Dr Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
INSOMNIA AND PREGNANCY
Insomnia is common during pregnancy, especially in the 1st and 3rd trimesters. Fluctuating hormones, nausea, and an increased need to urinate are some of the bodily changes that may keep women awake in early pregnancy. They may face emotional stressors such as anxiety about the increasing responsibilities as a new mother, or having a new child. Pain, such as cramps and back discomfort, may also keep them awake.
The pregnant body is undergoing many changes, like an active metabolism and increase in progesterone, to accommodate the new life growing inside. It’s normal for sleep patterns to change, too.
Lifestyle changes that may help include:
* Keeping active during your pregnancy
* Maintaining a healthy diet
* Staying well-hydrated
* Maintaining a consistent sleep schedule
* Practising relaxation techniques during the day, or taking a warm bath before bedtime.
If experiencing anxiety, have a medical consultation about any new exercise routines, medications, or supplements that may be of interest. It is important to ensure they are safe for pregnancy.
The good news is that pregnancy-related insomnia usually passes, and it doesn’t affect the baby’s development.
INSOMNIA DIAGNOSIS
In order to arrive at a diagnosis, clinicians will at times ask questions about:
* Medical conditions
* Social environment
* Psychological or emotional condition
* Sleep history
This information can help to determine the underlying causes of a sleep problem. Persons might be asked to:
* Keep a sleep log
* Record when they fall asleep
* Note the instances when they wake up repeatedly
* Report what time they wake up each day
A sleep log would give a picture of a person’s sleep patterns. Also, medical tests or blood work may also be ordered to rule out other medical problems that can interfere with someone’s sleep.
Sometimes a sleep study is recommended, not for the diagnosis of insomnia, but for confirmation if the clinician suspects an underlying sleep disorder, such as obstructive sleep apnea. There are two ways a sleep study may be carried out. One option involves an overnight stay at a sleep centre. The second option allows persons to do the study at home, in their own bed.
Both sleep study options involve having electrodes placed in various places on the body, including the head.
The electrodes are used to record brainwaves to help categorise the states of sleep. They’ll also help detect body movements while sleeping.
The results of the sleep study would provide clinicians with important neuroelectrical and physiological information to determine the underlying issues related to sleep.
INSOMNIA IN CHILDREN
Children can have insomnia, too; often for the same reasons as adults. These reasons might include:
* Stress
* Medications
* Excessive caffeine intake
* Psychiatric disorders.
If a child has trouble falling asleep or staying asleep, or if a child wakes up too early, insomnia may be the reason.
According to the Cleveland Clinic, symptoms of insomnia in children may include:
* Daytime sleepiness or restlessness
* Irritability and mood swings
* Repeated disciplinary issues
* Memory problems and attention deficits
Treatments for children are often the same as treatments for adults.
Children will benefit from a consistent sleep schedule and good sleep hygiene. Reducing stress and avoiding screen time near bedtime would help as well.
INSOMNIA AND ANXIETY
Anxiety can cause insomnia, and insomnia can cause anxiety. This can result in a self-perpetuating cycle that may lead to chronic insomnia.
Short-term anxiety develops when persons worry frequently about the same specific issue, such as work, or their personal relationships.
Short-term anxiety usually goes away once the issue is resolved. The sleep should return to normal as well.
People can also be diagnosed with an anxiety disorder such as generalised anxiety disorder (GAD), or panic disorder. These disorders can result in varying degrees of insomnia.
The causes of anxiety disorders aren’t completely understood. Treatment is usually long-term, and includes a combination of therapy and medications.
The same lifestyle and behavioural practices recommended for other forms of insomnia help diminish anxiety-related insomnia, such as restricting stressful topics of conversation to the daytime.
INSOMNIA AND DEPRESSION
According to a sleep study done in 2014, not only does insomnia make persons more likely to develop depression, but depression can also make them more likely to develop insomnia.
A meta-analysis of 34 studies concluded that poor sleep — especially during times of stress — significantly increases the risk of depression. Another study found that as insomnia persisted and symptoms worsened, subjects developed an even greater risk for depression.
For other people, symptoms of depression may precede insomnia.
The good news is that the same treatments often help both depression and insomnia, no matter which condition comes first.
The most common treatments are:
* Medications
* Therapy
* Lifestyle changes
These lifestyle changes can include:
* Developing better sleep habits
* Exercising in the daytime
* Eating a balanced diet
COMPLICATIONS OF INSOMNIA
Not getting enough sleep can take a toll on our health. Insomnia can increase our risk for a number of conditions, including:
* Anxiety
* Depression
* Stroke
* Asthma attacks
* Seizures
* Weak immune system
* Obesity
* Diabetes mellitus
* High blood pressure
* Heart disease
Insomnia can also:
* Increase risk for an accident, including vehicular
* Affect performance at school or work
* Lower sex drive
* Affect memory
Insomnia isn’t just a nuisance or a small inconvenience; it’s a real sleep disorder, and it can be treated. If you think you have insomnia, talk to a health care provider. That person can help explore possible causes, and develop a safe and appropriate treatment plan, based on your healthcare needs.
Also, technology makes us more alert, and can lead to insomnia when used at night. Lights from computer screens can mess with the body’s circadian rhythm, and can lead to poorer sleep.
<<“Electronic curfew.”>> At least 30 minutes before hitting the hay (sleeping), hit the “off” button on all electronic devices.
