A new approach for insomnia

It would be great if doctors never suffered from insomnia and if they could help their patients sleep like babies all night, every night. But actually, one recent morning when I had insomnia, I ended up getting out of bed to write about sleep for this blog!  Certainly, television advertisements for sleep aids give the impression that insomnia is a straightforward disorder. We see a restless, worried person who can't fall asleep or stay asleep. The next image is a relaxed face with a still body, implying the quick action of a pill that results in seven to eight hours of uninterrupted sleep.  It’s magic, right?  Well, not exactly.  

Insomnia, which is an inability to fall asleep or stay asleep, is just one of many types of sleep disorders. The International Classification of Sleep Disorders defines 84 separate types. Other groups have suggested broader categories based on symptoms rather than diagnoses.

The Association of Sleep Disorders Centers developed this list:

·         Disorders of beginning and maintaining sleep (the insomnias)

·         Disorders of excessive sleepiness, such as narcolepsy

·         Sleep-wake schedule disorders — a mismatch between a person's internal sleep-wake pattern and what is demanded by work and other obligations

·         Parasomnias — abnormal behavior or psychological events that occur during sleep or in the transition period between being awake and falling asleep. Examples are nightmares, sleepwalking and teeth grinding (bruxism).

Scientists are studying the causes of the different sleep disorders. In the process, they are finding novel ways to treat persistent difficulty with falling asleep or staying asleep. A study in the Journal Nature Medicine earlier this year offered the initial results of a new therapy for insomnia. The treatment is based upon what occurs in people with the opposite problem, narcolepsy.

People with narcolepsy have trouble staying awake because they have too little of a brain chemical called orexin (also known as hypocretin). Orexin stimulates the activity of many regions of the brain. It also inhibits the REM (Rapid Eye Movement) phase of sleep.

The researchers have been working with a drug that temporarily stops the action of orexin. This mimics what happens in narcolepsy. Theoretically, the drug could be very effective for some types of insomnia. Initial studies look promising, though the orexin inhibitor is likely to be useful in a minority of people with insomnia. Also there is concern that it could cause some of the other features of narcolepsy. These include sudden loss of muscle control (cataplexy) and hallucinations at the transition between wakefulness and falling sleep (hypnagogic hallucinations).

A few tips can help you fall asleep and stay asleep:

·         Establish a regular time for going to bed and getting up.

·         Sleep only for the time needed to feel rested. Don't linger in bed.

·         Keep your bedroom temperature comfortable (cool is better than warm).

·         Get regular exercise. Complete the exercise at least three hours before bedtime.

·         Don't use alcohol to help you sleep.

·         Avoid caffeine after noon.

·         Be careful about taking medications with ingredients that could keep you awake at night or make you sleepy during the day.

·         Try to avoid naps. If you must have one, keep it short — about 20 minutes.

·         Use relaxation techniques as you lie in bed, such as breathing exercises or meditation.

Stimulus control therapy can help people with persistent insomnia. With this therapy, you avoid lying awake in bed for more than 20 minutes at a time. If you can’t fall asleep, get out of bed and engage in something very relaxing such as light reading or listening to soothing music. Avoid any activity that might be stimulating. Go back to bed once you are tired. You may need to repeat the process if you don't fall asleep after another 20 minutes.

What techniques help you get to sleep—and stay asleep? Sleep can be as important to your health as diet and exercise, but for many people, falling and staying asleep isn’t easy. The Harvard Medical School Guide to a Good Night’s Sleeplays out a six-step plan to improve sleep and deal with common issues like insomnia, disrupted sleep, sleepwalking, and the many other chronic sleep conditions that affect more than 70 million Americans. Through lifestyle and environment changes, you can finally sleep soundly—without necessarily having to take a pill.  

Are you Living With Insomnia? Connect with others with similar health concerns and issues. Click here to join the group.