|
By
Dr David Delvin
SLEEP
PROBLEMS – INCLUDING ‘RESTLESS LEGS’
Sleep
as Shakespeare remarked in Macbeth is the ‘chief nourisher in
life’s feast’. In
other words, it is vital! If
you don’t get enough of it, not only do you become tired (and
probably edgy) but you also start losing your resistance to
infections. And any
medical conditions, which you may already have like arthritis for
instance, will probably get worse.
But how much sleep do you need?
Please bear two things in mind:-
1. People
vary a great deal in their need for slumber;
2. They need
less, as they get older.
That
second point is one that over-50s sometimes forget. Some of them think that they need 10 or 11 hours a night
‘just as I did when I was a youngster, doctor’.
But in fact, the requirements of the young are much greater
than those of the middle-aged and elderly.
We all know that tiny babies sleep most of the 24 hours with
luck! How much sleep do
bigger people need? Here
is a guide:-
¨
Teenagers need
about 10 or 11 hours a night, if possible;
¨
Young adults need 9
or 10 hours;
¨
People in their 30's
need around 8 or 9 hours;
¨
Folk in their
40's generally require about 8 hours;
¨
Those in their 50's
usually need 7 to 8 hours;
¨
Over-60's are OK
with 7 hours as a rule;
¨
People aged over 70
generally get by with about 6 hours.
Of
course there are many exceptions.
A lot of us still remember that Mrs Thatcher took only four
hours sleep per night while Prime Minister!
Was this good for her health?
I wonder………….
Click
here to go back to the top of the page.
Now
one of the biggest of all sleep problems is insomnia. People can easily be driven to the verge of a breakdown by
this, I assure you! I
have often seen patients who are absolutely desperate because, night
after night, they can’t get off to sleep.
In
a moment, we will come back to some simple remedies for insomnia.
But first of all, I’d like to make two vital points about it:-
1.
Sleeping pills are very rarely the answer!
2.
Very often, the real cause of the insomnia is Depression.
I’ll
explain more later, but first of all, here are some good and safe
ways of getting a decent night’s sleep:-
¨
Do not drink
tea or coffee in the evening, unless it is ‘decaffeinated’;
¨
Do not think
about anything difficult e.g.. Work, business or family problems after
about 8pm at night;
¨
Make sure you
have a light but nourishing supper, no big meals just before you go
to bed;
¨
If you like reading
in bed, try to limit it to a set time, like 20 minutes and don’t
read anything upsetting or scary (like a thriller!);
¨
Once you’ve put
the light off, do not let your mind wander onto any problem at all;
¨
Instead
there’s a lot to be said for concentrating it on some familiar
pleasant things, like SHEEP!
¨
If you find
that after 20 minutes you still can’t get off, then try the
well-known relaxation exercise of deliberately tensing the muscles
in each area of your body and then relaxing them, while thinking
about how good it feels;
¨
If after half an
hour, you still can’t drop off, then get up and go and have a
familiar hot drink (like milk or Horlicks or Ovaltine) and maybe a
small snack (like some biscuits) before going back to bed;
¨
Finally, you
might like to know that many experts say that sex is a very good way
of tipping yourself ‘over the brink’ and into sleep!
Certainly, a good orgasm, obtained either with a partner or
solo often leads to rapid slumber.
Click
here to go back to the top of the page.
SLEEPING
PILLS
Now,
many members of the public think that the answer to a sleep problem
is to take sleeping pills (or what used to be called ‘a sleeping
draught’). They’re
surprised when they find that doctors don’t agree.
Well,
why aren’t GPs in favour of sleeping tablets these days?
Why are good doctors so reluctant to prescribe them?
There are numerous reasons:
1.
Traditional sleeping pills will make almost anybody
‘hooked’ after a while. It’s
no good saying ‘Oh, that won’t happen to me’.
It probably will.
2.
If you take these pills regularly, their effectiveness on you
will gradually get less and less.
So you find yourself taking bigger and bigger doses;
3.
In people over 60, the pills frequently cause confusion and
hallucinations;
4.
It is astonishingly easy to take an accidental overdose,
particularly if you are a bit muddled in the middle of the night;
5.
These pills react dangerously with other medications and with
alcohol;
6.
Sadly people do often use them to attempt suicide;
7.
Alas, other members of the family, particularly teenagers,
may pinch Dad’s or Granny’s’ ‘sleepers’, in order to use
them for kicks or even to sell them;
8.
Finally the pills may affect your thinking and your reaction
times next day and so cause road accidents or home accidents.
So
we have learned by bitter experience that sleeping pills are
dangerous, particularly for older folk.
As a result, prescription of Barbiturate sleeping tablets
(like Seconal, Amytal and Tuinal) has practically ceased in this
country. As for the other major group of sleeping pills, the
Benzodiazepines, like Mogadon, Rohypnol and Temazepam, the
Department of Health long ago decided that they should only be
prescribed in really essential cases, and for a maximum period of
two weeks.
Good
family doctors abide by these rules.
Sadly at what I call the ‘slack end’ of general practice,
there are GP’s who will still dole out endless ‘repeat
prescriptions’ for these drugs – often without seeing the
patient. My advice –
have nothing to do with that sort of doctor!
But if you do desperately need a sleeping tablet for
short-term use (maybe after the loss of a loved one) what can you
take? Well there
are now some drugs, which are thought to be safer than Barbiturates
or Benzodiazepines. Currently
popular ones include Zimovane, which at present is thought to cause
fairly few side effects. But
you should try not to use these pills every night and you should
take care to come off them after a couple of weeks or so.
There
are also alternative sleep-inducing remedies available from
herbalists, homeopaths and pharmacists.
In particular, your local pharmacists may well offer you
Nytol which a lot of patients swear by.
It is not actually ‘drug free’, since it contains the
anti-histamine called ‘diphenhydramine’.
But if you stick to the instructions, it is very safe.
Much used herbal remedies include valerian and gentian.
Click
here to go back to the top of the page.
As
I mentioned a moment ago, inability to sleep is very, very often due
to a depressive illness.
Indeed I find that at least once a week a patient comes into
the surgery, complaining of insomnia and turns out to be seriously
depressed. Depression
commonly causes problems in getting off to sleep.
But more often it makes the person wake up in the ‘wee
small hours’. Usually
they can’t get back to sleep after that.
This happens so often that any doctor will tell you that the
words ‘early a.m. waking’ written on a patient’s notes almost
invariably means that the diagnosis is depression.
So
if you are getting severe sleep disturbances and particularly early
morning waking, do see your GP right away.
Click
here to go back to the top of the page.
‘Restless
legs syndrome’ is a condition which affects millions of people
worldwide, nearly all of them aged over 50.
It is so common that in America, there is even a special
magazine for them and a website.
Whole books have been written about it.
But
what is it? It is a
disorder in which your legs just won’t stop moving, either when
you are asleep or when you are trying to drop off.
That doesn’t sound much but actually it is pretty
distressing. No one
knows what causes Restless Legs Syndrome but it is probable that it
is linked with aging of the nerves in the legs and unfortunately
nobody has come up with a brilliant cure!
However, there are lots of ‘home remedies’, which have
given much relief to a lot of people.
My advice is to try them all and see which one suits you.
Here is the list:-
¨
Apply COLD to the
legs within reason! Ice
cubes wrapped in a towel are popular.
Some of my patients actually go and lie down with their feet
pointed towards an open refrigerator for half an hour;
¨
Conversely,
HEAT helps some victims. Try
wrapping a hot water bottle in a towel and putting it near your
legs;
¨
BEDROOM
EXERCISES seems to help most sufferers.
I always advise people to try jogging on the spot for a few
minutes, just before they get into bed;
¨
Deep muscle
MASSAGE, that is getting your partner to massage your calves, may
bring some ease;
¨
Cutting out
CAFFEINE is said to put a stop to ‘RLS’ in certain patients;
¨
Surprisingly,
just getting up and drinking a glass of WATER seems to help some
folk.
Click
here to go back to the top of the page.
MEDICAL
TREATMENT – sad to say, it is unlikely that your doctor
will be able to come up with a remedy.
A few medics do recommend the anti-Parkinson’s drug called
Sinemet and some others prescribe the anti-epileptic agent known as
Tegretol. But these are
powerful medications and their side effects can be considerable.
Alternative
treatments – among the wide range of treatments which
have been tried by alternative practitioners are magnesium tablets,
iron, vitamin E and various types of vitamin B, including folic
acid. Obviously none of
them has proved to be a sure fire cure but they are worth a go.
Click
here to go back to the top of the page.
Snoring is generally
considered to be a great source of mirth!
But it can be a blooming nuisance particularly for the person
who has to sleep next to the snorer.
It is caused by vibration of the back of the palate as air
rushes in from the nose and down the throat.
At least one in five of the population snores but a much
smaller proportion snores loudly enough and persistently enough to
be a real nuisance. Fortunately,
simple commonsense measures will often reduce the problem to
manageable proportions. They
are:
¨
Since snoring
mostly occurs when people are on their backs, a brisk elbow from
your partner can make you lie on your side and stop the noise!
¨
Similarly various
things can be stitched into the back of pyjama jackets, to stop the
snorer lying on his back, common choices are golf balls and
hairbrushes;
¨
Alcohol can make
snoring more likely so avoid drink before you go to bed;
¨
Catarrh behind
the nose can increase snoring, so if you have it, get it treated by
your doctor;
¨
Surgeons
sometimes advocate removing the back of the palate in order to try
to cure snoring. Not
surprisingly, this operation is more popular in the ‘private
sector’ than it is in the NHS.
There is no guarantee that will work.
Anti-snoring
devices – There are various anti-snoring devices on the
market and your local pharmacist will probably be pleased to sell
you one. Most of these
inventions rely on trying to alter the ‘inflow’ of air so that
it doesn’t vibrate. However,
a new approach is the ‘Snorestopper’ an electrical device which
you put by your bedside. If
it detects that you are starting to snore, it sends out a sequence
of light signals, which are supposed to make you change your
position. More details
on www.snorestopper.co.uk
Click
here to go back to the top of the page.
The
word ‘apnoea’ means ‘stopping breathing’.
It is pronounced ‘APP-KNEE-YA’.
Sleep apnoea is a potentially serious condition.
What happens is that while the person is asleep, he starts to
snore. But the
blockage of his air passages becomes so bad that eventually he stops
breathing altogether! Fortunately
he will as a rule restart breathing with a jerk when the amount of
oxygen in his blood falls to dangerously low levels.
Sadly there are occasions when a sufferer does not restart
breathing – obviously the results of this are fatal.
So urgent treatment by a hospital specialist, preferably at a
‘Sleep Clinic’ is essential.
Sleep
apnoea is commonest in middle-aged or elderly males who are
overweight, have high blood pressure and who drink quite a lot.
So treatment will usually involve slimming down taking
BP-lowering medication and avoiding alcohol.
Click
here to go back to the top of the page.
Q I sleep very poorly at the moment, because I keep getting bad
dreams. I asked the GP
for something to make them go away, but he said he couldn’t help
me.
A I am afraid there is not a
medicine which will stop nightmares.
This kind of dreaming can be caused by certain medications
(such as beta-blockers), by alcohol or by stress and worry.
Is there something unpleasant or worrying that has happened
to you lately? If so,
you should try and talk it out with a counsellor.
Q
I am a widower, and my problem is ‘sex dreams’, I find it
quite surprising that several nights a week, I dream about engaging
in sexual activity. Is
there something wrong with me?
A
No, sir.
Sex dreams are normal in most virile males, and may continue
until very late in life. I
appreciate that you may perceive these dreams as some sort of
‘unfaithfulness’ to your late wife.
But they are not your fault!
It may be that the dreams are nature’s way of telling you
that maybe it’s now time to ‘move on’ and seek a new romantic
interest.
Q Every night I am
woken up by numbness and ‘pins and needles’ down my arm.
Why?
A This suggests that the
bones in your neck are pressing on the nerves which run down the
arm. But you need to
see your GP and have a thorough examination.
It is possible that just a simple change of pillows or using
a neck support at night may help.
Q When I am asleep at
night, I get pain as well as a tingling sensation in both my hands.
Why?
A This is probably due to
the famous ‘Carpal Tunnel Syndrome’, which is caused by pressure
on a particular nerve (the median nerve) as it passes through the
wrist. Your doctor will
check you over to confirm the diagnosis.
Possible treatments include:-
¨
Weight reduction;
¨
Injection of steroids
into the wrist;
¨
Splinting the wrist at
night;
¨
Water pills (to reduce
the fluid in the wrist);
¨
Surgery.
Cheer
up – most cases can be cured!
Click
here to go back to the top of the page.
|
