Sleeping disturbances: when and how to treat them?

What causes sleep disturbances?

The quantity and quality of sleep vary greatly from person to person. Numerous factors including the environment, self-care and the rhythm of a person's life influence the amount of sleep they get. Some of the factors that disturb sleep include:

- Stressful events or situations (grief, unemployment, etc),

- Chronic psychophysiological insomnia caused by the fear of not being able to fall asleep or not getting enough sleep,

- A bad view of sleep

- Mental illness (depression and bipolarity, schizophrenia, chronic anxiety, etc)

- Bad sleeping habits (physical exercise, consuming stimulants or using devices with screens right before bed, under or overheated sleeping space, domestic animals, etc)

- Certain medications or drugs

- Other conditions like gastro-esophageal reflux disease, hyperthyroidism, asthma, sleep apnea, restless leg syndrome, etc.

- Unknown causes

When should you see a doctor for treatment?

Before going to see a doctor about your sleep disorder, adopt good sleeping habits paying particular attention to the causes mentioned above. If the problem persists, talk to your doctor about it. If sleeping disturbances begin to have an impact on your daily activities (feeling exhausted when getting up, feeling sleepy during the day, trouble concentrating, memory and attention lapses), it's important to see a medical professional.

What sort of physician should you see?

The first doctor you should talk to is your general practitioner. They may be able to diagnose what's troubling you by asking pointed questions about what is preventing you from going to sleep. In order to help your GP find out what's keeping you from falling or staying asleep, note the following information to share:

- How long has this been a problem?

- Is it difficult to fall asleep, or do you find yourself waking up at night or too early in the morning? 

- How many times per week does this occur? 

- Are you going through difficult personal, family or professional circumstances right now or in the recent past? 

- How is lack of sleep affecting you during the day (hard time getting up, falling asleep, feeling groggy)? 

- What have you done to try to fix the problem (relaxation, quitting caffeine, etc.)?

If the sleeping disturbances get worse or if your GP suspects you are suffering from obstructive sleep apnea (OSA) or from restless leg syndrome, they may refer you to a specialist or to a sleep center.

Treating sleep disturbances

It should be noted that insomnia and sleep disturbances are generally a symptom of other pathologies and not a separate illness. The first step is to treat the root of the problem and adopt better sleeping habits.

What are some good habits to adopt?

Here are 10 good habits to adopt to get a better night's sleep:

- Go to bed and get up at the same time every day

- One hour before going to bed, turn down the lights in your bedroom and avoid screens (telephone, television, tablet, computer, etc.)

- Avoid naps during the day as they may disturb your wake/sleep rhythm

- Don't use drugs or alcohol to get you to sleep because they reduce sleep quality

- Try not to stay in bed when you wake up, go into another space with low light, relax and wait until the desire for sleep returns

- If you wake up in the night, don't look at the time as this can make you feel more stressed

- Avoid excessive consumption of stimulants during the day and at least 5 hours before going to sleep

- Keep your bedroom very quiet, very dark, at a comfortable temperature and well-ventilated

- Avoid intense physical activities just before going to bed

- Avoid over or undereating at night. In general, avoid foods that are too acidic, fatty or lacking vitamins, minerals and iron.

What medications are available?

The sedatives (or tranquillizers) discussed in this article are mostly available by prescription only and are only prescribed for short periods of time as they present risks of dependence and withdrawal symptoms at the end of treatment. Never try to self-medicate. Make sure to talk to a physician first.

Benzodiazepines 

The National Center for Health Statistics estimates that in the US benzodiazepine drugs are prescribed at roughly 66 millions doctor appointments per year! They can be highly addictive and especially dangerous when combined with alcohol or other drugs. This is why benzodiazepine prescriptions are generally restricted to 4 weeks or less.

Benzodiazepines produce a sedative and anxiolytic (anti-anxiety) effect.  The most commonly prescribed benzodiazepines are Valium (diazepam), Xanax (alprazolam), lorazepam and temazepam.

Non-benzodiazepine sedatives

This category includes zopiclone. They have a shorter-lasting effect when compared to benzodiazepines, which reduces the risk of feeling groggy or hung-over the following morning.

Melatonin agonists and melatonin-based preparations

These are principally used to help with falling asleep or to avoid waking up at night. It is very important to turn down the lights at least one hour before going to bed to allow the melatonin to take effect. Melatonin should be taken one hour before going to bed.

In the US, low-dose melatonin is available for over the counter sale, but it should be used with caution.

Anti-depressants and anti-anxiety drugs

This class of medication is prescribed with great care and is meant for patients suffering from a psychological disorder and under the supervision of a mental healthcare professional.

What alternative therapies exist?

Behavioral therapy has been proven to help calm sleep disturbances. Talk to your doctor about it! Other activities like yoga or medication can also help reduce anxiety and better handle stress.