Sleep problems

Sleep problems

Sleep problems can interfere with daily functioning. An occasional night without sleep doesn’t necessarily mean your performance will suffer the next day. But if poor sleep is a common occurrence it can lead to various problems, such as lack of concentration, lack of energy, fatigue and drowsiness. These problems are mainly caused by sleep disorders. But rest assured, there is lots of information available about sleep disorders and help is just a few clicks away.  

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A distinction should be made between mild sleep problems and more severe forms. In general, severe sleep problems or chronic insomnia is defined as three or more nights of disrupted sleep a week over the course of three or more weeks, leading to significant reductions in performance during the day. If sleep is disrupted occasionally within a period of less than three weeks, and if it does not make it difficult for you to function during the day, then these problems are classed as mild sleep problems. These sleep problems usually resolve themselves. 

What are​ sleep problems​? 

​​Most healthy adults need between seven to nine hours of sleep per night to function at their best. One night of poor sleep is not harmful. But if you suffer from continued lack of sleep and this affects your ability to function during the day, this is classified as sleep problems. Our sleep is composed of four stages, through which we cycle every 90 to 120 minutes. Stage 1 is a short stage in which you are not really asleep, but in which the body prepares for sleep. During this stage your muscles begin to relax, your body temperature drops, your heart rate slows down and your eyes slowly roll back. After several minutes, you fall into light sleep. This is stage 2. During this stage, you are asleep but can be easily awoken. Like the first stage, this stage is relatively short. Now here’s where it gets interesting. In stage 3, also known as deep sleep, your heart rate slows down even further and your muscles relax even more. During deep sleep, you become less responsive to outside stimuli and have difficulty waking up. Stage 3 is the most rejuvenating and restorative sleep stage. This is when organ and muscle growth happens and when your brain consolidates and processes information from the day. Deep sleep is essential for re-energising your body and mind. The final stage of sleep is Rapid Eye Movement (REM) sleep. REM is when the brain is more active and your eyes move rapidly in different directions (hence the name). This stage requires a lot of energy and is when most dreaming occurs. During REM sleep, your brain is almost as active as it is when you are awake. There are several researchers who state that the dreams are used to process daytime events. The body cycles through these four stages several times each night. It’s not important how often you go through the stages, what matters is that the episodes are evenly distributed. It is apparent from the above that sleep plays a vital role in our well-being. While we sleep, our body and mind shut off for rest and repair, so that we wake up feeling refreshed and ready to take on the day. Lack of sleep, on the other hand, can lead to problems with concentration, alertness and learning. Sleep deprivation is known to be a risk factor for traffic accidents. It is estimated that drowsy driving is responsible for 15% of all car crashes. Not getting enough sleep makes us irritable, gloomy and listless – and this doesn’t contribute to a happy life. Sleep deprivation also confuses our hormone system which, among other things, increases our risk of obesity.​ 

What causes​ sleep problems​? 

Sleep problems and poor sleep can have various causes. Unhealthy sleep habits, also referred to as sleep hygiene, is one of the most common reasons people cannot fall asleep and stay asleep. The good news is that there is plenty you can do to manage your sleep hygiene. Sleep problems can also be caused by worrying. As soon as you relax, your mind gets filled with problem thoughts, which makes it hard to fall asleep. A racing mind can be very difficult to turn off and rob you of valuable hours of sleep. A physical health condition or illness can also be a reason for sleep disturbances. Itching, respiratory problems and restless legs can make it impossible to fall asleep. And if you fall asleep, you will soon wake up to these symptoms. Some of the most common health conditions that cause these kinds of sleep problems are:  

  • Restless legs syndrome (RLS) 
  • Allergies 
  • Asthma 
  • COPD 
  • Bowel diseases 

What types of ​sleep problems ​are there? 

Sleep problems can be divided into four categories: 

  • Snoring, causing interrupted sleep. 
  • Inability to fall asleep. 
  • Inability to stay asleep. 
  • Sleep-related disorders such as narcolepsy and sleep apnoea. 

How can you identify sleep problems?  

Common signs of sleep problems include:  

  • Not feeling rested or waking up stiff or still feeling tired. (If you feel stiff after sleeping, it can also mean your mattress does not provide enough support and needs to be replaced.) 
  • Falling asleep at inappropriate times, mostly when sitting still while watching television or doing paperwork. 
  • Perpetual fatigue or lack of energy during the day. 
  • Headache, especially around the eyes. 
  • Irritability, frequent crying or outbursts of anger (i.e. having a short fuse). 
  • Lack of concentration. This, especially in combination with drowsiness, is a major contributing factor in motor vehicle collisions.  

What can you do yourself to alleviate sleep problems? 

A large proportion of problems with falling asleep or staying asleep are the result of poor sleep hygiene. These tips will help you improve your sleep habits and help you to get a better night’s sleep. 

Make sure your bedroom is dark, cool and well ventilated. Ensure your room temperature is between 17 and 21 degrees Celsius, so that you feel relaxed and comfortable. Keep the environment noise free. Are your surroundings loud or noisy? Consider using a white noise machine or app. White noise is a monotonous sound that blocks away all the other sounds, putting the environment at peace. Remove all screen devices from your bedroom. Playing a game or watching TV may seem relaxing, but the blue light that is emitted from these screens delays the release of sleep-inducing melatonin. Follow a routine. Try to go to bed and wake up around the same every day. Developing a routine helps your body to enter a relaxed state more quickly. Invest in a new mattress, a good pillow and comfortable nightwear. Start a worry journal. The journal is an emotional outlet where you can write freely about your worries. Acknowledging these thoughts and getting things that are in your head down on paper will help you to relax and sleep better. 

What treatment options are there? 

Medication 

Doctors generally don’t recommend prescription medication for sleep problems. This is because sleeping pills are habit forming and have lots of side effects. You could say that sleep medication is nothing but a temporary band aid until the underlying problem is addressed. But if you need to resort to medication for chronic insomnia, make sure it is used sparingly for short-term situations. A short-acting benzodiazepine-antagonist, such as lormetazepam, temazepam, zolpidem of zopiclone, is preferred. These medicines have been around for a long time and have few next-day side effects when used in low doses. Mild or short-term sleep problems are not treated with medication. This is because the side effects do not outweigh the potential benefits. 

Alternative treatments 

There are also treatment options other than medication that can help to improve your sleep rhythm. Examples of alternative therapies include meditation and yoga, aromatherapy, herbal tea and melatonin. If the sleep problem cannot be solved with these options, you can ask your doctor for a referral to a sleep clinic for a more thorough evaluation. Disorders such as sleep apnoea and narcolepsy, but also insomnia and snoring are treated here.  

Lifestyle changes 

Changing certain aspects of the way you live can also lead to you getting a better night’s rest. Here are some lifestyle changes you can start making.  

  • Take about an hour before bedtime to relax and get ready to sleep. This means no TV, laptops, tablets or mobile devices. Instead, read a book or magazine, or listen to calming music to prepare your mind for a peaceful night’s rest.  
  • Get into an exercise routine. Exercise or go for a brisk evening walk. Start doing relaxing activities, such as dancing, yoga or meditation.  
  • Don’t overload your diary. Leave opportunities in between activities to relax and unwind. This applies to both your professional and personal life. Make time to relax.  
  • Avoid alcohol or caffeinated drinks in the evening. This also includes energy drinks, Coca-Cola and black tea. Also reduce the number of cups of coffee during the day. Caffeine delays the production of melatonin (a hormone produced by your body that controls your wake/sleep rhythm) and stimulates brain activity. This is not convenient if you want to sleep. 
  • Make sure you take in enough fluid. You may experience both physical and mental fatigue if your body is not properly hydrated. A well-hydrated body can dispose of waste products quickly and well, which promotes a good night’s sleep. 
  • Stop smoking. Smoking reduces the blood flow to tissues and organs, and this causes toxins to enter the blood.  
  • Keep your weight in check. Obesity causes extra fatigue in several ways.  
  • Adjust your eating habits. Deep-fried and sugary foods require a lot of energy to process and therefore cause fatigue. Make sure you diet includes plenty of fruit and vegetables, so that you also get enough vitamins and minerals. Eating late at night and going to bed on a full stomach can greatly disturb your sleep. 

Additional risks and side effects 

Given the risks and side effects associated with the use of sleep medication, such as tiredness during the day, influence on driving and dependency, using a short-acting soporific drug in the lowest possible dose is preferred. What’s more, the effectiveness for inducing sleep wears off after two weeks once the body adjusts to the medicine. 

How can you prevent sleep problems? 

Sleep problems cannot always be prevented. Sometimes poor sleep is caused by a sleep disorder or a health problem, such as depression. However, you can prevent sleep problems from developing or becoming chronic by following the recommendations provided above as well as sticking to healthy sleep habits. 

Sources 

Farmacotherapeutisch Kompas (2020). Slapeloosheid (Insomnia). Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/slapeloosheid 

Farmacotherapeutisch Kompas (2020). Zolpidem. Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/z/zolpidem 

Farmacotherapeutisch Kompas (2020). Zopiclon (Zopiclone). Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/z/zopiclon 

Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie (Royal Dutch Pharmacy Association). (2010, 26 August). Slapeloosheid (Insomnia). Consulted on 1 June 2020 on https://www.apotheek.nl/klachten-ziektes/slapeloosheid#wat-is-slapeloosheid 

 

 

Assessed by:

Dr Arco Verhoog, Pharmacist
Registration number: BIG: 19065378617

Mr Arco Verhoog holds a degree in pharmacy from the University of Groningen (RUG). He served as a pharmacist in the Netherlands and St Maarten from 2005 to 2008. Since 2008, Arco Verhoog has worked as managing pharmacist on Curaçao.