SLEEP HYGIENE part two…for those with problems falling asleep, maintaining sleep or poor quality

Last time I talked abut dealing with problems with falling asleep, maintaining sleep or not feeling refreshed after sleep all of which is otherwise called insomnia. In the last edition I also explained that insomnia becomes a clinically problem when it occurs 3 or more times in a month and has lasted for at least a month. Studies have shown that insomnia can be improved just by practicing some simple but effective methods without necessarily using sleeping pills. I also mentioned that sleeping pills should be the last line of action taken to address the problem of poor quality sleep. Using sleeping pills could be helpful but when taken for too long (longer than 4 weeks tops) highly increases the risk of becoming addicted to it such that when it is stopped the individual finds it extremely difficult to sleep to an extent that may sometimes be worse than the initial problem for which it was initially taken to address.

I had earlier discussed about one non-drug treatment for insomnia called sleep hygiene, in this edition I would like to conclude by sharing two other methods you could simply practice at home without constantly visiting a pharmacist or a doctor for sleeping pills. My advice is that all this various methods should be practiced together rather than in isolation; it’s more effective that way.

STIMULUS CONTROL

This entails not lying too long on bed when you observe you are not falling asleep and only going to bed when you are sleepy. It also entails eliminating circumstances or activities that tend to keep you awake e.g. work, watching T.V. etc, the idea is that your body then unconsciously associates the bed with sleeping. Studies have shown this method to be the ideal for treating long standing problem with insomnia.

SLEEP RESTRICTION

This obviously sounds like a paradox because the problem here is not having adequate sleep and I’m saying sleep should be restricted? Well it has also been proven to be a very effective non-drug treatment for insomnia. This entails several steps

· Keep a sleep diary for 7-14 days to allow the determination of the average time you spend on bed by the usual time you go to bed to the usual time you arise from bed, and the average hours you sleep during those periods.

· Then you eliminate the time you spend not sleeping while on bed by working back from your wake time. For example if you wake up by 4:30a.m and you sleep an average of 4 hours that means your actual ‘bed-time’ is 12:30. You then only go to bed at about 12:30 even if you feel like going before then you ‘restrict’ yourself. The idea is that since in this hypothetical case you sleep 4 hours most of your time between 12:30 to 4:30 would be spent sleeping unlike the usual lying on bed for perhaps 8 hours but staying awake for 4 hours.

· Do this new ‘prescribed’ bed time for about a week such that most of the time you are on bed (at least 85%) you are actually asleep. No day time naps is allowed despite however tired the individual may feel.

· After this has been achieved go to bed fifteen minutes earlier than your prescribed time and observe if you are still able to sleep 85% or more of the time you are on bed.

· Keep gradually adding fifteen minutes before your prescribed bed time as long as you are still achieving 85% or more of actual sleep until a satisfactory amount of night-time sleep is achieved.

Like I have earlier said all three techniques should be practiced together. To all those with poor quality sleep problem, practice these various therapies and have a lovely night rest…sweet dreams.

I HAVE A DREAM! ...my testimony

This is actually a previously published article with a few adjustments, I thought I should share it with my new (blog) friends...

“Sorry we won’t be able to publish your articles monthly… you know this is not a psychiatry magazine”. These were the words I was told after my first article was published in June edition of Genevieve 2008, and I was trying to push for a second publication. Some people suggested I should publish in any of the health magazines (for heaven sake, how many people even read that…I don’t…and I’m a doctor), many other lifestyle magazines kept turning me down and I must confess I sometimes felt discouraged.

It all started with an idea, or should I call it a dream in 2007. I had come to the conclusion that there was a great dearth of information regarding mental health in the general population in this part of the world. My resolve was to be an agent of change by enlightening people so I started scribbling my thoughts and experiences into articles hoping that someday it will be published in a nationally renowned lifestyle magazine-precisely, Genevieve. Someone told me my style of writing wasn't good because I was obviously a columnist 'wanna be'..." I needed to be more professional". The dilemma with this advice was that, if I was too professional I'll be boring and not too many people will get the gist.

During all those times I was turned down by various magazines including my dream magazine, the words of Otunba Gaddafi, one of Nigeria’s thriving entrepreneur, kept ringing in my heart; how he had persisted with his 'mobile toilet' idea… so I persisted.

Someone read one of my article and felt it was good enough so he introduced me to blogging where I could post my thoughts without being harassed by any editor and make some dough (cash) while at it…did you really think this was strictly for charity?

Anyway the main gist is, I look back and in the last 7 months from March till this month in 2009, my articles have consistently been published in Genevieve, they even gave me my own column... In The Pink (I wanted "Stop This Madness...notes from a concerned psychiatrist" but this name is cooler abi? It doesn't carry the stigma that comes with kolo health).

I may not have it all…yet! But like my pastor will say "the Journey is the Joy", it may look fuzzy and hazy sometimes but it pays to persist and keep at it, who knows, if only you just took one more step, the fruits of the whole waiting process would have been harvested.

In closing I want to give props to Tobenna of Shirak! who have inspired me and keep inspiring me in this blogging business. Also I really do want to appreciate aunty Betty Irabor for the priceless opportunity through Genevieve magazine as a platform to inspire right perspectives towards mental health and a more fulfilled life in general, indeed it is a dream come true.Also a big thank you to all of you who have been commenting.

To all my fellow bloggers, especially all up-coming artistes like me (until I have done one year in this business before I will agree I'm 'old')… keep at it; you are indeed making a difference…whether good or bad (lol).

SLEEP HYGIENE …for those with problems falling asleep, maintaining sleep or poor quality sleep

Sleep is a behaviour shared by all animals. The need for sleep is not fully understood but it is agreed upon that sleep gives the body ‘time-out’ to recuperate. Some people sleep an average of 5 hours while others sleep an average of 9 hours a day. On the average about a third of our lives is spent sleeping.

Sleep is usually taken for granted (at least I do); we take naps both during the day and at night, however sleep problems are quite common. Most of us have experienced a day or days with difficulty with sleep probably due to a temporary stress. About 30 percent of adults are said to have experienced difficulty with initiating or maintaining sleep at some point in their lives. Statistics show that women and the elderly are more susceptible to have such problems. About 6 percent of people actually suffer from persistent difficulty with sleep which is so severe that it interferes with their social or their occupational functioning.

One could be said to have a sleep problem called insomnia when you find it difficult falling asleep, maintaining sleep or waking up not feeling refreshed. Persistent insomnia becomes a clinical problem when it occurs at least 3 days a week for up to a month.

There are a lot of factors that may cause this problem with sleep ranging from factors from within, like anxiety, sadness, jet lag, to factors without like the environment, drugs, and meals. Poor sleep could also be associated with both physical and mental illnesses. In certain cases some individuals have had a life long problem with sleep which is referred to as idiopathic insomnia.

HOW TO SLEEP BETTER

I have noticed that most often than not when people have a problem with sleeping they self medicate themselves. Sometimes, when they have access to a doctor, they get sleeping pills to help them sleep. Sleeping pills can be very helpful a lot of times but the problem with its frequent use is that it can become addictive. Sleeping pills are only meant to be used occasionally, never use them everyday consecutively for more than 14 days if not you run the risk of becoming addicted to it. Once an individual becomes addicted, the sleeping pills then have a rebound effect such that it starts causing insomnia and the individual finds it difficult to sleep without the pills and may sometimes have to increase the quantity needed to fall asleep. Interrupted use of sleeping pills will reduce the risk of becoming addicted to them. The use of sleeping pills should also be a last resort or used in severe distressing cases.

Like it is said a problem understood is half way solved so you may need to first identify and address any underlying problem; is it due to a medical, psychiatric or a psychological condition? Could it be the environment, stress, drugs or perhaps persistent pain? Sometimes you may need a professional to help you identify this.

Let me share with you a better way to address that problem of poor sleep before resulting to the use of sleeping pills…

SLEEP HYGIENE

This can be defined as "all behavioural and environmental factors that precede sleep and may interfere with sleep. It is the practice of simple sensible guidelines in an attempt to ensure better rest. I like to remember these guidelines with the acronym S.E.A. (just imagine you are by seaside taking a nap).

Sleep environment

· It should be familiar and comfortable

· Dim light and quiet

Encourage

· Consistent bedtime and waking up time with not more than one hour variation even during weekends or holidays

· Thinking about problems before going to bed and winding down about an hour before bed by listening to music, having a warm bath, reading, watching T.V etc.

· Physical fitness by engaging in regular graded vigorous exercise programme during the day

Avoid

· Late evening exercise or other activities (except sex); don’t watch T.V or bring work to bed so that the bed is only associated with sleep

· Caffeine-containing drinks late in the day

· Excessive alcohol and smoking

· Naps during the day (confine naps to early afternoons and it shouldn’t be longer than approximately 40 minutes)

· Large late meals, and

· Too much time in bed lying awake; if sleep doesn’t occur do not remain in bed for more than 10-20 minutes, get up and go to another room (without turning on all the light) and returning to bed only when sleepy.

There are some few other non medication treatments for insomnia like sleep restriction and relaxation training but that will be a discussion for another day,meanwhile go and put into practice these guidelines and “ease up” on the frequent use of sleeping pills and I guarantee that there will be an improvement in your sleeping pattern.

Blogger's Note...I'M BACK!!!!

It's been ages since I wrote on my blog. I'm glad to be back, like some one said from 'set back' to 'come back'. Anyway I hope things have been great with you? It is not easy keeping up with blogging o...how on earth do you guys(who blog) do it?
I intend to put up an article on addiction, I notice it is a real menace that tends to ruin the lives of the affected individual and their loved ones so I feel it is my responsibility to try and help someone out there.
While I get round to do that do enjoy these articles on insomnia (for those with sleep issues), 'think on these things', and the hilarious captions. By the way if you live in Nigeria, particularly Lagos, do pick up a copy of Genevieve magazine monthly and check out my column, it's called 'In the Pink'...cool name se!

SCHIZOPHRENIA... understanding and dealing with it

It all started 10 years ago(at least that was when we noticed) when my mum had informed my brother and I (we were in secondary school)that we were not going to school that day because she had realized that she was being monitored by ‘certain’ people and now they wanted to get at her through us. Then we noticed she became very withdrawn and would often not go to work. We later got reports from her office that even while at work she would lock herself in the office and would not pick up calls even from her secretary. Her ideas of life and the people around her had become so weird that even when we tried to make her see reason with us it was as futile as trying to drain an ocean by fetching from it with a teaspoon…

Dorothy, Delta.

The lady above has a mental health problem called schizophrenia. About 1% of most populations is said to suffer from this condition. It is a common case seen in most psychiatric institutions. It is a brain disorder which can affect how the individual thinks, feels and acts. The rate of occurrence is same in both sexes.

WHAT CAUSES IT?

It is a complex and puzzling disease hence the actual cause is not yet known rather it is said to be the result of multiple interacting factors. Some of the implicated factors include genetics (hereditary), imbalance in certain chemicals in the brain which are responsible for the transfer of messages in the brain, and also various environmental factors which range from events during pregnancy, delivery, stressful events in childhood to stressful events in adolescence and adulthood. Smoking marijuana also puts one at risk of developing the illness.

Some misconceptions about this condition that I would like to clarify with regard to the cause is that schizophrenia is NOT same as ‘split’ personality or ‘multiple’ personality (as I have found out to be the popular assumption of many and this is partly why I wrote this article) neither is it caused by bad parenting or due to weakness in the affected individuals personality.

SIGNS AND SYMPTOMS (HOW TO RECOGNIZE IT)

Symptoms may first appear between the ages of 15 and 35 even though it could occur earlier or later and this has been observed to often appear earlier in males than females. The appearance of symptoms varies from person to person; symptoms may develop slowly over months or years, or may appear very abruptly. In the early phase of the illness they isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates. They may also be noticed to be sleeping poorly.

The person suffering from schizophrenia may experience one or all of the following symptoms:

• Delusions -- false ideas that are strongly held unto despite contrary evidence. For example, individuals may believe that someone is spying on him or her, or that they are someone famous. They may believe that someone or some people want to harm them.
• Hallucinations -- imaginary voices which give commands or comment on the thoughts or actions of the individual. It could just also be a disturbing sound or the person may think he or she sees, feels, tastes, or smells something which really doesn't exist.
• Disordered thinking -- moving from one topic to another, but making no sense. Individuals may even make up their own words or sounds.
• Oddity of behaviour—the person is withdrawn, mute, may neglect personal hygiene, talk and laugh with self or often assume very unusual postures.

There are variations in the pattern of presentation. The impact on the social functioning of the affected individual varies from minimal to severe. Some people may experience symptoms only a few times in their life while others may need to manage their symptoms through medication and self-care. The worst form of the disorder can make it difficult for a person to tell the difference between real and imagined experiences, to think logically, to express normal emotional responses or to behave normally in social situations.

HELP TIPS FOR THOSE WITH THE ILLNESS AND THEIR LOVED ONES

In the past it was said that only about a third of people with the illness recover fully while another third do not respond at all to treatment. The remaining third are in between, that is, they get better following treatment but they still have residual symptoms which give them away that they are not completely mentally healthy or stable.

In more recent times studies have shown that only less than 20% of those with the illness show no response or significant improvement following treatment. Schizophrenia usually runs a persistent course and like other persistent medical conditions such as hypertension and diabetes, the medications only control and not cure the illness hence the need to take the medication persistently even when the individual is mentally stable thus preventing a reoccurrence of the illness.

The burden of the illness could be remarkable both on the ones with the illness and their loved ones; family members, colleagues and friends. However the following steps could help

· Educate yourself about the illness.

· Learn to communicate better with those with the illness; keep it brief and straight forward, don’t argue with one who has a strongly held false belief (its part of the illness and it could make him or her irritable and then aggressive).

· Set realistic expectations for them in view of the limitations placed on them by the illness. Help them set goals and assist them achieve it while being patient with their pace. Avoid criticism.

· Encourage independence by creating a structured and supportive environment this will improve self care and self confidence.

· Encourage them to take their medications.

· Find support for yourself and possibly be in contact with medical personnel who can come in handy during the crisis period of the illness.

Just like any other disease, early detection and appropriate intervention on this illness goes a long way to improve the general outcome of treatment and invariably, the quality of life those with the illness will eventually enjoy.