Nature's second course

Do not lose sleep over insomnia, says the physic. Resort more to behavioural changes and less to pills. The rest is zzz...

Published: Tuesday 31 August 1999

-- (Credit: akhilesh)despite intensive research for over 50 years, very little is known about sleep. One thing, however, is clear: it is not a luxury. Everybody needs sleep. But how much sleep one needs is also not clear. No biological signal has been found so far that indicates exactly when you have slept enough in a given 24-hour period. Physicians who deal with this growing problem say an adequate sleep is that which produces a full degree of daytime alertness and feeling of well-being the following day.

Among sleep-related disorders, insomnia is the most common complaint, with about 30 per cent of urban adults suffering from it occasionally and 10 per cent reporting chronic insomnia. Not surprisingly, urban chaos has more than something to do with insomnia. The National Institutes of Health in Bethesda, Maryland, usa , define insomnia as the perception or complaint of inadequate or poor-quality sleep. Insomnia is not defined by the number of hours of sleep or how long it takes to fall asleep. The reason could be one or more of the following:
- difficulty in falling asleep;
- waking up frequently at night and having difficulty returning to sleep;
- waking up too early in the morning; and
- unrefreshing sleep.

Failing to get good sleep at night not only makes a person less efficient the next day but can also slow down the recovery from an illness or lead to emotional or mental problems. When problems in sleeping last more than a few days or persist after a stressful event, it may signal a sleep disorder.

A recently published study offers some effective options to get a good night's rest. Charles Morin and his team from Laval University in Quebec, Canada, report that in the short-term, behavioural treatment accompanied by drug treatment can be effective for dealing with insomnia in older people. But improvements in sleep are better sustained over time with behavioural treatment. Adopting a few basic habits like limiting the amount of time you spend in bed works better than pills in controlling chronic insomnia ( Journal of American Medical Association , Vol 281, No 11).

Yet, much remains mysterious. Despite thousands of hours measuring the brain waves of unconscious subjects, monitoring their breathing and noting the effects of sleep deprivation, scientists still do not know the answers to some of the most basic questions, such as why we need to sleep in the first place.

Insomniacs are so desperate that they are prepared to try out anything to get a few hours of undisturbed sleep. Everybody experiences a sleepless night or two at some point. The subjects in Morin's study -- all of whom were over 55 years of age -- had been fluffing up their pillows in vain for 15-20 years. Most of them had no trouble falling asleep. The hard part was staying asleep through the night.

After excluding patients whose insomnia may have resulted from some other conditions such as depression, researchers divided the remaining 78 subjects into four groups. One group took the sleeping pill Restoril. The second group underwent cognitive-behaviour therapy designed to promote better sleep habits, among other things. The third group received both medication and behaviour therapy, and the fourth group took a placebo, or sugar pill. Each of the groups was treated for eight weeks.

Not surprisingly, the sleeping pills helped patients sleep longer right away. But the results were not really different, at least in the short term, from those provided by behaviour therapy and the combined treatment. And when the researchers contacted their subjects two years later, only the behaviour-therapy group had maintained its initial recovery. As soon as participants stopped taking sleeping pills, the sleepless nights returned.

This study assumes more significance in view of a recent report by Julie Carrier and her team from the University of Pittsburgh School of Medicine, usa , that quality of sleep begins to deteriorate during what many consider the most productive years -- the middle age, which is much earlier than previously estimated. Carrier and her colleagues tracked sleep patterns in 110 healthy volunteers between 20 years and 59 years of age. They found that sleep changed dramatically between the 20s and the 50s. They found that, with age, people go to bed and get up earlier, sleep less, wake up more during the night, have more light stages of sleep and fewer deep stages.

So, what is on the offer for insomniacs? For starters, restrict your time in bed to two activities: sleep and sex. If you don't fall asleep within 20 minutes, get up and read quietly in another room so that your brain associates your bed with sleep, not anxiety. Meanwhile, work with your body instead of against it. Avoid napping after 3 pm. Cut down on caffeine, especially in the afternoon or evening. Avoid alcohol at night as it may allow you to fall asleep more easily but you are likely to suffer a rebound effect in a few hours. Getting up at the same time every morning is also important, because that makes it easier to synchronise your body's biological clock. Whatever you do, do not panic if you become sleepless once again. The most important message is that there is no simple prescription to insomnia.

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