Section editor: Latica Friedrich, MD, neurologist
I’ve trouble sleeping for a long time. Is it okay for me to start taking sleeping pills, will it help me, and will it cause addiction?
Your doctor will talk to you and determine the cause of your trouble sleeping. It could be insomnia or some other disorders that can lead to sleep problems, such as sleep apnoea, depression, various types of pain, and frequent night urination, when a consultation of the appropriate specialist is required. The most commonly used medicines for better sleep are the so-called benzodiazepines or related drugs (In Croatia eg Normabel, Sanval, Praxiten…). However, although these medicines shorten the time of falling asleep, they might not help people who wake up later in the night or wake up early in the morning and can no longer fall asleep. Besides, these drugs are primarily intended for short-term use in occasional sleep problems (eg during stressful situations such as family deaths and the like). If there is a need for longer-term medication, more complex treatment is required. According to the current guidelines, the first line of insomnia therapy is not medication, but cognitive-behavioural therapy that addresses psychological, behavioural and cognitive (thought) factors that may play a role in the development of insomnia.
According to the more recent scientific knowledge, it is considered that drug tolerance will not develop if benzodiazepines are taken at therapeutic doses for better sleep (ie, the person will not become “resistant” to the drug after some time). Also, these medications in insomnia therapy will most often not lead to physical addiction, but they can lead to psychic addiction (in a way that a person thinks they can no longer fall asleep without the drug). When a person stops taking a benzodiazepine, a few nights of poor sleep can be expected (the so-called rebound phenomenon, when the symptoms of insomnia are worse than before starting the drug), but after that, the symptoms return to their previous level (before taking them. benzodiazepines).
Can I somehow help myself to sleep better without medication and professional treatments?
Numerous, proven effective methods help people with insomnia. Most of them require effort and persistence, but unlike medications that work only while taken, and with the risk of side effects, these methods can lead to a permanent cure for insomnia.
- Sleep hygiene
Sleep hygiene involves acting on environmental and health factors that are important for sleep quality. The most important are:
Avoid stimulants (coffee, caffeinated beverages such as Coca-Cola, nicotine) for several hours before bedtime
Avoid alcohol before bedtime. It is a common belief that it is easier to fall asleep with the help of alcoholic beverages, but it leads to frequent nighttime awakening and thus poor quality of sleep.
Exercise regularly (preferably not just before bedtime).
Provide at least one hour before bedtime to relax and thus prepare for sleep.
Go to sleep and wake up at the same time every day (including weekends).
Do not use electronic devices (cell phone, computer, tablet, television) in the bedroom.
The bedroom should be quiet, dark and comfortable.
- Sleep restriction
People with insomnia often spend a lot of time in bed hoping to get enough sleep in this way, but this can lead to fragmented, poor quality sleep. This method, seemingly paradoxical, is based on limiting the amount of time spent in bed to the minimum amount of time still acceptable to the person concerned. This time is gradually extended over the coming days and weeks until optimal sleep time is reached.
- Stimulus control
The adherence to the following instructions aims to re-establish a positive relationship between sleep and bed/bedroom, and finally to establish a continuous rhythm of sleep and wakefulness.
Go to bed only when you feel sleepy.
If you wake up and can no longer sleep, stay in bed for a maximum of 15-20 minutes and then get out of bed, go to another room and return to bed only when you feel very sleepy.
Restrict non-sleep-promoting activities in the bed and bedroom (without reading, watching television, and other electronic screens, avoid planning and troubleshooting while lying in bed).
Get up every day at the same time, no matter how much you slept the previous night.
Avoid sleeping during the day.
- Relaxation training
It is conducted to reduce anxiety, muscle tension and distressing thoughts that can interfere with sleep. Most of relaxation training methods are performed, at least initially, with the assistance of a professional, and require regular performance every day for several weeks.
- Cognitive therapy
It is carried out with the help of an expert psychologist, to reduce the excessive concern about unsatisfactory sleep.
- „Mindfulness“ techniques
These are techniques aimed at developing mindfulness, that is, the ability to be in the present moment without judgment
- Cognitive-behavioural therapy
It includes combinations of the above techniques.
What is sleep apnoea? Why does my doctor suspect this condition even though I have never had trouble breathing?
Sleep apnoea is a sleep disorder that causes short and repeated interruptions of breathing during sleep. There are two main types of sleep apnoea, obstructive and central. The obstructive one is far more common and occurs when the muscles in the back of the pharynx are unable to keep the airway open, so it collapses, causing breathing to stop. In central apnoea, a disorder of breathing regulation occurs at the brain level.
When a person suffering from obstructive apnea stops breathing, he/she first wakes up, and then starts breathing again and falls asleep shortly. This can happen even hundreds of times in an hour! Such breathing cessation is seldom remembered by the person himself, but may be evidenced by a partner sleeping in the same room. The symptoms most commonly experienced by the patient are tiredness and decreased concentration during the day, a tendency to fall asleep in inappropriate situations (eg during a meeting or while driving a car), morning headaches, etc. Also, prolonged sleep apnea very often leads to the development of high blood pressure, heart failure and arrhythmias, heart attack, stroke and depression.
People who are at increased risk of developing obstructive sleep apnea are those who are overweight, snore and have a wide neck. Also, the risk factors are smoking, age and male gender. The presence of several of these factors, along with subjective symptoms of drowsiness and/or witnessed interruptions of breathing during sleep, certainly requires a physician evaluation. Sleep apnea is diagnosed by using a special type of night-time recording – polygraphy or polysomnography. Today, sleep apnea can be successfully treated, most commonly by using assisted breathing devices (so-called CPAP devices).
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