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Sleep problems

 

Many people have experienced a night of poor sleep, but in some people the sleep problems are present almost every night. Such problems affect the level of function - both privately and at work. 

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This is what sleep expert Bjørn Bjorvatn writes Helse Bergen's website.

 

Symptoms of sleep problems

Helsenorge.no writes:

Insomnia, or insomnia, is the most common sleep disorder. The sleep difficulties vary from person to person. Some struggle most with falling asleep, others with restless night's sleep and many awakenings. The most common form of treatment has been sleeping pills, but new knowledge shows that treatment without medication has a better effect in the long term.

They write further:

To be diagnosed with insomnia, the sleep problems must go beyond daily functioning and have lasted for at least three months. The diagnosis is made on the basis of the symptoms described above, ie it is based on self-reported subjective ailments. There can be problems with either

  • falling asleep
  • many awakenings at night
  • waking up too early in the morning
  • poor sleep quality
  • ... or a combination of these symptoms.

Kognitiv.no writes:

About one in three adults has sleep disorders from time to time. Over one-tenth have persistent sleep problems, also called insomnia, daily or almost daily. Some experience premature awakening while others have trouble falling asleep at night, or they wake up again and again. 

 

What Causes Sleep Disorders?

Bjørn Bjorvatn continues to write Helse Bergen's website:

There are many causes for sleep problems, and within the sleep field there are six different diagnostic groups. It is therefore important with a thorough investigation. The symptoms may be the same from patient to patient, but the cause / diagnosis may be different. Therefore, treatment should not be started until a thorough medical history and any clinical examination has been performed.

Many people with long-term sleep problems are depressed, and it is therefore especially important to investigate with a view to mental illness. Other causes of sleep problems can be metabolic disorder (high or low metabolism), heart or lung disease, nocturnal itching, nocturnal urination or pain.

Some medications can cause sleep problems, and if this is suspected, the doctor should consider whether the patient can change the preparation, or possibly change the time of the medication.

Coffee contains a substance (caffeine) that has a strong activating effect. Patients with sleep disorders should therefore avoid coffee and other caffeinated products (tea, cola, energy drinks) after 5 pm.

Kognitiv.no writes about causes of sleep disorders:

Sleep problems can have many causes. Most of us have experienced such problems in connection with periods of life characterized by sleep disturbances, perhaps by toddlers, illness, grief or worries. Some medications can cause sleep problems such as side effects, such as medications for asthma, high blood pressure, diabetes and metabolic diseases. It is a good idea to check the information about the medicine and also talk to your doctor about it.

 

Consequences of sleep problems

Bjørn Bjorvatn writes Helse Bergen's website:

It is easy to understand that poor night sleep affects work ability and productivity during the day. In addition, mood and not least quality of life are affected. In case of severe sleep problems, the patient faints throughout the next day. Several traffic accidents are due to the driver dropping off behind the wheel. 

 

Advice on good sleep hygiene

You can read more useful advice for good sleep hygiene on the websites of kognitiv.no. They mention the following points, which you can read more about on their website:

 

  1. Lie down to sleep only when you feel sleepy and ready to sleep
  2. Sleep at regular times and get up at the same time every day
  3. Be outdoors in daylight for at least half an hour every day
  4. Do not use alcohol as a sleeping pill
  5. Be sparing with caffeinated foods and beverages
  6. Do not exercise just before bedtime
  7. Let the day have a good tone
  8. Avoid a heavy meal in the evening
  9. Do not cancel activities the next day

 

Treatment of sleep problems

Helse Bergen writes on their website on medical treatment for sleep problems:

It is important to distinguish between recent (acute) sleep problems and problems that have lasted for a long time (more than three months). Hypnotics are effective drugs, and have few side effects when given for a short period of time. By shorter period is meant here under 2-3 weeks. Most sleep experts believe that patients with acute sleep problems should be offered a short-term treatment with hypnotics.

In case of long-term sleep problems (chronic insomnia), ie insomnia that has lasted for more than three months, one should be careful with hypnotics. The effect of hypnotics usually diminishes rapidly with regular use, which often necessitates higher doses. In addition, there is a risk of addiction in most hypnotics.

 

They also write about non-medical treatment of sleep problems:

Here is an overview of the best documented treatments for chronic insomnia:

 

  1. Stimulus control

    Treatment with stimulus control involves correcting unfortunate sleep behaviors, and strengthening the association between sleep and bed. The patient is given a set of instructions that must be followed carefully. It is emphasized that the bed should only be used for sleep, not for work, watching TV, reading or other things (sexual activity is allowed). If you are not allowed to sleep for a short time (for example within 15-30 minutes), you should get up, get out of the bedroom, and not return to bed until you are sleepy again. The time to get up in the morning is determined in advance, and should not be adjusted according to how much sleep the patient actually gets each night. This form of treatment requires a motivated patient who is able to follow the instructions. The treatment is demanding, and often a worsening of the sleep disorders is seen in the first 1-2 weeks before improvement occurs. It is important to prepare the patient for this. According to a scientific review based on 59 different treatment studies with over 2000 patients, stimulus control was the most effective form of treatment for chronic insomnia. Research results show that around 80% of patients get better sleep. It also appears that the effect of treatment persists after the end of treatment.

  2. Sleep restriction

    Many patients with poor sleep compensate by spending a long time in bed, hoping to sleep, and at least get some rest. It is not uncommon for patients with about five hours of night sleep to lie in bed for 9-10 hours. This is considered an important explanation for why sleep disorders persist. Sleep restriction aims to reduce the time in bed, until the time the patient actually sleeps. A sleep diary is used to calculate how long the patient sleeps. It is recommended that time in bed is never reduced to less than five hours. If the calculated sleep duration per night is 5,5 hours, the patient's time in bed is limited to 5,5 hours. In consultation with the doctor / psychologist, the patient decides when he / she wants to get up in the morning, and then counts back to the time of bedtime, e.g. go to bed at 1.30 am and get up at 7 am. 

    The time the patient is allowed to stay in bed is adjusted from consultation to consultation based on changes in a parameter called sleep efficiency (total sleep length divided by time in bed, given in percent). A sleep efficiency of 50% means that you are awake half the time you are in bed. With treatment with sleep restriction, a sleep efficiency above 80-85% will increase the time in bed, while if the value is below 80%, you will continue unchanged. The increase in time in bed is usually 15 minutes. The follow-up takes place with the help of sleep diaries. The treatment is demanding for the patient. Often, sleep initially worsens before improvement occurs. It is important to prepare the patient for this. The treatment results of sleep restriction are on a par with the results from stimulus control, ie around 80% of patients report better sleep after the end of treatment.

  3. Relaxation techniques

    Relaxation therapy aims to reduce physical or mental activation. There are different types of relaxation, such as. progressive relaxation training, autogenic training, mental relaxation and meditation. Some physiotherapists and other health professionals use such methods. The effect is usefully documented, but such treatment does not give as good results as stimulus control or sleep restriction. Such relaxation treatment is often best suited for anxious insomnia patients with signs of increased activation.

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Written by

ove heradstveit

Ove Heradstveit

Psychologist, specialist in clinical community psychology. PhD.
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