We spend nearly a third of our lives sleeping. It is hard to understand how important sleep is to staying healthy and feeling your best until you haven't slept enough. Sleep is critical for the formation of memories and it helps us repair and restore our organ systems including our muscles and our immune systems. Perhaps this is why so many people come to us seeking help with their sleep when they experience insomnia. Let’s review how we assess insomnia and look at the ways that we can help.
First, we should distinguish between acute and chronic insomnia. Acute insomnia lasts for less than thirty days and is often provoked by a stressful event, pain, medications or an illness. If it is well managed and the underlying issue improves, things usually return to normal quickly. This article is focused on a different form of sleeplessness-chronic insomnia. Insomnia is called chronic when a person has insomnia at least three nights a week for three months or longer and we may have recommended that you read this to help us both sort out why you are having trouble sleeping and how we can help.
How do we assess insomnia?
The first step is to search for physical causes which can include:
Pain
The need to urinate at night
Sleep apnea. You can take a simple test here.
Restless leg syndrome
Psychological disorders such as depression or post traumatic stress disorder.
Perimenopausal symptoms in women, like flushing.
The next step is to make sure that medications aren’t causing a problem. Many medications can interfere with sleep. Some examples are:
Stimulants.
Medications for depression or anxiety.
Steroid medications. These are used to treat conditions that cause inflammation.
Opiates or painkillers.
We should talk about whether we can change any of your medications to see if they are interfering with your sleep.
Next we should also talk about your sleep habits. Sometimes our behaviours can interfere with sleep and when we change them, sleep improves. Some examples include:
Napping
Inconsistent timing of bedtime and wake time
Anxiety about sleep.
Clock watching.
Environmental disturbances (children, pets, bed partner, electronics).
How do we treat chronic insomnia?
Now that we have reviewed some of the causes of chronic insomnia, let’s review the idea of “Good Sleep Hygiene.” This list of behaviours may help with insomnia and it is worth trying them out. I like this list that comes from the American Academy of Sleep Medicine:
Keep a consistent sleep schedule. Get up at the same time every day, even on weekends or during vacations.
Set a bedtime that is early enough for you to get at least 7 hours of sleep.
Don’t go to bed unless you are sleepy.
If you don’t fall asleep after 20 minutes, get out of bed.
Establish a relaxing bedtime routine.
Use your bed only for sleep and sex.
Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
Limit exposure to bright light in the evenings.
Turn off electronic devices at least 30 minutes before bedtime.
Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
Exercise regularly and maintain a healthy diet.
Avoid consuming caffeine in the late afternoon or evening.
Avoid consuming alcohol before bedtime.
Reduce your fluid intake before bedtime.
There are also some nice tips on relaxation techniques to promote healthy sleep at Healthlink BC.
For patients who have not improved after treating underlying conditions and removing medications that interfere with sleep and when sleep hygiene hasn't helped, there are studies that show that cognitive behavioural therapy can help. We can help with information and referrals and resources in our community.
Preparing for your visit:
When you come to your appointment please let us know if any of these conditions or medications are relevant for you. Please also let us know if you have tried changing habits or if you have tried working on your “sleep hygiene”.
Finally, no discussion of chronic insomnia is complete without a word or two about medications. We would really like to avoid prescribing medication for sleep, especially over a long period of time. There are multiple risks with the use of sleeping pills and these risks rise with age. Here are some articles that review the risks:
Choosing Wisely: Insomnia and Anxiety in Older People: Sleeping pills are usually not the best solution
Mayo Clinic: Prescription Sleeping PIlls, What’s Right for You?
Healthlink BC: Insomnia: Should I Take Sleeping Pills?
Therapeutics Initiative: To Sleep or Not to Sleep: Here Are Your Questions
