Key words: Insomnia, sleeping tablets, sleep hygiene, sleep cycles, Nigeria.
Insomnia and Sleeping Tablets in Nigeria. How does one sleep? How much sleep does one really need every night? What causes insomnia? What are the dangers of taking sleeping tablets?
Insomnia is a sleeping disorder that is characterized by problems with falling asleep, maintaining sleep and early waking. This sleep problem must have occurred for at least 3 nights per week and cause major distress to the person. It must also affect the person’s day time functioning.
Sleep is very important for human survival, and getting quality sleep at night is very important. Sleep helps remove toxins from the brain that is formed during the day. Sleep is also necessary for proper functioning of other parts of the body like the heart, lungs, immune system, etc. Different parts of the brain are involved in sleep like the hypothalamus, brain stem, amygdale, fore brain, etc.
The prevalence of insomnia is quite high in Nigeria. In one research family clinic at Ile Ife, about 49% had insomnia. In one study, between 52% and 73% of the adult population had insomnia over one year period. And in some communities in the southwest, 26% of the elderly had insomnia.
Even though sleeping tablets are not available over the counter in Nigeria, somehow, some still get it. Sometimes they visit doctors who give them medication prescriptions for these sleeping tablets. The unfortunate aspect is that most people do not know that taking these medications for long, can cause them harm. And death can also ensure.
There are safe ways to treat insomnia. In medicine it is better to treat cause, than to treat symptoms.
Stages and cycles of sleep.
1. The none Rapid Eye Movement (NREM) sleep:
This is the first cycle of sleep. It has 3 stages. Dreams may occur at this cycle of sleep, but they are not remembered.
a. Stage I – This is the dosing off stage. It is light sleep and it is easy to wake up the person at this stage of sleep. The breathing, heart rate, and the eye movements slow down. The muscles in the body begin to relax. The brain activities also begin to slow down.
b. Stage II – The eye movements stop altogether at this stage. All the organs slow down and body temperature begins to drop.
c. Stage III – This stage of NREM sleep is called delta sleep. This is deep sleep. Breathing and heart rate reach to their lowest levels. And because the muscles are so much relaxed at this stage, it is difficult to wake the person. This stage of sleep is very important because it is a restorative sleep. It helps the body repair itself. It also helps in thinking and creativity, as well as in memory.
2. The Rapid Eye Movement (REM):
- Here, the eyeballs move very fast from one side to another. And brain activities speed up.
- The activities of other organs also increase, like breathing and heart rate. The blood pressure also increases.
- But the muscles remain paralyzed. This enables us not to act out our dreams.
- This is the cycle of sleep where most dreams, especially the ones that are remembered occur.
- The REM sleep is necessary for cognitive functioning, like memory, creativity and learning.
- Alcohol reduces REM sleep.
How much sleep does one really need?
- Zero age to 3 months of age require 14 – 17 hours of sleep in a day.
- From 4 months – 12 months need 12 – 16 hours of sleep a day.
- By ages 1 – 2 years, 11 – 14 hours of sleep is needed. Including naps.
- Ages 3 – 5 years requires 10 – 13 hours of sleep per day. This includes naps.
- From ages 6 – 12 years require 9 – 12 hours of sleep per day.
- Ages 13 – 18 years need 8 – 10 hours of sleep in a day.
- Those 18 – 60 years of age require 7 – 9 hours of sleep per night.
What are the causes of insomnia?
1. Psychological, psychiatric and neurological causes:
- Stress from work, from the home, sleep deprivation and excessive worrying.
- Psychiatric conditions like anxiety, post traumatic stress disorder, depression, schizophrenia, bipolar disorders, etc.
- Others include delirium, dementia, restless leg syndrome, etc.
- Then substance use disorders, like alcohol, cannabis, cocaine. Other stimulants like coffee, etc.
- Withdrawal from substance like alcohol, opioids, etc.
2. Environmental conditions:
- Hot and noisy environments as well as stuffy and overcrowded rooms can cause insomnia.
3. Medical conditions:
- These include hypertension, cardiac diseases, diabetes, kidney diseases, etc.
- Others are headaches, fever, muscle pain, arthritic pain, etc.
- Even excessive urination, snoring, etc.
- Even the use of certain medications can predispose one to insomnia.
Complications of insomnia.
- This will include psychological and psychiatric complications such as excessive anger, and aggression. Others include fearfulness and anxiety, depressive disorders, bipolar disorders, etc. Insomnia can be a predisposing factor to suicidality.
- Also medical conditions like hypertension, heart attack, stroke and sudden deaths can result from prolonged insomnia.
Sleeping tablets and insomnia.
- Sleeping tablets are used when one has problems with sleep, like insomnia.
- These are called sedative hypnotics. They are sedative in the sense that they cause drowsiness. They are hypnotics because they promote sleep.
- There is no ideal sleeping tablet.
- Most people use both prescribed and not prescribed sleeping medications to treat insomnia, in Nigeria.
Types of sleeping tablets.
1. The Benzodiazepines (BDZ):
- Some of these are short acting, some intermediate and others long acting.
- Being short acting means that their actions start fast, i.e. as soon as they are taken. But their effects last only a few hours and end.
- Those that are intermediate or long acting, can last for hours and even days.
2. The none Benzodiazepines:
- These are called Z drugs, and are mainly short acting.
3. There are the antihistamines:
- These are actually used to treat allergies, running nose, rashes, etc. But due to their sedative side effects, some people use them for insomnia.
Complications of the abuse of sleeping tablets.
- The abuse of sleeping tablets can predispose to the person becoming dependent or addicted to the medicines. So the person will not be able to sleep without them.
- Tolerance is another. When the person has developed tolerance, he/she will require higher doses of the medicine to be able to sleep.
- Withdrawal syndrome can also occur. These are the symptoms that come up when the person addicted to the sleeping tablets attempt to stop the medicines. These symptoms include anxiety, tremors or shaking, insomnia, confusion seizures, etc.
- The person would also have drowsiness and sleep during the day, dizziness, falls, fractures and weakness. Accidents, be it road traffic or machine, are possible. There could also be cognitive impairments like poor memory, poor concentration, and difficulty in learning.
- There are also risks for sleep walking, aggression, suicidality and even low blood pressure. There could suppression of respiration and death.
- For pregnant women, exposing the baby in the womb to certain sleeping tablets can predispose the baby to floppy baby syndrome.
- Sleep hygiene is a process by which someone develops a daily routine to help one get uninterrupted night sleep. It also involves making the bed room environment comfortable for sleep. It does not make use of medications.
- A sleep hygiene is good for everyone. But it is important to know that good sleep hygiene may not be able to solve all sleep issues.
1. The first thing is to ensure that during the daytime and evening –
- You expose yourself to adequate sunlight.
- Be physically active and do exercise, if possible.
- Make sure not to take afternoon naps. But if it is absolutely necessary, do so early in the afternoon. And keep it very short.
- Do not smoke or take alcohol late at night. Cut off all forms of caffeine from evening, including stimulants like cola drinks.
- Eat the night food early and do not eat heavy and spicy meals.
2. The next thing is to make the bed room very comfortable.
- So, make sure that the mattress, pillows and bed sheets are comfortable.
- Use your bed only for sleep and sex. So no reading on the bed.
- Next is to ensure that the room temperature is not hot and not too cold.
- Reduce the bed room light or turn it off altogether. This will help increase the chemical melatonin necessary for sleep.
- Keep all screens away in the bedroom. So no television lights, no phone lights, etc.
- Make sure that the bed room is noiseless. You may need to use ear plugs if the noise cannot be prevented.
3. Then take a warm bath, every night.
- You must establish a going to bed routine every night.
4. You should get into bed at the same time every night, and get out of bed every morning at the same time.
- This is irrespective of if you slept or not.
5. While on the bed, do not spend time tossing and turning, if you cannot sleep.
- After 20 minutes of being unable to sleep, get up and leave the room.
- Go to another room and do something boring, like reading a boring book.
- Do not go back to bed, unless sleepy. When sleepy go to bed.
Words of advice.
- Those with sleep problems should consult with a doctor to get the cause the insomnia.
- There is need to treat the cause and not the symptoms of insomnia.
- Never do self medication with sleeping tablets.
- When on sleeping tablets, do not drive or operate any machine.
- Make sure that you tell your doctor other medications you are on. Because some medications cannot be taken with sleeping tablets.
- Do not take alcohol while on sleeping tablets. It can over sedate and cause death.