Insomnia - Health Wellbeing - Abc


02:25 | Author: Kate Thompson

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Insomnia - Health Wellbeing - Abc

It doesn't help if you have reduced ability to perform activities that previously kept you occupied; for example impaired vision or hearing which means you can no longer read or watch evision, or perhaps painful hands from arthritis make knitting impossible. These problems often underlie frequent, but unwise, requests for sleeping medication. Boredom is also compounding problem, especially if living alone, it makes you inclined to try to use sleep to fill your empty hours. Top.

About 5 per cent of adults report chronic problems with insomnia and those with depression or ongoing anxiety issues are the highest risk group.

There is no specific test to diagnose DSPS, although measuring the sleep-wake cycle over a period of weeks using activity monitoring plus or minus a sleep diary would certainly help.

It's often said that older people need less sleep, and they certainly need less sleep at night to feel alert during the day compared with much younger people. Your ability to "extend" sleep and "sleep-in" diminishes over age 65 and this occurs primarily because of age-related changes to the sleep centre in the brain.

Some antidepressants are quite sedating, but in general it is not recommended to use them for this purpose alone. (However, sleep disturbance is a common symptom of depression, and effective treatment of the condition – which may involve antidepressants – can go a long way towards fixing the sleep problems.) The earlier antidepressants – amitriptyline, nortriptyline, doxepin and related compounds – were more commonly used as sleeping medication, but their side effects and safety profile makes them far from ideal for this use.

However, as you get older you are more likely to get a range of sleep disturbing illnesses, such as issues with the prostate gland in men (which can increase the need to urinate at night), chronic pain (from arthritis for example), the side effects of certain medications, and conditions that affect the central nervous system, such as dementia and stroke.

The most commonly prescribed prescription sleeping medications are members of the benzodiazepine family, which includes temazepam (Temaze, Normison) and nitrazepam (Mogadon, Alodorm).

Sleeping in and insomnia.

However, if you can't prolong this sleep into the morning, then drowsiness and tiredness will follow you into the day. Usually, it presents as difficulty getting to sleep – often not before 2am – with consequent problems rising at 'normal' times, such as 7am or 8am. If you are able to sleep for the full seven to eight hours, you feel fine – just late for everything in your life.

Lack of sleep is also linked to a wide variety of negative outcomes including impaired concentration and memory, as well as an increased risk of heart disease, diabetes and industrial and motor vehicle accidents. However, most patients with insomnia are not sleep deprived but just perceive poor quality sleep.

Reviewed by Ron Grunstein, professor of sleep medicine, University of Sydney.

Long-acting benzodiazepines (eg Valium) also increase the risk of falls, although short-acting forms (such as Temazepam) do not. Their main problem is that with continued use, they may create chemical dependence and may lead to addiction. They are appropriate for occasional use – such as in the early stages of bereavement or for short periods, say, during hospitalisation.

There is no shortage of products on the market that claim to induce a natural sleep without side effects, but you should regard these claims with scepticism.

You should take particular care with many so-called 'natural medicines', as depending on the source, there can be issues with the quality control, accuracy of dosage and contamination of the supplied product.

The good news is most forms of insomnia are treatable. Around a third of all Australians report having problems getting to sleep, staying asleep or waking too early. Published 21/01/2010.

You might feel tired in the day, but hopefully that will be temporary. That means avoiding sleep-ins while you're trying to fix an insomnia problem. Establishing a regular sleeping and rising routine can also be very helpful in overcoming insomnia. Remember, your alarm is your friend! Top. Advice often centres on going to bed at the same time each night, but a regular rising time – regardless of the quality of sleep the night before – is actually more important.

These might include: The bed-sleep link. Specialist help can be very helpful, but it's worth trying some simple measures on your own first. Improving poor sleep habits usually involves changing some of your beliefs and behaviours concerning sleep and possibly aspects of your lifestyle as well.

If your insomnia follows a consistent pattern where you have difficulty getting to sleep until the early hours of the morning, you may have delayed sleep phase syndrome (DSPS).

Top. And insomnia is also a risk factor for depression and anxiety, although it can also be a symptom of these conditions.

Although it is hard to know how common DSPS is, it is thought to be one of the more common sleep disorders and occurs when your body clock is 'out of synch' with the environment.

The fact that sleep deprivation has been used as a psychological torture says it all. We don't do well if we don't get enough sleep. The cost of insomnia to the Australian economy is estimated at $220 billion annually in medical and lost productivity costs.

Some research suggests there are links between insomnia and your immune system.

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Women report symptoms of insomnia nearly twice as often as men and almost 50 per cent of adults over 65 describe some symptoms at least a couple of nights per week. Older women in particular seem prone to more prolonged insomnia.

Like benzodiazepines, these drugs may cause bizarre behaviours (especially if taken while you are trying to stay awake, or if mixed with alcohol), however, these events are rare. Newer drugs include Zopiclone (Imovane or Imrest) and Zolpidem (Stilnox), both of which have been the subject of adverse publicity. Stilnox now carries a consumer warning which says it may: "be associated with unusual and potentially dangerous behaviours whilst apparently asleep".

It is treatable and with persistence, the sleep pattern will return to a more usual form. Key treatments involve melatonin along with attention to light exposure in the morning and avoidance of light in the evening. (For more information on melatonin, see the 'Treatments' section under 'Medications – Prescription'.).

Insomnia in the elderly.

If you think you might have insomnia, your GP should be your first port of call. Behavioural. They will take a detailed history and may be able to suggest some strategies to overcome the problem. You may also be referred to a specialist – either a sleep physician, a psychologist or both – for further advice and/or assessment.

Definitions vary, but the Australasian Sleep Association says, if you have difficulty "falling asleep, going back to sleep or waking too early" and you have periods in bed when you are awake for longer than 30 minutes, you have insomnia.

However, an important element of the condition is that you are dissatisfied with the quality or amount of sleep you receive despite allowing yourself adequate time in bed.

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Prescription. Some over-the-counter items based on antihistamines have sedation as a side effect of their primary function in treating allergies. For occasional use in strict accordance with the instructions, these are safe enough but they don't address the problem in the long term because they stop working after a few days.

While this is true to an extent (it can help you drop off to sleep by making your more relaxed), its overall effect is negative because it fragments sleep, making you wake more often. Top. Many people think alcohol can help you to sleep.

Delayed sleep phase syndrome.

Insomnia is more than the odd night of disturbed or unsatisfying sleep.

A key aspect of insomnia treatment is helping your brain learn that when you are in bed, you want to be asleep. To strengthen the association your brain makes between your bed and being asleep, it helps to limit as much as possible the time you spend in bed awake ie:.

Top. Young to middle-aged adults are more likely to develop insomnia after major life events, such as separation, divorce or death of a spouse or partner.

Flunitrazepam (Rohypnol), a more potent member of the group, has such potential for abuse that – in New South Wales at least – it has been placed on the restricted drug list (Schedule 8 of the Poisons Act), the same category as narcotic drugs.

Melatonin, a hormone naturally occurring in the pineal gland of mammals, is associated with sleep induction as its levels increase as night approaches and decrease with exposure to bright light in the morning. (It is also available in homeopathic – highly dilute – form over the counter, but its efficacy in that form is compley untested and unlikely to be of any benefit). Its prescription form has some benefit in the treatment of jet lag and delayed sleep phase syndrome, but is not as yet widely promoted for insomnia in the long term.

Valerian, an extract from the root of a plant by the same name, is used for sleep but its effectiveness is very limited.

Other causes of insomnia include: Alcohol and insomnia. By far the most common cause of insomnia is poor sleep hygiene, which is medical jargon for bad sleep habits (for more information about this, see 'Treatments' below).

In several Australian surveys, around one third of people reported having at least one insomnia symptom (such as difficulty initiating or maintaining sleep or feeling the quality of sleep was inadequate) each month.

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Medication should preferably be used for short-term management of insomnia as an adjunct to behavioural treatments. However, there is some recent evidence that certain medications can be effective if used for periods up to six months. Non-prescription.