Alcohol hinders good sleep — Expert

Dr. Increase Adeosun
A
former Head, Emergency Unit, Federal Neuro-Psychiatric Hospital Yaba,
Lagos and consultant psychiatrist, Babcock University Teaching Hospital,
Ilishan-Remo, Dr. Increase Adeosun, in this interview with MOTUNRAYO JOEL, talks about insomnia
What is insomnia?
Insomnia
is a disorder characterised by insufficient quantity or quality of
sleep usually significant enough to cause distress and impair the
functioning of the individual.
What causes insomnia?
There
are several causes classifiable into primary and secondary causes.
Secondary insomnia which arises from the symptoms of some other problems
occurs more commonly. There are environmental factors such as noise,
heat or cold, insects or mosquitoes; interruption in normal sleep
schedule due to change in time zone or jet lag or shift work; stressful
life occurrences, for instance bereavement, job loss, conflicts,
relationship break-ups, financial misfortune, exams, bad news or other
negative life events. Others include positive life events that involve
change of routine or role shifts for example a new job, moving to a new
house, birth of a new child and others.Normal physiological changes such
as aging or pregnancy can cause insomnia; medical conditions associated
with pain, difficulty in breathing, nocturnal (frequent urination at
night), frequent bowel movement can cause pain; certain drugs or
substances like caffeine, stimulants, and alcohol can interfere with
sleep; and very importantly, insomnia is a symptom of several
psychiatric disorders including depression, bipolar disorder, anxiety
disorders, schizophrenia, substance use disorders, delirium, organic
brain disorder and many others. Primary insomnia is essentially a
psychiatric disorder that is not primarily attributable to an extrinsic
factor
What are its symptoms?
Insomnia
commonly manifests as difficulty in falling asleep, difficulty staying
asleep (i.e. waking up often), waking up too early in the morning, or
not feeling refreshed on wakening. Secondary symptoms include daytime
sleepiness, emotional disturbances, irritability, anxiety, fatigue, poor
concentration, poor memory and so on.
How long does insomnia last?
To
make a diagnosis of primary insomnia, the individual must have
experienced unsatisfactory sleep about thrice weekly for a minimum of
one month, with associated distress and impairment of functioning. In
some cases, insomnia is transient especially if the genesis is traceable
to environmental or modifiable factors.
Is insomnia treatable?
Definitely,
insomnia is treatable and nobody should suffer from the distress
arising from lack of sleep without seeking for help.
Must one see a doctor for this disorder?
As
a starting point, there are simple self-help tips (sleep hygiene) that
may be helpful depending on the cause of the insomnia. If this does not
help,one needs to talk to one’s doctor. Subsequently, one may need
referral to a psychiatrist. As earlier mentioned, primary insomnia is a
psychiatric problem and secondary insomnia may be a secondary
manifestation of other primary psychiatric disorders such as depression.
What does sleep hygiene entail?
It
entails maintaining regular bed time routines; minimising daytime naps;
reserving bedroom for sleep , this means one shouldn’t climb the bed
till one feels sleepy, one shouldn’t turn one’s bed into a work station
or dining arena. If one finds it difficult sleeping on a bed, get up and
move to another room for a while before going back to bed; allow time
to wind down before bed time music, for example take a warm bath,or
engage in light reading. When eating, one’s food should be warm, small
in quantity and easy to digest. Also one needs to work on other
environmental factors such as noise, reduced lighting, comfortable bed.
One needs to say no to drugs, alcohol, caffeine/kola/stimulant; avoid
dwelling on negative issues at bed time.
What are the other treatment options available?
The
first step the mental health expert (psychiatrist) takes is to conduct a
thorough assessment which would culminate in a diagnosis. This process
involves taking a comprehensive history from the patient and bed-partner
and may include objective assessments such as polysomnography. This
would inform the appropriate intervention. There may be need to
prescribe certain medications in some instances, but going over the
counter to buy drugs for sleep would do more harm than good on the long
run. Psychological interventions, relaxation techniques and addressing
concomitant or underlying problems are also essential.
Can insomnia be life-threatening?
Insomnia
is very distressing and causes significant suffering. Remember that the
functions of sleep is for psychological restoration, energy
conservation, memory consolidation and maintenance of
physiological/emotional equilibrium. You can’t function optimally if you
are persistently sleep deprived. You are also prone to accidents.
When should one talk to their physician about it?
In some cases it should be done immediately. Once sleep hygiene is unhelpful, then seeing the doctor is essential.
What is the right amount of sleep one should get?
It
varies from individuals to individuals. There are short-sleepers who
don’t experience distress and find their sleep satisfactory. Required
sleep also varies with age, on the average it is about seven hours.
How can one tell if they are getting enough sleep?
It
depends on the quantity and quality (satisfaction, waking up
happy/refreshed). You can also keep a sleep diary. Some people claim
they are not sleeping but they actually are. There is what you called
sleep-state misperception. They may need more objective assessments from
video recordings, polysomnography or history from a roommate or spouse.
What can one do to avoid insomnia?
One
should maintain regular sleep-wake schedule, maintain a healthy
lifestyle, exercise, avoid drugs without prescriptions and hard drugs,
seek help for emotional and mental health problems, seek appropriate
treatment of medical problems and minimise offending environmental
factors.
Does insomnia ever go away naturally?
If it is due to an environmental factor, or secondary to other problems, once the primary problem is removed, sleep may improve.
What is rapid eye movement sleep and why is it important?
Rapid
eye movement sleep occurs in cycles and constitutes 20 to 25 per cent
of duration of adult sleep. It is also called paradoxical sleep. During
REM sleep, brain activity is fast, while muscle activity slows down
almost to a point of paralysis. Dream is vivid during this period. The
functions of REM sleep are not completely understood but evidence
suggests that memory consolidation and brain development occurs during
this phase. Infants spend up to half of their sleep time in REM phase.
Why is alcohol detrimental to sleep?
Alcohol
is both a stimulant and a relaxant to the brain depending on the time
interval after use. Alcohol may induce sleep initially but eventually
leads to sleep fragmentation, frequent awakening and loss of sleep in
the second half of the night. It has a rebound/withdrawal effect which
makes the user worse off. If one really wants to enjoy quality sleep
with no painful strings attached in the long term, avoid alcohol. Many
people get hooked by the initial sedative property.
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