Sleepless in Jamaica

Dahlia McDaniel, Gleaner Writer

Many of us experience difficulty falling asleep. We toss and turn all night, waking up long before morning. This can be grief!

Sleep is a basic necessity, as important as food, water and air. It rejuvenates mental and physical health. The quality and quantity of sleep influence health, work and relationships. Although individual requirements for sleep vary (from about four to nine hours), there are far-reaching consequences to not getting the ideal amount of sleep. For example, our immune system functions poorly and we become prone to illness. We may also experience reduced ability to think clearly, become confused, irritable and less productive.

Causes of insomnia

Insomnia refers to difficulty falling asleep or staying asleep. It becomes a real challenge when it is regular or persistent. Possible causes include:

Age - The elderly may experience age-related sleep changes. They tend to sleep less.

Pain and discomfort - Medical conditions which cause pain, breathing problems, acid stomach, allergies, menstrual problems including pre-menstrual syndrome, heart problems, and hot flashes from menopause will affect sleep quality.

Psychological problems - Stress, depression, fear and anxiety affect relaxation; the mind becomes preoccupied and we become too alert to 'go down'.

Drugs - Some drugs like caffeine in coffee, alcohol, and nicotine stimulate the brain. Medications like those for high blood pressure, steroids, some asthma medications, pseudo-ephedrine decongestant, some tranquilisers and sleeping pills can actually prevent us from sleeping well!

Sleep-rhythm reversal - When we sleep at inappropriate times, we sometimes cannot fall asleep at the regular times; shift work, long-distance air travel and extensive use of alcohol can cause this.

Poor sleeping environment - Overcrowded beds, uncomfortable sleeping surfaces, excessively warm or cold sleep spaces, snoring partners and other forms of noise pollution contribute to insomnia.

Treatment

Treatment is determined by the cause and severity of insomnia. Sleeping drugs (sedatives/ hypnotics) are prescribed as a last resort when self-help techniques fail or when insomnia affects general health. They are expected to be for short-term use, about three weeks. Long-term treatment of persistent insomnia is aimed at restoring sleeping habit and resolving the main cause of insomnia.

Sleeping pills work by interfering with chemical activity in the brain, reducing communication between nerves. Brain functioning and activity slow down so we fall asleep more easily. However, most sleeping pills reduce deep-sleep and dream-sleep. Sleeping drugs include:

Benzo-diazepines like flurazepam, temazepam, nitrazepam. Most are habit-forming if taken regularly over long periods. Their effects grow weaker over time. With prolonged use they may disturb sleep patterns and contribute to insomnia.

Newer bon-Benzo-diazepine hypnotics like zolpidem (Ambien).

Antidepressant drugs - some antidepressants have sedating actions - they promote sleep in depressed people while they treat depression.

Anithistamines - these are drugs like diphenhydramine (DPH, Benadryl), promethazine (Phensedyl), chlorpheniramine (Histal), which are normally used to treat allergy symptoms but which have the side effect of drowsiness. They are not a great hypnotic option because of other serious side effects and diminished effectiveness after a few days.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London. Email: yourhealth@gleanerjm.com.