Sleep problems

Sleep problems can interfere with your daytime functioning. An occasional night without sleep does not necessarily mean your performance will suffer the next day, but if poor sleep occurs frequently (if sleep deprivation occurs frequently), it can lead to a range of problems, such as lack of concentration, lack of energy, fatigue and drowsiness. These problems are mainly caused by sleep disorders. Fotunately, there is a lot of information available about sleep disorders and help is just a few clicks away.

A distinction should be made between mild and more severe sleep problems.In general, we speak of severe or chronic insomnia if you sleep badly at least three times a week for a period of more than three weeks, and if this leads to reduced daytime functioning. If you only sleep badly once in a while, for less than three weeks, and if this is not accompanied by daytime dysfunction, then you are suffering from mild sleep problems. Normally, these problems go away by themselves.

Most healthy adults need between seven and nine hours of sleep per night to function at their best. One night of poor sleep is not harmful, but if you suffer from continued lack of sleep and this affects your daytime functioning, this is seen as a sleep problem.

During sleep we go through a four-stage cycle which is repeated every 90 to 120 minutes.

Stage 1
This is a short stage in which you are not really asleep, but in which your body prepares for sleep. During this stage, your muscles begin to relax, your body temperature drops, your heart rate slows down and your eyes slowly roll back.

Stage 2
After several minutes, you fall into a light sleep. During this relatively short stage you are asleep but can you can easily wake up again.

Stage 3
In stage 3, also known as deep sleep, the heart rate slows down even further and the muscles relax even more. During deep sleep, you become less responsive to outside stimuli and have difficulty waking up. Stage 3 is when your body and brain restore and repair themselves and regain strength: your organs and muscles grow and your brain stores and processes daytime information. Deep sleep is essential to re-energise your body and mind.

Stage 4
The final stage of sleep is rapid eye movement (REM) sleep, when the brain is more active and your eyes move rapidly in different directions (hence the name). This stage, which requires a lot of energy, is when most dreaming occurs. During REM sleep, your brain is almost as active as when you are awake. According to several researchers dreams are used to process daytime events.

The body goes through these four stages several times each night. It is not important how often, but rather that they are evenly distributed.

It is clear from the above that sleep plays a vital role in our well-being. While we sleep, our body and mind shut off for rest and repair, so that we wake up feeling refreshd and ready to face and get through the day. Lack of sleep on the other hand can lead to problems with concentration, alertness and learning. Sleep deprivation is known to be a risk factor for traffic accidents, and it is estimated that drowsy driving is responsible for 15% of all car crashes. Not getting enough sleep makes us irritable, gloomy and listless, which does not contribute to a happy life. Sleep deprivation also confuses our hormone system which, among other things, increases our risk of obesity.

Sleep problems and poor sleep can have various causes. One of the most common causes of people failing to fall and stay asleep is the so-called sleep hygiene, which is fairly easy to manage. Sleep problems can also be caused by worrying. As soon as you relax, your mind allows these worries to come back, which makes it hard to fall asleep. A racing mind can be very difficult to turn off and can deprive you of valuable hours of sleep. A physical discomfort or illness can be another reason for sleep disturbances. Itching, respiratory problems and restless legs can make it impossible to fall asleep, and if you fall asleep at all, you will soon wake up again due to these symptoms.

Some of the most common health conditions that cause sleep problems are:

• Restless legs syndrome (RLS);
• Allergies;
• Asthma;
• COPD;
• Bowel diseases.

Sleep problems can be divided into four categories:

• Snoring, causing interrupted sleep;
• Inability to fall asleep;
• Inability to stay asleep;
• Sleep-related disorders such as narcolepsy and sleep apnoea.

Common signs of sleep problems include:

• Not feeling rested or waking up stiff or still feeling tired (do check your mattress regularly; it may need replacing);
• Dozing off without reason, mostly while watching television or doing paperwork;
• Listlessness and lack of energy during the dayHeadache, especially around the eyes;
• Irritability, frequent crying or outbursts of anger (i.e. having a short fuse);
• Lack of or poor concentration. This, especially in combination with dozing off behind the wheel, is a major cause of car accidents.

A large proportion of problems with falling and staying asleep are the result of poor sleep hygiene. These tips will help you improve your sleep hygiene and get a better night’s sleep:

• Make sure your bedroom is dark, cool and well ventilated;
• Ensure your room temperature is between 17 and 21 degrees Celsius, so that you feel relaxed and comfortable;
• Keep the environment noise free. If there is too much ambient noise, consider using a white noise machine or app. White noise is a monotonous sound that shuts off all the other noise;
• Do not play games, work on your laptop or watch TV just before going to sleep: the blue light coming from these screens delays the release of sleep-inducing melatonin;
• Keep a routine. Try to go to bed and wake up at around the same time every day. Your body can then better prepare for sleep. Invest in a new mattress, a good pillow and comfortable nightwear;
• Start a diary of worries, the journal is an emotional outlet for your daily concerns. This is a way to let go of these worries and clear your head so that you relax and sleep better.

Doctors generally do not recommend prescription medication for sleep problems, since sleeping pills are habit-forming and have a lot of side effects. To a certain extent, sleep medication is a temporary fix until the underlying problem is addressed. If you do need to resort to medication for chronic insomnia, make sure to use it sparingly for short-term situations only. A short- acting benzodiazepine-agonist, such as lormetazepam, temazepam, zolpidem of zopiclone, is preferred in such cases. There is extensive experience with these medicines and when used in low doses, there is little risk of their having an after-effect the next day. Mild or short- term sleep problems are not treated with medication because the side effects do not outweigh the potential benefits.

Other alternative treatments are also possible to regain and improve your sleep rhtyhm. Examples of such alternative therapies include meditation and yoga, aromatherapy, herbal tea and melatonin. If the sleep problem cannot be solved with these options, you can ask your doctor for a referral to a sleep clinic for a more thorough evaluation. Disorders such as sleep apnoea and narcolepsy, and also insomnia and snoring are treated here.

A change in lifestyle can also contribute to sleeping better. Here is what you may consider to do:

• Take about an hour before bedtime to relax and get ready to sleep. This means no TV, laptops, tablets or mobile devices. Instead, read a book or magazine, or listen to quiet and relaxing music to prepare your mind for a peaceful night’s rest;
• Get into an exercise routine. Exercise or go for a brisk evening walk. Start doing relaxing activities, such as dancing, yoga or meditation;
• Do not overload your agenda. Leave space in between activities to relax and unwind. This applies to both your professional and personal life;
• Make time to relax;
• Avoid alcohol or caffeinated drinks in the evening. This also includes energy drinks, cola and black tea. Also reduce the number of cups of coffee during the day. Caffeine delays the production of melatonin (a hormone produced by your body that controls your wake / sleep rhythm) and stimulates brain activity, which is not ideal if you want to sleep.
• Make sure you get enough fluids. You may experience both physical and mental fatigue if your body is not properly hydrated. A well-hydrated body can eliminate waste products quickly and effectively, which promotes a good night’s sleep;
• Stop smoking. Smoking reduces the blood flow to tissues and organs, and this causes toxins to enter the blood;
• Keep your weight in check. Obesity causes extra fatigue in several ways;
• Adjust your eating habits. Deep-fried foods and food high in sugar consume a lot of energy and therefore cause fatigue. Make sure your diet includes plenty of fruit and vegetables, so that you also get enough vitamins and minerals. Eating late at night and going to bed on a full stomach can greatly disturb your sleep.

Given the risks and side effects associated with the use of sleep medication, such as tiredness during the day, influence on driving and dependency, using a short-acting soporific drug in the lowest possible dose is preferred. Furthermore, the effectiveness for inducing sleep wears off after two weeks once the body adjusts to the medicine.

Sleep problems cannot always be prevented. Sometimes poor sleep is caused by a sleep disorder or a health problem, such as depression. However, you can prevent sleep problems from developing or becoming chronic by following the recommendations provided above as well as sticking to healthy sleep habits.

Farmacotherapeutisch Kompas (2020). Slapeloosheid (Insomnia). Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/slapeloosheid

Farmacotherapeutisch Kompas (2020). Zolpidem. Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/z/zolpidem

Farmacotherapeutisch Kompas (2020). Zopiclon (Zopiclone). Consulted on 1 June 2020 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/z/zopiclon

Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie (Royal Dutch Pharmacy Association). (26 August 2010).

Slapeloosheid (Insomnia). Consulted on 1 June 2020 on https://www.apotheek.nl/klachten-ziektes/slapeloosheid#wat- is-slapeloosheid