March 14, 2013

Insomnia : Why do we put up with it? And should we?

Anyone who works with me knows I am a fanatic about sleep. How well do you sleep? How much do you sleep? Do you have any trouble sleeping? I am always surprised by how inarticulate many people become when trying to answer this question. I hear things like, “I get enough” or “last night I slept well” or “I get about 5 hours but it’s been that way for years and I’m used to it” or even “I don’t really need much sleep.”

There are few things more vital to well being than sleep but people often fail to focus on it as a problem or take it seriously. You wouldn’t put up with a chronic cough or a chronic runny nose or a frequent pain in your knee but poor sleep, sure!  We all know that without adequate sleep we are more irritable, less alert, more prone to errors, less able to function well in many areas but still we get by with less than we need and don’t feel compelled to do anything about it.

WHY DO WE PUT UP WITH INSOMNIA?

There are many reasons why we tolerate chronic or long term insomnia. For men, it often becomes a source of macho bragging rights, “I do just fine on only six hours a night.” Others accept it as a normal part of life or of aging It’s not! .There is a stigma against using medications for sleep. It is true they can be addictive but there is rarely a problem unless they are abused.  If you have a history of substance abuse you are at risk and non-addictive medications should be used. If you have no prior history of substance abuse, sleep medicines will not cause a problem even if they are habit forming. Sleep is a good habit!  Older people are afraid of sleep medications because they remember the horror stories of year ago when barbiturates were commonly prescribed. That category of drug is now rarely used because it did carry a much higher risk of addiction or excessive daytime drowsiness. Many other people see it as a sign of weakness to ask for medication when anxiety and stress disrupt sleep.

BREAKING THE CYCLE OF INSOMNIA

Insomnia often begins in periods of change or distress. When we are excessively worried our sleep tends to be disrupted. When we miss sleep our ability to cope effectively with that stress becomes reduced adding to our anxiety and intensifying the cycle. Yes, it is normal to have trouble sleeping when going through a divorce, facing an important job interview, taking a big test or coping with financial trouble. The difficulty  is that the more sleep we lose the less capable we become of coping with the circumstances that are causing us to worry and be upset. Breaking that cycle by making good sleep a priority is a very important way of coping with major life changes or stress.

I’VE TRIED MEDICINES FOR SLEEP, THEY DIDN’T HELP

I find that even when patients receive sleep medications (known as hypnotics) they often fail to use them correctly. They resist taking them and don’t use them regularly. They don’t go back to the doctor if it doesn’t help to see what alternative there might be. There are many medications on the market for sleep and they target different types of insomnia and have different dosages. It can sometimes take a few tries to find the right type in the right dose.

Some doctors are very reluctant to prescribe anything for sleep. If that is the case, a psychiatrist is the proper doctor to consult or a sleep specialist as they are the physicians who deal regularly with insomnia which is, after all, a problem that originates in our brains.

If  a prescribed medicine is too strong, patients often give up without giving the doctor the feedback so that a good alternative could be prescribed. People are quick to say, “I felt like a zombie” without trying a different approach that might work well for them.

ANXIETY AND DEPRESSION AS A CAUSE OF INSOMNIA

Another reason sleep medications can be unsuccessful is that the underlying cause is an anxiety disorder or clinical depression. When depression is the cause of the insomnia-and that is commonly the case, particularly at times of divorce or relationship conflict or breakup or when someone experiences a chronic illness or death in themselves or a loved one-then hypnotics alone are rarely sufficient to improve sleep. In fact, I have found, that the failure of hypnotics to help sleep is often diagnostic of an underlying mood disorder. Anxiety and depression are highly treatable with psychotherapy and medication as needed. Chronic insomnia is a warning sign. It is your brain letting you know you need to take action.

Long term insomnia is a risk to your health,  your well being, your safety and happiness. Don’t accept it as something that can’t be changed. This very treatable condition deserves to be taken seriously. Fix your insomnia and you may fix your life.

Contact me, and get your life back, or call 561.212.5408 today.

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