Insomnia as a symptom: treat the underlying cause

Insomnia and other sleep disorders are common problems that patients present to their doctors.

Sleeping pills are usually not the best solution.

They sedate the brain and by doing so may increase our risk for accidents including falls. This is particularly risky in the elderly who happen to be the group that is prescribed the most sleeping pills. Sedation may persist into the morning, impairing our judgment and alertness at home, at work and on the road.

The regular use of sleeping pills may result in dependence – when your brain requires a pill every night to fall asleep and tolerance – when the same dose no longer works and you have to switch to a stronger medication.

Instead, you and your doctor could think of sleeping difficulties as a symptom – a marker for a more significant problem. Together you can treat the underlying cause.

Early insomnia – or difficulty falling asleep – can be due to anxiety, stress or stimulants. Avoid exciting activities (i.e. vigorous exercise and arguments) just before bedtime along with caffeinated drinks. Reduce unnecessary stress, and adopt strategies to manage anxiety during the day. These might include meditation, self-reflection, debriefing with your friends or professional counseling. Moderate exercise earlier in the day is often helpful.

Middle and late insomnia, such as early morning awakening can sometimes be a symptom of depression. If you are having persistent symptoms, don’t hesitate to talk to your doctor.

Some medical conditions can interrupt your sleep. These include bladder problems (such as enlargement of the prostate), congestive heart failure (when individuals feel more short of breath when lying flat) and asthma (wheezing or bronchospasm that is often worse at night or in the early morning). Nocturnal symptoms suggest that something more is needed to adequately control the underlying condition.

Nonrestorative sleep can be a sign of a respiratory problem, including obstructive sleep apnea. If you have significant daytime sleepiness, talk to your doctor. The diagnosis can be confirmed with noninvasive tests.

Next: non-drug sleeping solutions.

Dr. Davidicus Wong is a physician and writer. His Healthwise column appears regularly in the Burnaby Now, Vancouver Courier and Royal City Record. You can find his posts at davidicuswong.wordpress.com.

Not every moment has to be magical

I took this photo on the Sunshine Coast the last time I went camping with my family. A little girl was flying a Tinkerbell kite and it looked so magical in the air . . . and hilarious whenever it landed.

It’s a lighthearted reminder that life can be fun and worthwhile even if it’s not always perfect.

It’s okay not to be graceful all of the time.

Getting Enough Sleep: Three Questions to Ask Yourself

How can you tell if you are getting enough sleep? Ask yourself three questions.

Do you feel well rested when you awaken in the morning? If it’s easy for you to make the transition into your morning’s activities, you’re probably getting enough rest. It’s not just about logging enough hours in bed; the quality of your sleep matters just as much.

Patients with obstructive sleep apnea stop breathing so many times during the night that the oxygen level in their blood (and getting to their brain cells) is abnormally low. They commonly feel less rested in the morning than they did going to bed. They experience daytime sleepiness and can fall asleep easily during the quiet times of the day.

Are you alert throughout the day?

Making stupid mistakes doesn’t mean we’re stupid. We all make them when we are rushed, inattentive or just sleep-deprived. What kind of mistakes do you make each day? How attentive are you in your conversations with others?

When you finally roll into bed, how quickly do you fall asleep? If you’re sound asleep the moment your head hits the pillow, you’ve likely accrued a sleep debt.

Next: The Special Challenges of Shift Work, and Practical Strategies for a Good Night’s Sleep

Are You Getting Enough Sleep?

We celebrated at my son’s high school graduation dinner last Friday. I was reminded of the novelty of staying up all night when I was seventeen, and at 4 a.m. when I picked him up from his dry aftergrad, how countless sleepless nights have taken away the luster of sleep deprivation. Not quite caught up with my sleep, I spent the early hours of Victoria Day with a patient in labour.

Special events, the stages of our family lives, the demands of school and the nature of our work push aside the priority of a full night’s sleep.

But we can just get accustomed to insufficient sleep (to the detriment of physical, emotional and mental health). We can fall into habits of staying up late at different stages of our lives. Many young people stay up to study; others stay out partying. New parents, especially breastfeeding moms, sacrifice their sleep for their children.

If you need an average of 7.5 hours of sleep each night and only allow yourself 6, you’ll create a sleep debt of 7.5 hours after just 5 days. That’s why teens can sleep well into the afternoon on weekends.

We’re not at 100% without a good night’s sleep. A generation ago, it was customary for doctors in their residencies to work 24 to 48 hours without a break. This was found to be harmful not only to young doctors but the patients they cared for.

When we are sleep-deprived, we are not at our best. We are less alert and more forgetful. We are slower to react and our judgment is impaired. Imperfect as we are, we are more imperfect. We make more mistakes.

Those mistakes can be very serious if you are a doctor or nurse making life and death decisions, an airline pilot, a NASA engineer, the captain of a ship, or the driver of an automobile. Consider the many moments throughout your day where a sleep-deprived error can have serious repercussions.

Next: How can you tell if you’re getting enough sleep. Three questions.

Setting the Right Pace

Most of us are working for our weekends.

We can run a treadmill for five or more days of the week and long for our brief weekends and distant holidays. I think weekends and holidays are great for spending extended time with the people you love.

Yet we shouldn’t wait that long to find balance and rest in our lives. To prevent the cumulative effects of unremitting stress, we need to balance each day. We can’t wait for the weekends.

We need our morning recess, lunch and mid-afternoon breaks. It doesn’t have to be a game of tetherball or a full-scale walkout. A change of tasks, a healthy snack, your favourite music or a stretching break may suffice.

Our bodies are machines that need fuel throughout the day. We don’t have big tanks that we can fill with one big meal. To keep our bodies and minds running smoothly, we need daily exercise (at least a good walk) and regular healthy meals.

Attend to the pace of your thoughts – with the goal of being fully present in every waking moment. I encourage medical students to be mindful with each patient encounter so that we may be totally focused on the needs of the patient before us. I teach them to view hand washing as a mindful ritual; in this transition between patients, we ensure that we have been complete and thorough with the patient we have just seen and fully awake for the next.

This makes us more empathic listeners, better diagnosticians and safer health care providers.

How is the pace of your day? How present are you in the moments that make up your life?

Are You Living at the Right Pace?

The pace by which you live the moments of each day is an oft neglected source of stress. A dizzying pace can push us to act and react mindlessly. We make more mistakes, we may bypass the beauty of the day, and by nightfall, we know not where the time has gone.

How can you tell if the pace of the day is right for you?

If you’re bored, you could use more challenge, and you need to pick up the pace. If you’re mentally and physically exhausted at the end of the day, your pace and workload are overwhelming.

If you lose your focus or feel restless at different points in the day, you may need a break. We can get so accustomed to a fast pace that we may never think about slowing down in order to do things right.

We can run a treadmill for five or more days of the week and long for our brief weekends and distant holidays. I think weekends and holidays are great for spending extended time with the people you love.

Next: Setting the right pace.

A Source of Stress: The Pace of the Day

There are infinite sources of stress in our days: the competing demands of home, work or school; conflicts with others; illness, injury and addiction; financial stress and debt; suffering from the past, worries about the future; mean bosses, bullies and angry customers.

But we often neglect one source over which we have some control – the pace of the day.

Emergency physicians and family doctors are no strangers to demanding, high intensity workdays. In a typical shift, they may not have time to eat or even go to the washroom. Fortunately for their patients, they do take the time to wash their hands.

The constant pressure to keep up with a never-ending queue can create sufficient mental and physical stress to affect the quality of our work.

Employees in downsized offices, taking on the workload of laid off colleagues can face burnout from the ever-growing mountains on their desktops.

And let’s not forget the mothers and fathers of young children. Their only downtime is when their kids are finally sleeping (hopefully throughout the night).

There is a tempo and rhythm at which we function best. We need just enough challenge to keep growing, moving forward and experiencing the satisfaction of accomplishment. Without such positive stress, we would be stagnant, bored and unproductive.

But too rapid a pace – when the demands of work exceed our capacity to meet them – can lead to physical stress, anxiety, burn out and depression. And if we are acting faster than we can think, we are bound to make mistakes. Quality and productivity suffer. Our sense of wellbeing suffers.

Next: How can you tell if your pace is right for you?