It’s something most of us take for granted but those with a poor night’s rest may experience a toll on their overall wellbeing

It’s a function most of us take for granted but for the those who suffer insomnia and spend the night counting sheep instead of enjoying some quality shut-eye, insufficient sleep, can take a serious toll on both mental as well as physical health.

Dr Martin Kelly, Consultant Respiratory Physician and Western Trust Lead for Lung Cancer at Altnagelvin Hospital, puts insomnia under the microscope.

The Oxford Dictionary defines insomnia as ‘the inability to fall asleep or to remain asleep for an adequate length of time’. But what is an adequate length of time?

“It depends on the individual,” Dr Kelly says. “Some need more rest than others but in general, it’s recommended that adults need between seven and nine hours per night. Of course, as we get older, sleep patterns change and people often wake earlier but tend to nap during the day.”

At some time or other, everyone will experience a period of interrupted sleep. When does an occasional nuisance become ‘insomnia’ and a potential health hazard?

“Insomnia is an umbrella term for a variety of sleep disorders and a massive subject that, even today, is poorly understood.

“However, a few sleepless nights won’t have a major impact on long-term health. For most, it’s a temporary situation, triggered by circumstances, such as anxiety, illness or just general worries. In medical circles this is known as transient insomnia.

“Sleep issues that persist for between one and six months are known as short-term insomnia but unfortunately, some patients continue to struggle for much longer, and are classed as suffering from chronic insomnia.”

Dr Martin Kelly, Consultant Respiratory Physician

From earliest times, people have been struggling to find a cure for sleepless nights. Ancient Egyptians used a milky brew of lactucarium, a substance found in wild lettuce stems and believed to have sedative properties.

The Romans thought the key to sweet dreams lay in dormice droppings which they slathered on their feet, while in Victorian times, Charles Dickens was convinced the Land of Nod lay to the north and pointed his bed accordingly. Today, solutions for mild insomnia are less dramatic but are they effective?

“There are a few simple things we can do to help promote a good night’s sleep. Limiting fluid intake at least an hour before bedtime can prevent waking up to use the bathroom. Replace stimulants like tea and coffee with a caffeine-free or milky drink (just not directly before bedtime.)

“Try to develop a wind-down evening routine. Perhaps have a warm bath, read a book, anything that helps you relax. Although alcohol is off the menu: a glass of wine might initially make you feel drowsy but it will keep you awake.

“When it comes to therapies like massage, reflexology, mediation etc, I’d say give it a go. However, I’d caution against any type of drug that hasn’t been prescribed by your doctor. Some of the natural remedies claiming to cure insomnia can actually be harmful so always check with your GP.”

Simple self-help measures are useful for mild sleep disturbances. However, chronic insomnia requires further investigation.

“Long-term sleeplessness can be a symptom of an underlying medical condition,” says Dr Kelly.

“For example conditions such as COPD (Chronic Obstructive Pulmonary Disorder) that causes severe breathing problems is also associated with insomnia. But one of the most common disorders that leave people longing for a good night’s rest is known as sleep apnoea.

“In fact, I’d estimate that as many as 50% of patients referred to my clinic will be diagnosed with mild to severe sleep apnoea.”

Characterised by abnormal breathing patterns during sleep, there are two main types of sleep apnoea — central sleep apnoea (CSA) is caused by a lack of communication between the brain and the muscles involved with breathing while the more common, obstructive sleep apnoea, (OSA) is due to narrowing of the airways.

How is sleep apnoea diagnosed?

“Firstly, it’s important to listen to the description of symptoms. People often complain they don’t sleep well and use phrases such as tossing and turning. Very often a partner will say they notice a ‘pause’ in breathing or the sufferer will recall how they wake up gasping for air.

“I always ask how they feel during the day and most complain of constant fatigue or falling asleep in front of the television. If I suspect sleep apnoea, I’ll refer the patient for overnight oximetry which is a test to record oxygen saturation and pulse during sleep. This is often effective in helping to diagnose obstructive sleep apnoea but if required, there are other more sophisticated tests available.”

Age is a factor when it comes to the condition, says Dr Kelly.

“As we get older, there’s a tendency to develop other health conditions, including diabetes, which contribute to OSA. Also, ageing affects muscle tone and research suggests that when this lack of tone affects the neck muscles, it can compromise the airway, causing OSA.

“According to the UK Sleep Apnoea Trust, 13% of men and 6% of women have sleep apnoea that equates to approximately 10 million sufferers in the UK alone.”

In terms of factors that contribute to OSA, he says that obesity does play a role and losing weight can help.

“Having said that, I realise it’s not an easy ask of patients, many of whom are already struggling with low mood and other issues.”

Why is it more common in men?

“Good question. There needs to be a lot more study of the whole ‘sleep’ area, but I think it’s probably to do with anatomy. The shape of the male neck is often larger than in women.”

And finally, any advice to those for whom sleep is the elusive dream?

“If self-help remedies don’t work, insomnia is lasting longer than one month or you are experiencing symptoms of sleep apnoea, it’s time to get professional help. Speak with your doctor. There is a lot that can be done to help.”

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