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“ A well-spent day brings happy sleep “ says Leonardo da Vinci. Sleep impacts on our memory and the restoration of our body systems.
Insomnia is a common sleep disorder in Singapore - with a local reported rate of 15.3%. A local study also found that 13.7% of older adults aged 60 and above were reported to experience insomnia.
So what is Insomnia?
It is defined as the inability to fall asleep or difficulty to stay asleep,
or if the individual wakes up still feeling tired or poorly-rested. This low quality rest constituting to poor function of daily activities and daytime sleepiness over the period of more than 1 month.
Causes of Insomnia
There are many causes for insomnia., some of the common causes are
Stress can provoke a profound reaction in the body that poses a challenge to quality sleep. This stress can come from work, school and relationships. When the body responds physically to the stress, the body goes into this heightened Hyperarousal state that makes it harder to sleep.
Imagine if you were constantly under stress to complete that work project before the deadline in two weeks, would you be able to sleep well? Many patients report that they may be thinking about work so much that the moment they close their eyes, they visualise their computer in their mind. This inability to sleep may itself become a source of stress, making it increasingly harder to break the cycle of stress and insomnia.
2) Irregular sleep schedules
In an ideal world, the body’s internal clock closely follows the daily pattern of day and night. Hence the timing best suited for sleep would be at night.
However in reality, many people have sleep schedules that disrupts this internal clock. Two well known examples are shift-work and jet lag.
Shift work that requires a person to work through the night and sleep during the day will have a profound disruption to the body clock. Many patients may develop insomnia as a result.
3) Mental health disorders
There are many mental health disorders that may give rise to insomnia. Depression, Anxiety, bipolar disorders and more . Its estimated that 40% of people with insomnia have some form of mental health disorder.
These conditions can cause pervasive negative thoughts and mental Hyperarousal that disturbs sleep. In addition, it is also known that insomnia may exacerbate these mood and anxiety disorders.
4) Unhealthy habits and routines
There are many habits and routines in our modern world that can contribute to insomnia :
- Keeping the brain stimulated until late in the evening such as by working late, playing video games or using personal electronic devices like your handphones
- Napping long durations and late in the afternoon can throw you off your sleep timing and make it hard to sleep at night.
- Sleeping in later on weekends or off days to make up for lost sleep can again confuse your body’s internal clock.
- Using your bed for activities besides sleep can create mental associations between your bed and wakefulness.
- Consuming drinks high in caffeine like coffee or tea too close to bed time makes it harder to sleep.
- Nicotine in cigarette smoke is also a brain stimulant that can negatively affect sleep. Hence smokers may have a higher chance of insomnia.
- Alcohol is a drug that can actually disturb your sleep cycle causing fragmented, non-restorative sleep.
- Taking heavy meals and spicy food too close to bed time can also generate sleeping problems.
5) Medical conditions
There is also a multitude of medical conditions that can contribute to insomnia. Some of the common medical conditions includes
- painful disorders like headaches, neck pains or back pains
- neurological conditions like dementia or ADHD.
- specific sleep disorders like obstructive sleep apnoea or retells leg syndrome.
6) Advancing age
Elderlies above 60 have a big problem with sleep. These patients tend to have multiple chronic medical conditions and mental conditions that may make sleep challenging.
In addition their sleep pattern is less efficient. They spend less time in deep sleep and REM sleep. As a result, they maybe woken up by the slightest of distractions.
Is insomnia an issue?
Yes of course. It has been reported that insomnia can result in
- higher probability of developing chronic medical conditions such as hypertension, type 2 diabetes and cardiovascular disease
- It is an independent risk factor for developing mental illnesses in otherwise healthy individuals.
- it causes increased work absenteeism, lower productivity
- even an increased rate of road accidents.
- overall results in poorer quality of life and impaired the individual’s ability enjoy life
Now this is a simple questionnaire for you guys to try out to see if you have any clinical insomnia.
10 ways to sleep better
- Set up a wake time and sleep time and stick to it daily. Try to maintain this timing even during weekends
- Set up your sleep environment to hypnotise you to sleep. Make it like a spa if you wish. Dark, cool and spacious. Put on soft ambient music or sounds of waves or trees rustling in the wind. Use lavender or other aromas.
- Set up and practise a relaxing pre-sleep routine. For example, 1 hour before bed, switch off all electronic devices and TV and read a book. Have yourself a light snack like a biscuit and a warm glass of milk.
- Prepare your body to sleep starting from the afternoon. Stop caffeine 6 hours before sleep. Cut down afternoon nap to a maximum of 30 minutes.
- Go to bed only when you feel sleepy. Otherwise stay out of the bedroom and do something relaxing till you feel sleepy.
- If you wake up at night and find it hard to sleep, again, get out of the bedroom and do something relaxing until you are sleepy before hitting the bed again.
- Engage in exercise of at least 15-20 minutes a day to deepen sleep
- See a doctor if you are experiencing emotional symptoms such as depression and anxiety or other mental conditions that can cause insomnia. Or see a doctor if you are in pain or having other medical conditions that are not well controlled.
- Stop looking at the clock or your watch if you are unable to sleep, as it may make you frustrated and even more awake because of mental over-arousal.
- Make a plan of your schedule and activities for the next day so that you can quit worrying about what will happen tomorrow.
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)