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SLEEP PROBLEMS

Normally an adult needs 7 to 8-hours of sleep per day. Few manage with as less as 5 hours a day and few need as much as 10 hours a day, which is still to be considered normal for the person. Children need more sleep. New borns sleep for nearly 20 hours a day for first few days and the requirement gradually decreases over a period. Even then,  a child would require about l2hour sleep a day till it is about 3 to 4 years of age. By about 15 years the requirement will come down to about 8hours a day Elderly people (age about 50 years) start having less sleep and by 65 to 70 years of age one may sleep 3 to 5 hrs at night making up for the lost sleep by day time naps. Yet they tend to complain of poor sleep, though it is normal for their age. 

Sleep disturbance occurring occassionaly or in times of stress due to any reason does not warrant any treatment.

It is only when sleep disturbance is persistence  for several days that one needs to be concerned about it. Self-medication with sedatives for sleeplessness can be the beginning of dependence on a drug, hence has to be avoided. 
  
Intake of alcohol excess coffee, tea, tobacco can cause sleeplessness. Abstaining from these is a way to improve one's sleep. Usually,  a psychiatrist help is needed to come out this, If it is a part of a psychiatric disorder like depression or anxiety disorder.  Excessive sleep is also abnormal when the condition causes considerable problem to the person in attending to daily activities. This also requires expert help.

Rules of sleep hygiene  

  • Go to bed at night and leave the bed in the morning at fixed times regularly, all the seven days of the week. 
  • Insulate bedroom against sounds (eg. Closing the doors, thick curtain, carpeting etc.) 
  • Maintain moderate room temperature. 
  • Avoid coffee/tea in the late evenings, so also use of tobacco & alcohol. 
  • If not getting sleep, do not try hard to fall asleep. Instead leave the bed & engage in reading something that is boring. Do not involve in stimulating activities. 
  • Wake up at the same time in the morning even if you have poorly slept at night. 
    Regular exercise helps deepen the sleep.


Sleep problems in children
 

Bedwetting, normally  stops by about 6 years of age. If it does not they it requires medical attention. A urologist should be consulted first, and if there are no urological problems, here are some hints: 

  • Restricting fluid intake after 6 p.m. 
  • Making the child pass urine before going to bed.  
  • Appreciating the dry nights and encouraging the child for dry night
  • Do not let anyone to humiliate the child for wet nights. 

If this fails to bring good results over a month try consulting a psychiatrist is necessary.

Nightmare  

Child wakes up from sleep all of a sudden screaming and crying. If child is able to respond to you and with your assurances goes back to sleep and is able to recollect the event next day it is 'nightmare' due to some fearful dream. One need not worry about this as this responds to reassurances from parents.

Night-Terror 

If child wakes up screaming, doesn't respond to you at all, goes back to sleep after some time and is unable to recollect the event next morning it is night terror, which if occurs frequently, requires expert intervention. Grinding teeth (bruxism) sleep talking and sleep walking need expert attention if occurring frequently.

Emotions 

All should be emotions - happiness, sadness, anger, fear etc, are  experienced and expressed. But, the type and extent of the expression should be appropriate to the situation.

Anger/Irritation 

This is normally experienced, and when one feels frustrated, when things are not the way one expectes them to be. If the anger/irritation is out of proportion to the seriousness of the event and/or persists for longer period it is harmful to one's physical as well as mental health. Frequent outbursts of anger is also equally harmful. Such inappropriate outbursts often bring about guilt feelings later on which adds to the psychological trauma. One should make conscious efforts to check anger and to say in words whatever one wants to say about the provoking event. This helps others involved to understand the situation to explain matters etc., often just saying " I am angry with you" helps release the emotion from oneself. When irritability/anger is totally irrational and outright inappropriate, it suggests an underlying psychiatric problem requiring expert help.

Sadness/Depression 

Feeling sad in response to negative events is normal. But when the sadness is out of proportion to the nature of the provoking event or lasts for an unduly long time, and becomes pervasive, one needs to seek help from others as it would bean episode of depression.

Depression as a disease has following features 

  • Marked sleep disturbance.  
  • Poor/appetite with weight loss. 
  • Persistent sad or anxious mood, with feeling of "emptiness".  
  •  Feelings of hopelessness, worthlessness, helplessness, passimism. 
  • Feeling of guilt/sin 
  • Fatigue, decreased energy. 
  • Decreased interest in work, in daily routines. 
  • Death wishes, ideas of suicide. 

If such is the case, it calls for treatment from an expert.

Anxiety/Fear 

Normally all feel anxious or experience some fear while facing certain situation like examinations, interview or where there is uncertainty  Threat of any kind can cause anxiety to anyone. Even marriage, pregnancy, attaining parenthood, getting promotion, transfer to distant places etc, evoke anxious reactions. But when the reaction is out of proportion and /or in-appropriate, or lasts too long and impedes ones ability to face the situation it gets labeled as a pathological problem, requiring help from a mental health professional. Relaxation excercises, Yoga, meditation, pranayama are also useful to overcome this problem. Anxiety caused by an urge to repeat certain acts or due to repeated unpleasant thoughts are called obsessions and these also need appropriate treatment from a psychiatrist. Examples of this disorder are  washing hands or articles repeatedly, counting things repeatedly, repeatedly checking if things are in order repeatedly or repeating certain acts even when knowing the 
acts to be purposeless or senseless. This condition is called 'Obsessive Compulsive Disorder`. There is specific treatment for this disorder.

Suspiciousness 

Uncalled for suspisions about motives of others around and constant preoccupation with such suspicions giving rise to fear of harm - are invariably signs of a serious mental disorder, which needs early consultation with psychiatrist. 

Forgetfulness/memory problems 

Some are habitually forgetful and some tend to be forgetful when under stress. This need not worry a person as it is not  a brain disease or a mental disorder. When the forgetfulness is severe and causes significant problems in one's regular work it should be taken seriously. Forgetfulness can be due to other preoccupations or due to brain disease and the issue has to be determined by an expert. Inability to concentrate in what one is doing, either because of lack of interest or because of other preoccupations of the mind, is invariably the cause of poor memory  often reported by students. Similarly anxiety and depression can give rise to forgetfulness, inability to understand a task etc., 

Appropriate methods of study to suit the individuals level of intelligence and the nature of the subject being studied, are often sufficient to help such situations. Yoga, meditation also are helpful in increasing the level concentration.

- Dr. Sripathy M. Bhat



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