Insomnia

What is insomnia?

Insomnia is a condition where a person has difficulty falling asleep or in staying asleep, or has a disturbed sleep patterns causing inadequate sleep. The individual wakes up not rested and feeling tired.

How prevalent is insomnia?

Roughly 10% of the population suffers from insomnia, and 50% of these people have the severe form. This is indeed a common symptom.

What are the types of insomnia?

Primary type is long standing and has not related to psychic events or somatic (body) ailment. Secondary insomnia is one that is due to some physical or emotional problems, pains, or the use of, or withdrawal from, certain drugs. Drinking heavily in the evening can impair sleep and cause some withdrawal symptoms in the morning.

What is initial insomnia?

Commonly associated with an emotional dilemma, like anxiety, fear or depression, stimulant drugs or beverage (coffee, coke, etc.), pain, withdrawal of sedatives or hypnotics, poor sleep schedule, and sleep disorders, initial insomnia means difficulty in falling asleep.

Is early morning awakening normal?

This may be normal for some, especially the elderly, as long as the person falls asleep normally and feels rested upon awakening.  However, in many cases, the individual awakens early and cannot fall back to sleep, or drifts into a restless and unfulfilled sleep. Depression and some psychological dilemma could cause this. Early morning awakening is a common phenomenon of aging.

What is Sleep Rhythm Reversal?

This is a circadian disorder, where the persons sleeps during the day and stays awake at night. Examples of this are:  jet lag, working irregular night shifts, sleep apnea (holding breath on and off while asleep, leading to poor oxygenation, restlessness and impaired sleep), misusing sedatives, or damage to the hypothalamus of the brain following head injury. Rebound Wakefulness is another condition. This results from withdrawal of hypnotics (sleeping pills) among persons who regularly take large doses of this drug.

Are hypnotics the answer?

No, they are not the answer to insomnia. The proper way to deal with the situation is to determine the cause of the impairment in sleep. Is the sleep schedule appropriate? Is the insomnia due to ingestion of stimulants like coffee, cola drinks, or to alcohol or nicotine?  Is misuse or abuse of hypnotic or sedative a factor? Or, is there a psychological problem or emotional stress or depression?  If the insomnia is recurrent, persistent, and unexplained, we recommend clinical investigation in a Sleep Laboratory.

When are sleeping pills helpful?

Occasional use of sleeping pills, under the supervision of a physician, is safe, so long as there is no medical condition that would require further diagnostic tests. In many cases where psychological or emotional stress is present, discussion and reassurance may help alleviate the anxiety to the point that insomnia is minimized, if not controlled.

Do naps cause insomnia?

Taking afternoon naps can certainly lead to a sleepless night among majority of people. We see this a lot among post-surgical patients, who take naps during the day, and are awaken by the nurses at night for shots, etc, leading to a reversal in sleep pattern and in impaired sleep.

What is the role of exercise?

Physical exercise (scheduled in the afternoon but not close to bedtime) is one of the best ways to deal with insomnia. Exercise and relaxation can help in warding off insomnia. Some people induce sleep by drinking a glass of milk before bedtime.

Does Melatonin help?

Melatonin and other herbal drugs have been advertised to help promote a restful sleep, but we caution the public because these are unregulated drugs, whose content, purity, efficacy and potential harmful side effects are fully unknown. Melatonin is a hormone secreted at night by the pineal gland (in the brain) to regulate the circadian system. Because it can reset the rhythm, it has been used in clinical studies in insomnia and jetlag. There are some reports Melatonin could cause cardiac arrhythmia (heart irregularity), one reason why many physicians are reluctant to prescribe this drug. As a matter of fact, since I fly back and forth from the United States to Cebu every other month, I have tried Melatonin and found it to help lessen my jetlag. However, my daughter, Sheillah Gentile, M.D., provided me convincing evidence that Melatonin can indeed cause cardiac arrhythmia. This prompted me to stop using Melatonin. Instead, I adjust my sleeping pattern a few days before my trip, and while on board, I eat moderately, drink a lot of fluids, (water, not coffee or pop), minimize alcohol intake, walk a lot, schedule my sleep on the plane accordingly, based on my arrival time at my destination, and plan on a leisurely day schedule upon touch down.

What are some strategies to improve sleep?

Adopt a regular bedtime and wake-up time schedule each day, including weekends.

Make it a habit to have regular evening routine to set the mood for sleep, like washing or showering, brushing your teeth, moisturizing your face and hands, setting the alarm clock, etc.

The bedroom ambiance (dark and comfortably cool) should be conducive to, and used only, for sleep and sexual activities, and not for eating, paying bills, watching the television, etc. Ear plugs to reduce external noise can be helpful, where needed.

Pillows must be fluffy, and putting one between the knees, or using a body pillow, could add comfort for a more restful sleep.

Do daily physical exercise earlier in the day, away from bedtime.

Avoid stimulants like coffee, caffeinated beverages, chocolate, alcohol, smoking, diet pills, diuretics (water pills) before bedtime.

Try to indulge in relaxation technique, like taking a warm shower or bath before bedtime, reading, listening to soft music, saying your night prayers, etc., all of which will help reduce the stress and anxiety of the day, and induce sleep.

Planning for a happy morning after, a day of sunshine to look forward to, can also help.

***

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA,  a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

Dr. Philip S. Chua
Dr. Philip S. Chua

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States.

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