Sleep is not a luxury, it is a important part of our patients' health argues Dr Karine Nohr.
‘Six hours for a man, seven hours for a woman, eight hours for a child and nine hours for a pig,' said the Reverend John Wesley.
I recently attended a fascinating lecture by Dr Rubin Naiman, a sleep specialist in the States. He suggested that much insomnia is due to ‘overconsumption', in a society that is fundamentally undernourished.
Consuming, he explained, energises us. We over consume food (often of poor quality), light, (mainly ‘junk light' at night and ‘blue light' from TV's/computers) information and air (most of us breathe badly).
We are unable to process this overconsumption and thus unable to surrender to sleep.
He proposed four pillars of healthy living: nutrition, exercise, stress management and sleep. ‘We live in an age where drama is so ubiquitous, we are often unaware of its pernicious impact on our well-being.
‘Whether in the guise of news, entertainment or reading material, drama abounds. I think that most of us are less traumatized, but more dramatized,' he said.
He went on to say the amount of stimulation that we are exposed to over a fortnight is the same as a lifetime in the 19th century. Our average sleep length has decreased about 20% since 1900.
We take activity into the night, when we should be restful, as if we were sleeping in our clothes. Look at some people's night table, and it is full of ‘noise': books, light, LED alarm, mobile phone, laptop, wineglass, notebook, ashtray…
The rituals of preparing for sleep are so important and many of us need a couple of hours for the descent into the surrender to sleep. We need to reduce the ‘noise' - dimming lights, turning off screens, having a warm bath, meditation/relaxation or prayer etc.
Several studies indicate that sleep length represents a stronger predictor of mortality than a history of smoking, heart disease, or hypertension, even after age, body mass index and physical endurance are taken into account.
Insomnia can be a pretty good predictor of reduced mental health. The fatigue associated with chronic insomnia has a lot of depression-like features, such as social withdrawal, lack of motivation and poor concentration.
With some patients presenting with ‘depression', I have found that helping them establish a reasonable sleep pattern is the most useful therapeutic goal.
As a some-time insomniac myself, I can identify with James Maas's description of reduced consciousness when awake.
‘Often we are totally unaware of our own reduced capabilities because we become habituated to low levels of alertness. Many of us have been sleepy for such a long time that we don't know what it's like to feel wide-awake.'
I only realised quite how fatigued I was when I returned to normal sleep patterns and felt alive and well again.
Sleep can become more difficult as we get older. Younger people tend to have more difficulty with the onset of sleep, older people with the maintenance of sleep. Intercurrent illness, menopause and certain medications can also contribute to insomnia.
I was interested to hear, in the lecture, that tricyclics, SSRI's, many hypnotics and other medications such as analgesics actually interfere with REM sleep. Apparently, a short-term benzo only increases our sleep by an average of 15 minutes, the difference being in the perception that the patient doesn't remember all the periods of wakefulness!
As the anthropologist Matthew Wolf-Meyer notes: ‘If a society can't rest, how can it sleep?'
Dr Karine Nohr is a GP in Sheffield
Dr Karine Nohr
