Physician's Weekly
February 25, 2022
Suffering from (chronic) insomnia

Q: I’ve suffered from insomnia for years and I can only get to sleep if I take lorazepam. Help! What can I do to return my sleep to normal?

Introduction

Up to 1/3 of adults have suffered from insomnia. Some have difficulty falling asleep, others staying asleep and many have both. Seven or more hours of nightly sleep is considered ideal. Chronic insomnia lasts for three months or more.

Chronic insomnia can be primary or secondary. With the former there are no identifiable causes. In the case of the latter, this may be as a result of a medical condition, drugs/ medication, lifestyle and other contributing factors.

Symptoms

These may include:

  • Difficulty falling asleep, remaining, and returning to sleep
  • Early morning waking
  • Lack of energy and tiredness during the day
  • Irritability
  • Difficulty performing tasks, concentrating
  • Prone to making mistakes and accidents
  • Anxiety/ depression

Causes

Secondary chronic insomnia has a wide array of causes, some are listed below:

Medical conditions

  • Asthma
  • Chronic bronchitis
  • Emphysema
  • Heart failure
  • Diabetes
  • Hyperthyroidism
  • Menopause
  • Stress
  • Depression
  •  Anxiety
  • Alzheimer’s
  • Parkinsons
  • Chronic pain
  • Fibromyalgia
  • Reflux/ GERD

Medicines/ Stimulants

  • Beta blockers – e.g. atenolol, propranolol
  • Antidepressants
  • Decongestants
  • Diuretics
  • Cocaine
  • Alcohol
  • Coffee, tea, energy drinks
  • Nicotine

Lifestyle

  • Shift work
  • Sedentary
  • The environment – Too hot, cold, noisy, brightly lit
  • Daytime napping
  • Excess exposure to blue light from electronic devices
  • Frequent travel across time zones

Cutting edge information

Research emerging from the University of Tsukuba in Japan suggests that one’s gut bacteria may impact the serotonin and dopamine levels in the brain which in turn can influence sleep. The researchers ultimately hope that changing the diet of someone suffering with insomnia will significantly improve their sleep.

Treating chronic insomnia

Lifestyle modification where possible

  • Set a consistent sleep and wake time
  • Seek out an 8am to 5.00p.m job as opposed to shift work
  • Avoid alcohol and products with caffeine
  • Avoid heavy meals after 6.00p.m
  • Make sure pillows/mattress are/is comfortable
  • Minimize light in the bedroom when going to sleep. If this is not possible, use a sleep mask.
  • Start an exercise program
  • Avoid sleep environments that’s too hot, cold, noisy or brightly lit
  • Avoid daytime napping
  • Avoid exposure to blue light from 2 hours before bedtime
  • The bed should only be used for sleep and sex.
  • Practice relaxation techniques – e.g. breathing exercises, yoga, and meditation.

Medications

While there are a number of medications that can be prescribed for chronic insomnia, however many of these should be used sparingly because of the potential for addiction and other side effects. Such side effects include daytime sleepiness, forgetfulness, balance issues, and falls. Discuss with your doctor the pros vs the cons of taking such medications long-term.
Many opt for non-prescription formulations to help with their chronic insomnia. Examples include:

  •  Diphenhydramine (found in a number of cough meds)
  • Melatonin
  •  Valerian root
  • Chamomile tea

Treating underlying medical problems

If the chronic insomnia is caused by an underlying medical condition, the satisfactory treatment of such often leads to the resolution of the chronic insomnia.

Author’s contact Information: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnosis, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.