Good quality, restorative sleep is necessary for optimal physical and psychological wellbeing. Many people struggle with sleep issues and fail to ask for help. Help is available!
Common sleep disorders include insomnia, obstructive sleep apnea, circadian rhythm disorders and restless legs syndrome.
Insomnia
Any traumatic or distressing event in a person’s life can trigger a sleep disorder, most notably insomnia – either difficulty initiating sleep or difficulty maintaining sleep. The emotions around a cancer diagnosis, medications used during cancer treatment, chronic pain, and anxiety about ongoing cancer surveillance following remission, are all reasons for an individual to develop sleep challenges.
A healthcare professional needs to understand the predisposing factors, the precipitating factors and the perpetuating factors, which have resulted in insomnia, and then tailor a treatment plan to best assist the patient.
CBT-I (cognitive behavioural therapy for insomnia) is the treatment of choice for insomnia. CBT-I addresses the cognitive problems associated with insomnia, e.g. anxiety provoking thoughts, ruminating thoughts, inappropriate expectations of hours of sleep, fear about the results of inadequate sleep, and teaches calming practices such as breathwork, counting and muscle relaxation.
Anxiety and depression can both impact the ability to sleep well, and may need to be managed separately, through therapy and possibly medication.
Daytime and evening behaviours which facilitate healthy restorative sleep are termed “sleep hygiene”, and include: reduced audio-visual stimulation before sleep, regular exercise, reduced caffeine and nicotine intake, limiting alcohol intake, optimisising the sleep environment in terms of lighting, temperature and noise, setting boundaries for work, having a bedtime routine, and going to bed and waking up at the same time every day.
There are a variety of medications that can be prescribed to aid in the management of insomnia. Healthcare professionals should try to limit the prescribing of addictive sleep medications, and reserve them for the acute short-term management of insomnia. There are other medications which can be used safely in the long term.
Obstructive sleep apnea
Obstructive sleep apnea or OSA is a common and serious sleep disorder that causes an individual to stop breathing during sleep. It is serious in terms of the severe fatigue because of poor sleep which can have dangerous consequences e.g. motor vehicle accidents, as well as causing significant cardiovascular complications, e.g. heart attacks. Patients usually present with loud snoring, extreme tiredness, and possibly a partner having witnessed gasping or choking during sleep.
An overnight sleep study can diagnose this condition and treatment via continuous positive airway pressure therapy (CPAP) is available.
For further consultations regarding sleep concerns, the SA Sleep Lab, is based in Rivonia, Johannesburg.
SA Sleep Lab
Dr Lorna McCrindle, Family Physician