01 Jan Two Common Myths and Multiple Ways to Treat Insomnia

Myth #1.  As we steel hours from our sleep to do “more productive tasks,” we assume that those lost extra hours will not be detrimental.  Truth – Sleep deprivation has numerous repercussions.

Myth #2.  Many people think that insomnia is always caused by another underlying disorder.  Truth – Often insomnia is a primary disorder.

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Sleep Deprivation Repercussions
1.  Increased Accidents – The National Highway Traffic Safety Administration estimates that sleep deprivation causes 100,000 auto accidents and 1,550 crash related deaths a year.  An Australian study found that sleep deprivation for 18-24 hours produced similar impairment as a blood alcohol level of 0.8, which is considered legally drunk.

2.  Poor Memory – The American Academy of Sleep Medicine found that sleep deprivation had an equal effect on academic performance as binge drinking and marijuana use. Lack of sleep hinders long-term memory formation.

3.  Impaired Judgement – We all know that sleep deprivation impairs attention, alertness, and concentration. It also affects reasoning and problem solving. A study published in Lancet revealed that sleep deprived physicians took 14% longer to complete tasks and made 20% more errors.

4.  Depression, Anxiety, Hyperactivity, and Impulsivity.

5.  Diminished Labido

6.  Weight gain – According to one study, people who sleep less than 6 hours a night were almost 30% more likely to become obese.

7.  Increased Mortality – Many health problems are associated with sleep deprivation such as Heart disease, High Blood Pressure, Strokes, and Diabetes.  The “Whitehall II Study” which studied 10,000 British civil servants found that people who slept 5 hours or less doubled their risk of death from all causes.

Secondary Insomnia is defined as Insomnia that is caused by another underlying cause.
1. Psychiatric illnesses – Depression, Anxiety, Substance Abuse, Posttraumatic Stress Disorder
2. Medical Conditions – Pulmonary disease, Heart Disease, Hypertension, Cancers, Diabetes
3. Sleep disorders – Obstructive Sleep Apnea, Periodic limb movements, Restless leg Syndrome, Circadian rhythm sleep-wake disorder (Jet lag is the most familiar.)
4. Medications

Primary Insomnia – One should treat possible causitive processes first.  If treating those underlying disorders does not solve your sleep problem, you likely have primary insomnia.

16 Tips For a Restful Night

1. Avoid caffeinated beverages after lunch
2. Keep your room in the ideal temperature range.  62-68 degrees seems ideal.
3. Keep a regular sleep schedule
4. Use bedroom only for sleep and sex.  Remove the TV from the bedroom.  Don’t do work in the bedroom.
5. Exercise regularly for at least 30 minutes most days of the week, preferably 4 to 5 hours before bedtime.
6. Maintain a healthy body weight.
7. Avoid excess alcohol use.  Avoid alcohol near bedtime: no “night cap”. Alcohol may help you get to sleep, but it significantly diminishes the quality of your sleep
8. Dress comfortably.
9. Limit stress.  Consider meditation.  Deal with your worries before bedtime.
10. Hide the clock, if you are a clock watcher.
11. Avoid prolonged use of light-emitting screens before bedtime.  Avoid TV, laptops, smartphones, and iPads.
12. If can’t sleep get out of bed after 5-10 minutes.
13. Avoid naps during the day.  Each of us requires an ideal number of hours of sleep per 24 hours. Napping decreases the number of hours you will sleep at night.
14. Sleep only as much as you need to feel rested and then get out of bed.  The ideal number of hours each individual needs is different. It will also change with each season of life.
15. Avoid smoking, especially in the evening.
16. Do not go to bed hungry.  Contrary to popular belief, a small snack will not make you gain weight. Weight gain is caused by consuming too many calories in a 24 hour period of time not snacking before bedtime.

Over-the-Counter Remedies

1. Herbal products – The most studied are Valerian, Chamomile, Kava, and Wuling. Little good scientific data suggests they work. 14 well designed trails with over 1600 patients found no significant defference between those taking the hebal remedies and placebo. Valerian was the only substance that had more side effects than placebo. It has been shown to also cause liver inflamation.
2. Melatonin – Predominately two groups of people respond, those with jet lag and those with low melatonin levels.
3. Alcohol – As discussed earlier, alcohol can reduce the time it takes to get to sleep. I also promotes sleep disturbances late in the night. Alcohol also has the risk of dependence.
4. Diphenhydramine (Benadryl) – Diphenhydramine in the acive ingredient in many over-the-counter medications. It stays in the blood stream a long time. Sedation the next day can be an issue. Other side effects include blurred vision, dry mouth, constipation and difficulty urinating.

Many pescription medications are available for the treatment of insomnia if all the above remedies are not helpful. Seek the attention of a good physician to see which one would be best for you.

Controversies of Treating Elderly With Prescription Sleep Aids

Use caution if you are taking an sleep medication and you are over the age of 60.  Side effects of sleep medicatons including excessive sedation, mental fogginess, night time wandering, confusion, hallucinations, impaired balance, and fractures are all more prominent.

There is also controversy about the effects sleep medications have on mortality and the development of cancers in the elderly.  So far only observational trials have found an association.

Observational trials can not prove one disorder causes another.  They only show an association.  One explanation for the incresed mortality found in elderly is that older people treated for insomnia are more likely to have a serious underlying medical condition.  It is not the medication used to treat the insomnia that increases the death rate.  It is the underlying deadly medical condition that just so happens to also cause insomnia.

Until this question is settled, if you are over the age of 60, use sleep medications sparingly.

3 Summary Points about Insomnia

• Getting adequate sleep is important for good mental and physical health.
• There are many ways to improve insomnia without medication.
• Primary insomnia is common.  Seek treatment from a good physician if the recommendations above do not help.

Here’s to the Journey!