It was a bad night. You didn't get to sleep until after 1 a.m., then you tossed and turned until close to daybreak. Yet here you are, up at 7 a.m., grumpy as an old bear.
You are not alone. Sleep -- or lack of it -- is a significant health issue in North America.
About 30 per cent of the population has disturbed sleep and 10 per cent meet the diagnostic criteria for insomnia. Insomnia is difficulty in falling asleep or staying asleep, even when the person has the chance to do so.
At some point, most of us have experienced acute insomnia; for example, the night before an exam, worrying about finances or experiencing jet lag. It commonly tends to resolve without treatment.
Insomnia is considered chronic if it happens at least three nights a week for three months or longer. The consequences of chronic insomnia are varied and include impaired cognitive function, poor quality of life, increased incidence of bodily pains, poor general health, decreased job performance and increased risk of accidents.
Insomnia can be triggered by medical or psychiatric issues. Many cases of insomnia start with an acute episode, then evolve into long-term problems, mostly because the people affected tend to adopt unhealthy sleep habits such as getting up in the middle of the night or drinking alcohol before bedtime. Once the problem becomes more chronic, worries and concerns such as "I will never sleep" start to become associated with bedtime, which reinforces the cycle of insomnia.
This is why it is important to address insomnia instead of letting it become the norm. If you have trouble sleeping on a regular basis, it is a good idea to review your sleep habits. Simple steps to improve sleep include:
- Don't go to bed unless you're sleepy.
- If you are not asleep after 20 minutes, get out of bed and find something very relaxing to do, preferably in another room. Your bedroom should be the only place where you sleep. Once you feel sleepy again, go back to bed.
- Begin rituals that help you relax each night before bed. A few minutes of reading or a warm bath are two ideas. Practise simple breathing exercises and disconnect from close-range electronic devices (laptops, phones) that can disrupt your sleep.
- Get up at the same time, within reason, every morning, even on weekends and holidays.
- Avoid taking naps. If you must take a nap, keep it short (less than one hour) and avoid napping after 3 p.m.
- No caffeine after lunch, no alcohol within six hours of your bedtime.
- No smoking before bedtime. Nicotine is stimulating.
- Avoid heavy exercise within six hours of your bedtime.
- No big meals near bedtime.
- Assign "worry time" earlier in the day.
Cognitive behavioural therapy (CBT), which includes psychological and behavioural techniques, can also be used to treat insomnia. CBT challenges unhealthy beliefs and fears around sleep and teaches rational, positive thinking. Relaxation training, breathing exercises, mindfulness meditation and guided imagery can help to calm the mind and induce sleep. Exercise and body-mind work, such as yoga, can also be very helpful. Some of these techniques can be self- taught, while for others it is better to work with a trained therapist.
If insomnia continues to interfere with your daily life, talk to your doctor to see if sleep aids might be right for you. The Winnipeg health region offers help through the Sleep Disorder Clinic at Misericordia Health Centre.
For more information, visit www.misericordia.mb.ca/Programs/SleepDisorders.html.
Dr. Eleni Giannouli is an assistant professor in the department of internal medicine, section of respirology, University of Manitoba, and an ABIM sleep medicine certified physician. She is the medical director of the Sleep Disorder Clinic at the Misericordia Health Centre.