Sleeping Problems

What is insomnia?
Insomnia can be defined as any severe problem falling asleep or staying asleep. Insomnia is a rather common problem, affecting about 30% of all adults. Insomnia is more common among women and older adults but can occur in people of all ages and all social classes.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) primary insomnia is defined as a complaint of difficulty initiating and/or maintaining sleep or a non-restorative sleep for at least 1 month.
The definition of an international sleep medicine organization (Classification of Sleep Disorders-Revised ICSD-R) describes the term "psycho-physiological insomnia" as severe impairment of sleep with decreased functioning during wakefulness. Any sleep impairment longer than 6 month is regarded as a chronic problem.
Insomnia has to be differentiated from circadian rhythm disorder (sleep periods or duration is not according the local clock or usual time) parasomnias (behavioural events like sleepwalking or night terrors interfere with restorative sleep) secondary insomnia (medical and psychiatric problems are the source of the sleep problems.
Other sleep-related disorders like sleep apnoea with additional respiratory impairments or problems or extended sleep or tiredness like narcolepsy are classified in separate sections.
To evaluate the degree of impairment you have to consider the daytime consequences of the problem. Usually insomnia will cause fatigue during the day, with loss of concentration or trouble focusing on tasks. Sleep problems can also have an influence on the mood or psychosomatic complains like hypertension. We know that different factors can contribute to insomnia including psychological issues or psychiatric disorders, environmental factors, stress or medical disorders. Alcohol and even some drugs can also cause chronic sleeping problems.
Short periods with disturbed sleep for a night or two usually do not cause any severe problems. But if it affects daily functions and lasts for weeks, months or even years you should consider professional help.
Transient insomnia is a disturbed sleeping pattern or the inability to sleep well and feel refreshed next day over a period of some days up to 4 weeks.
Almost everybody has had this experience before important events or changes of the daily routine like going on holiday in a foreign country, taking an exam, or after an argument with a close friend or relative. So this type of sleep problems is usually linked to a higher stress level or the inability to calm down at night and stop worrying. But also extreme physical or mental activity close to bedtime (less than 3-4 hours before your usual bedtime) or illness can cause transient insomnia.
Usually no treatment is necessary or recommended. Sleeping pills usually will help. But you should not depend on a pill to find rest and sleep at night. It would be better to identify the sources of stress or worrying and to find a better way to relax in the evening, because of the risk of becoming dependent on sleeping pills.

Nonrestorative Sleep; Sleep Deprivation; Circadian Rhythm Disturbance
In the modern industrialized society many people have severe sleeping problems or a lack of restorative sleep. Instead of feeling refreshed upon awakening they complain about tiredness, lack of concentration, irritability and negative influences of their working performances although they had enough sleeping time.
It is important to consider different aspects of sleep-onset, sleep-maintenance as well as daytime hypersomnolence or impaired daytime functioning.

1. Circadian Rhythm disturbances
Some people have severe sleeping problems due to shift work or interruption of the normal sleeping pattern because they have to take care of a crying baby or an old relative with dementia. Especially adolescents quite frequently do not get enough sleep if they tend to stay up until the early morning hours after a party or long computer games.

2. Psychiatric or organic causes
Insomnia is a common symptom of many psychiatric disorders like depression, manic-depressive disorders or schizophrenia. Chronic pain or heart diseases are two examples of somatic disorders with disturbances of sleep onset and maintenance.
A specialized diagnosis of sleep-related cardio-respiratory disorders with a polysomnographia in a specialized sleep center is necessary if sleep related breathing disorders, narcolepsia or other distinct forms of sleeping disorders are concerned.

3. Sleeping hygiene
There can be a lot of possible causes in the environment or your behaviour that have a negative impact on the quality of sleep.

4. Intake of sleep disturbing substances
Coffeine or nicotine can have a negative influence on your sleep. This is also true for alcohol, although many people believe alcohol would be a good "sleeping medicine". Even some medical drugs can cause insomnia.
So after all a sleep debt will be the consequence of recurrent sleept deprivation or interruption of normal sleeping paterns. If the individual does not get a sufficient amount of the restorative daily sleep that is required. There a large individual differences of the necessary amount. But something between 5 and 11 hours a night will be appropriate.

Reading Bedtime Stories or Singing Songs for Children at Bedtime.
The child appreciates your time together.
He will settle down and prepare himself for the transition from play and activities to sleep and rest.
Children respond well to structure and routines. They like it and recognize things. Chaos and unpredictability, on the other hand, makes them feel unsafe.
There is nothing that says that there must be reading and singing involved; one can also listen to a tape together, playing music and telling a story. It will help the child to go to sleep.
To go to bed is boring, but to listen to a story on a tape in the dark together with mum and dad is fun and the child will fall asleep without any whining or protests.

How could a doctor evaluate my sleeping problems?
A rather simple screening test might help your doctor to evaluate a possible sleeping disorder. Here is a list of 11 questions (Global Sleep Assessment Questionnaire GSAQ):
Did you have difficulty falling asleep, staying asleep, or did you feel poorly rested in the morning? More
Did you fall asleep unintentionally or did you have to fight to stay awake during the day? More
Did sleep difficulties or daytime sleepiness interfere with your daily activities?
Did work or other activities prevent you from getting enough sleep?
Did you snore loudly?
Did you hold your breath, have breathing pauses, or stop breathing in your sleep?
Did you have restless or "crawling" feelings in your legs at night that went away if you moved your legs?
Did you have repeated rhythmic leg jerks or leg twitches during your sleep?
Did you have nightmares, or did you scream, walk, punch, or kick in your sleep?
Did the following things disturb you in your sleep: pain, other physical symptoms, worries, medications, or other (specify)?
Did you feel sad or anxious?

How many people suffer from sleep disturbances? What is the frequency of sleeping problems?
Persons suffering from chronic sleep disturbances, often believe that everyone else is having a good night sleep while they are lying awake. Friends, colleagues and partners do not always understand the problem, or start giving helpless tipps such as "You must relax", "Have a glass of wine every night" aso... Many persons choose therefore not to talk about their problems and many doctors do not even know that their patients are suffering from sleep disturbances.
The subjective impression that everyone else sleeps well is not true though. Scientific studies in many western countries show:

In the adult population, about one third is suffering from temporar sleep disturbances. About one in ten is suffering from a chronic sleep disorder which is also affecting the persons mood and efficiency daytime.
Sleep disturbances is thereby ranked (apart from headache) as one of the most common psychosomatic disturbances.
This information was taken from the site "www.disturbedsleep.de" (in german), where it is possible to find more information about causes and how common sleep disturbances are.

Bruxism and Sleep Apnea (OSA)
Obstructive sleep apnea is a condition which is very often complicated by additional disorders or problems. Many patients with this common sleep disorder had a problem with severe teeth grinding (bruxism)! According to a recent scientific study in Israel obstructive sleep apnea was even the highest risk factor for sleep bruxism!
Sleep apnea is characterized by loud snoring and so called arousal episodes. In these episodes the respiration stops for a rather long time (with a significant drop of oxygen levels). After this stop the patient often has a rather lood noise (like very loud snoring). The teeth grinding is often associated with these arousals and may also depend on the position at night. However, it is very important to think of this possible cause of bruxism.
Diagnosis requires an interview (including information by the partner) and a polysomnographia. Here the sleep is monitored with a special equipment.
With a special therapy method (possitive airway pressure respiration (CPAP) it is possible to handle the sleeping disorder rather effectively. This will not only improve the quality of life but can also have a positive effect on bruxism. Most patients of this study reported a significant reduction of bruxism after treatment.
The results of this study suggest that when sleep bruxism is related to apnea/hypopneas, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.

Rules/Tips for Healthy Sleeping
The following recommendations regarding sleep can be considered as rules for healthy sleeping:
Do not drink anything with caffeine past lunchtime or the early afternoon (coffee, black tea, Coke and other beverages). Also smoking can make sleep more difficult.
Avoid alcohol as far as possible and do under no circumstances use it as a substitute for sleeping pills. (More info.)
Keep away from appetizers.
No large meals in the evening, but keep the blood sugar level up with a light carbohydrate meal, preferably with a low glycemic index, which will keep the blood sugar level up for a longer time. (More info about glycemic index.)
Regular physical activity is very important, but there may have to be a delay to calm down after the exercise before you go to sleep.
Gradual decreasing of mental and physical activity before going to bed.
Follow a personal ritual when going to bed, at the same time each evening.
Provide a pleasant atmosphere in the bedroom, not to hot, silent, dark.
Do not look at the alarm clock or watch during the night.
If you cannot fall asleep, go up and do something else and try again some time later.
Some people finds that listening to calming sounds help them get a sleep, can be special records or boring recorded lectures.
During the night, the body's ability to fall asleep varies in a rhytm with a period of about 90 minutes. Thus, some people feel that it helps to read a not-too-exciting book until they arrive at the point in time when their body's rhytm says that it is time to sleep.