INSOMNIA: difficulty in getting to sleep or staying asleep.

Disturbed sleep may lead to daytime problems such as tiredness, poor concentration and difficulties with short term memory.

Types of insomnia

1. Transient: This refers to a person's inability to sleep normally for a few nights.
2. Short-term: Times of ongoing stress may result in two to three weeks of poor sleep. Relief from the stressful situation will usually return sleep to normal.
3. Chronic: This occurs when sleep is disturbed most nights for several months.

Causes of insomnia

1. Physical: Any painful condition canaffect sleep quality.
2. Psychological: Stress, anxiety, depression and learned insomnia (people who sleep poorly in tmes of stress worry about not being able to function the next day. They resolve to try harder to sleep and this effort makes them more alert and sets off a new round of worried thoughts.)
3. Lifestyle: Stimulants such as caffeine and nicotine especially near bedtime, can disturb sleep. Alcohol may induce sleep but may also make sleep more fragile and broken during the night. Irregular hours, late hours at weekends as well as shift work may undermine sleep. People who exercise regularly will sleep better.
4. Sleep apnoea: Heavy snorers actually have repeated interruptions of their breathing which may rouse a sleeper up to 100 times a night. While most cases are mild and may need little treatment such as weght loss and avoiding lying on their back, more severe cases may benefit from a treatment known as continuous positive airway pressure. This treatment keeps the airways open with a a steady stream of air delivered through a mask worn over the nose at night.

What can be done?

• Get up about the same time every day. Go to bed only when sleepy.
• Avoid daytime activities in bed such as eating or watching T.V.
• Reading before sleep may be helpful.
• Do not extend bedtime in the hope of sleeping longer. In most cases you will only be awake longer.
• If you are unable to sleep or return to sleep leave the bed and engage in a quiet activity. Return to bed only when you're sleepy.
• Avoid caffeine 6 hours before bedtime and keep daytime quantities low.
• Do not smoke before bedtime.
• Alcohol within 4 hours of bedtime is not recommended.
• Use sleeping pills conservatively and only on advice of G.P.
• Do not use relative's or friend's hypnotics as they may not suit your case at all.

When can sleeping tablets be used?

Hypnotics are generally prescribed for people with transient insomnia, particularly if it is related to a specific stressful event. If they are used it should be on a non-consecutive night basis if possible and for less than three weeks. It is worthwhile trying the above guidelines first.