (like heart disease), sleep-related disorders, excessive use of stimulants (like coffee) and eating heavy meals late at night.

Your risk for insomnia is higher if you experience any of the following factors :

• If you are a woman. This may be due to hormonal shifts during your menstrual cycle, pregnancy and menopause.
• If you are under a lot of stress. This may be a stressful event or accumulated stress over time.
• If you travel to a far away country with a different time zone may cause sleeping issues.
• If you work at night. Your brain can get accustomed to being awake at night.
• Older adults tend to be more at risk of insomnia.
• If you take coffee, caffeine, alcohol or recreational drugs like weed.
• Having a family history of insomnia.
• Certain physical or mental health conditions can put you at risk of insomnia.

Whatever your reason for sleep loss, not getting enough sleep can take a toll on your health, visit a healthcare provider if you notice that:

• You lose sleep because of discomfort or pain in any part of your body.
• You depend on certain drugs or alcohol for sleep.
• You lack focus and feel sluggish and sleepy during the day, this may lead to errors or accidents.
• You get worried and anxious about sleeping.

You can reduce the severity and duration of your insomnia through self-care:

• Keep your bedtime consistent all through the week.
• Keep physically active, getting as much exercise as you can.
• Ask your healthcare provider to review your medicines and suggest alternatives for those that contribute to insomnia.
• Drink water instead of tea or coffee.
• Quit smoking. Your healthcare provider can help you with this.
• Avoid eating a lot before bedtime, hefty carbohydrate meals.
• Make your bedroom comfortable for sleep and only use it for sex or sleep.

The treatment depends on the underlying cause and the type of insomnia you have.
Self-care tips:

• Establish a sleep routine. Read a book, listen to music, or take a bath before you go to sleep.
• Implement some sleep hygiene practices. Don’t use your bed for anything other than sleep and sex.
• Make the room cool and dark to put your body in a sleepy mood.
• Avoid taking your phone with you to bed.
• Avoid going to bed hungry or immediately after a meal.
• Limit caffeine and alcohol intake, especially at night.
• Eat a healthy diet to boost your overall well-being.
• Exercise more. Exercise helps you fall asleep more easily.
• Do breathing and relaxation exercises, especially before sleeping.
• You may also use over the counter medicines (like diphenhydramine 25mg only before bed).
• Supplements like melatonin may be useful in some patients.

Treatment Options:

Your healthcare provider will talk to you about what treatments may be appropriate. You may need to try several different treatments before finding the one that is most effective for you. Some options include:

• You may be referred for counselling or a behavioural therapy.
• Your healthcare provider can prescribe drugs to make you sleep or relax if this will be helpful (like Lexotan).
• Your healthcare provider may recommend meditation to you. Meditation aids like mild incense or soft music may also be useful in therapy.
• Your healthcare provider can refer you to another doctor if you have any underlying health issues causing your insomnia.

Insomnia causes a lot of discomforts and disrupts the quality of a patient's life. It can however be treated effectively using one or more interventions. It is important to implement sleep hygiene and keep a sleep diary (or use wearable technology to record sleep). This can help your healthcare provider identify issues and work with you to resolve your most pressing sleep needs quickly.