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.