Wednesday, February 19, 2014

To Sleep or not to sleep?

We all try and do it each and every night. Babies will do it for 20 to 22 hours each day and Teenagers seem to take to it like a duck to water. But for many people, trying to get a good nights sleep can be a challenge. Each year more than 5 million prescriptions are written in Australia, a rise of almost 9% since 2001. And a study released in 2011 found 95 per cent of patients who went to the GP to report an issue with sleep were given sleeping pills. These are very worrying trends and ones that we need to reverse as soon as possible. 

Recently, our nocturnal sleeping habits have been in the news because of the concern about the negative impact that these Sleeping Pills can have on our health. It’s been known within the medical community for many decades that giving sleeping pills to older people increases the risk of falls, confusion and the very real potential for serious interactions with other powerful medications that they take. But a report, released last year has now highlighted a possible link between taking these medications and premature death.
According to Daniel F. Kripke, MD, of the Viterbi Family Sleep Center at Scripps Health in San Diego, his study shows that (quote) “sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease and other ailments." (unquote) In fact even those who reported taking between 1 and 18 sleeping pills in one year increased their risk of premature death by a factor of 3.6.

Their study is not only an interesting read, but it should sound alarm bells ringing within the wider community about the safety of sleeping tablets and why people need to take them. Despite the 2011 study findings about the ease with which sleeping pills appear to be prescribed, in my experience, most people within the medical profession treat sleeping tablets with the
respect and will generally only prescribe them when the benefits of using them outweigh the potential harm that they may cause - and then only for a very short course too. But for many with sleep disturbance there are usually some other underlying issues that need to be looked at such as:
Stress and anxiety 

All of which need to be attended to before one reaches for the sleeping pill bottle. The challenge here is that if you’ve missed several nights sleep, the benefits of a long term sleep hygiene program seem less attractive than popping a pill to get you to sleep that night - hence the emotional pressure on the treating doctor to use short term hypnotics as an aid to achieving a longer term, non sleeping pill associated goal. 

But another article which intrigued me from the New York Times, was on the subject of what is “Normal Sleep”? Because if we can’t define normal sleep and pass that onto our patients, then many people may ask for help when, in fact, they are having a “normal” nights sleep.

The article was based on the work of the historians Ekirch (2005) and Koslofsky (2011) who propose the theory that before the Industrial Revolution, segmented sleep was the normal pattern. In these pre- industrialized times there were two distinct sleep phases that were bridged by a period of wakefulness. In fact, during this wakeful period people used the time to reflect and pray: for the tired labourer who went to bed “dog tired”, this was the time that they usually had sex: and for the poet and writer these early hours were often the most fruitful as they were able to write uninterruptedly.
Some people used to get up and visit the neighbours and of course, it was also the time when the “bad guys” went and did their evil deeds!

Today, there is sound scientific evidence that a midday nap associated with nighttime wakefulness is associated with greater alertness than with the “mono-phasic” sleep-wake cycle - or a straight eight hours.

According to Eklrcks theory, it was the introduction of street lighting that allowed people to stay up later, and that, coupled with domestic lighting, started the trend to longer social evenings. With longer evenings came the idea that an eight hour sleep should be the “norm”. But according to Erlick there are abundant references throughout literature that refer to “first sleep” or first waking, with examples to be found in Shakespeare, Homers Odyssey as well as many personal records of lay persons who were able to write in centuries past.

If Erlick and Co are correct in their assessment, then I would suspect that millions of people will take a big sigh of relief and realize that their sleep patterns are “normal” after all.

In this 21st century of ours we like to have everything neatly packaged and labelled so that we have a feeling of control - and for many millions of people, this applies to their work/play/sleep cycles too. If there is one thing that sleep and dreams teach us, it’s that in the sleeping state there is no control and that we still have so much to learn about what sleep actually is and what dreams are.
For those who would like to improve the quality of their sleep, then my suggestion is to try to improve your sleep “hygiene”. So here are a few tips taken from the Mayo Clinic that I hope will enhance your quality of sleep over the months ahead.

  • Stick to a sleep schedule in other words. try to go to bed at around the same time each night.
  • And if you're not sleeping Give yourself 20 minutes and Get out of bed. read a book or magazine until you are sleepy and then try again.
  • Avoid the temptation of trying to sleep when you can’t. The frustration this causes will only make you more alert
  • Use your bed and bedroom for just two things: sleeping or sex. PLEASE, no TV or computer screens in the bedroom.
  • Find ways to relax. A warm bath before bedtime can help prepare you for sleep. Having your partner give you a massage also may help relax you. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer.
  • Try and take your Exercise and physical activity. at least five to six hours before bedtime.
  • Avoid or limit caffeine, alcohol and nicotine in the evening. 
  • Avoid large meals and beverages before bed. 
  • Check your medications. Especially anti-cold and flu medications.
  • Don't put up with pain. See your Doc.
  • Hide the bedroom clocks. The less you know what time it is at night,
    the better you'll sleep. 

     Happy dreams
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1 comment:

Fakhita Sousou said...

Thank you for sharing this thought provoking post
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