“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Insomnia

"I'm having trouble sleeping" is one of the most common complaints I hear from patients. This is understandable, as up to 25% percent of the American population reports occasionally not getting enough sleep (though it seems like more to me). However the percentage suffering from the true definition of insomnia is smaller, about 6 percent. Per the DSM-5 definition, insomnia patients feel impaired from lack of sleep during the daytime; symptoms last at least a month; and are not associated with other medical conditions, substance use or other sleep disorders (restless legs syndrome would be a good example of this).

Certainly sleep issues are seen most often in the elderly but insomnia can hit at any age. Recently while sorting through a bunch of stored papers I found a literary quarterly published by my university which I had saved for some reason. The theme was "All Night Long" and at least two of the pieces dealt with insomnia... it could have been more, possibly three or four. (These were written by people in their late teens and early twenties, mind you, and they were complaining of insomnia!) There are plenty of factors other than age, however. Sleep problems are often connected to lack of physical activity, especially these days when so many people work sedentary jobs. Daytime naps are also not a good idea as they relieve physical fatigue just enough to make it difficult to fall asleep. And irregular sleep patterns, such as working nights or sleeping late, can also ruin a good night's sleep.

I empathize with patients as a fellow sufferer. I have had insomnia most of my life, to the point that if I sleep through the night I almost feel cheated. My nighttime awakenings are my "me time," when I ponder my work schedule, to-do lists and various deep thoughts. Certainly I need sufficient sleep to function, at least six hours. Back when I was a medical resident I realized that I was usually very depressed the day after being on call. It took a surprisingly long time for me to figure out the connection between my mood and lack of sleep.

The basic recommendations:

• Regulating your sleep pattern is a big one. Yes, you have to become one of those boring people who goes to sleep at the same time every night. 
• Don't go to bed too early. If you go to bed at eight-thirty, you won't sleep through the night unless you have to get up at four-thirty every morning - or even earlier than that. 
• Limit alcohol and caffeine. Alcohol can really screw with your sleep. No caffeine after noon. 
• Don't go to bed until you are ready to go to sleep. I once had a friend, a fellow MD, who stated that if he had his way every bedroom in the US would be deprived of its television. Likewise, no reading or crossword puzzles in bed. You should do these fully dressed and in a separate room until you are ready to go to bed. 
• Keep the bedroom cool, dark and quiet. 
• And now that we have computers and smartphones, the same applies. Don't grab for your phone if you awaken in the middle of the night. You don't want to be looking at a glowing screen. 
• Do try to get some physical activity in, it will tire your body and you will sleep better. 
• Don't use sleep medications if you can possibly avoid it. 

Labels: Medicine, Random Thoughts

posted by Dr. Alice at #