Volume 10 Issue 8 August, 2019
“The best bridge between despair and hope is a good night’s sleep”.
-Matthew Walker
Sleep is fundamentally a physiological drive, just as hunger and thirst are, which is necessary to maintain homeostasis in every human being. Sleep is essential for various physiological functions including energy conservation, hormone secretion, neuronal development, modulation of immune responses, alertness, concentration, memory and performance. Sleep deprivation has been linked to medical conditions including heart disease, diabetes, hypertension, obesity and shorter life expectancy.
Non-pharmacological measures including universal sleep hygiene techniques are the first line options to help improve sleep. These are as follows:
- Ensuring a healthy lifestyle:
- Regular physical exercise.
- Healthy diet-with high fiber content and low fat.
- Avoid excess consumption of caffeine, alcohol, tobacco or other drugs of abuse.
- Environment conducive to sleep
- Quiet, cool and dark room-wear eye shades if necessary
- Comfortable bed
- Hide the clock, which otherwise can serve as a reminder of the passing time without getting sleep proving to be more disturbing.
- Develop good sleep habits
- Maintain a regular sleep wake schedule
- If not getting sleep in twenty minutes, get out of the bed
- Avoid long day time naps
- Relaxing pre-sleep routine-which helps unwinding such as listening to soothing music, warm shower, reading a book.
- Reserve the bed for sleep and intimacy
Cognitive behavioral therapy for insomnia which includes sleep hygiene education, cognitive therapy, relaxation therapy, sleep-restriction therapy and stimulus control therapy has been found to have a good evidence base.
Benzodiazepines (triazolam, estazolam, temazepam) benzodiazepine receptor agonists (zolpidem, zopiclone, zaleplon) are suitable for short-term treatment of insomnia. Patients with sleep on set difficulties may benefit from melatonin receptor agonists like ramelteon. Chronicinsomnia (>4weeks) can be treated with low dosese dating antidepressants (trazodone, mirtazapine, amitriptyline). Low dose a typical antipsychotics (quetiapine, olanzapine) is yet another option, especially for patients with comorbid schizophrenia or bipolar disorders.
Medical health professionals should be cognizant of the importance of adequate sleep in their patients and in themselves to ensure optimal mental and physical health. Insomnia should receive medical attention and interventions in a nearly stage to prevent the deleterious consequences of sleep deprivation on health and functioning.
Dr Kathleen Anne Mathew Senior Resident, Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Kochi
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