Insomnia: How to know and manage it

Dr. Raphael E. Ogbolu is a consultant psychiatrist at the Lagos University Teaching Hospital (LUTH). He spoke with Geraldine Akutu on too much sleep and loss of it.

What is the likely cause of insomnia?
Simply put, insomnia can be termed sleep that is poor, either because it is too short, not restorative or refreshing in quality. It can be primary, when it just occurs with no identifiable cause, or it can be caused by other medical problems, which may be physical or psychological in nature. Physical causes may be any condition that causes pain, such as terminal cancer, painful peptic ulcer, arthritis, or breathing problems, which cause one to wake up several times at night, among other causes. Psychological causes include, depression, anxiety, manic disorders, etc. Certain lifestyles may also make one prone to insomnia. These include, alcohol or other drug abuse, as well as inappropriate use or abuse of sleeping pills.

What are the signs to look out for?
Signs of insomnia are: difficulty falling asleep, difficulty staying asleep, waking up much earlier than usual, or sleep that is not refreshing or non-restorative. These signs have to have been occurring regularly and affecting the individual’s functioning. If a person is experiencing insomnia, what should he or she do? If a person is experiencing insomnia, he/she

If a person is experiencing insomnia, what should he or she do?
If a person is experiencing insomnia, he/she should first of all, keep a sleep diary, which includes a recording of the times you are awake at night, among other things. This could be kept for about a week. Then the person should seek the service of a sleep therapist, who will analyse the sleep diary. Because sleep therapists may be difficult to find, the person may need to try sleep hygiene measures, which include: – maintaining a regular sleeping or going-to-bed time. – engaging in early evening exercise, – taking a lukewarm evening bath after the exercise, – avoiding caffeinated beverages from evening onwards, – using the bed for sleep and sex only, and not for any stimulating activity, such as, reading an interesting novel or watching television, – avoiding late meals, etc. What amount of sleep is ideal? The ideal amount of sleep has been quoted differently. However, six to eight hours is most often stated as the ideal amount of sleep. Sleep that is less than five hours or more than nine hours is not

What amount of sleep is ideal?
The ideal amount of sleep has been quoted differently. However, six to eight hours is most often stated as the ideal amount of sleep. Sleep that is less than five hours or more than nine hours is not healthy, and has been found to be associated with likelihood of having other medical illnesses (physical and psychological), and even with increased mortality.

At what point should one seek treatment and what is the best treatment for insomnia? One should seek treatment once the insomnia is affecting the person’s daily functioning or activities. The best treatment will depend on the cause, but may or may not include the use of drugs. Sometimes, after evaluation, all that may be needed may be sleep hygiene measures mentioned above, or lifestyle adjustments. Sleep-inducing medications may be used, which may include sedatives, such as sleeping pills. These must be given under a doctor’s prescription, because their abuse may lead to the worsening of the insomnia. Self-medication should be avoided.

Are there lifestyle factors that should be changed?
Lifestyle factors that can be changed to solve insomnia include, alcohol or illicit drug abuse, wanton use of addictive sedatives, late night meals, engaging in over-strenuous exercise late at night, use of caffeine or caffeinated drugs, use of nicotine, and avoidance of stress or managing unavoidable stress.