IF SYMPTOMS PERSIST By DR. JOSE PUJALTE JR.

“O sleep! O gentle sleep! Nature’s soft nurse, how have I frighted thee, That thou no more wilt weigh my eyelids down, And steep my senses in forgetfulness?”

–William Shakespeare (1564–1616), British dramatist, poet.

King Henry, in Henry IV, Part 2, act 3, sc. 1, l. 5-8.

Dr. Jose Pujalte Jr. Why is it that even if the dailies trumpet that the peso “sizzles” and the market is up and that businessmen are upbeat, most of us are still worried sick and unable to sleep? We have become a nation of insomniacs – victims of troubled sleep, in a time that we need it the most. Insomnia Defined. There’s no clear cut definition of insomnia but just like undefinable pornography (as opposed to “art”) you know it when you see it. Now you know you have insomnia (as opposed to sleeping like a baby) when you have it. Just the same, insomnia means lack of sleep occurring regularly or frequently. Most somnolence experts recommend an average of 8 hours of sleep a day but some people get by on 4 to 6 hours of sleep. Therefore, insomnia is also relative and varies with individuals and changes with age. Causes. The common causes of insomnia are:

• Stress – as it relates to sleep is excessively worrying about something – about work, school, health, love, family, etc.
• Anxiety – is also worrying but not about anything in particular. It is a general sense of dread
• Depression – may either cause little sleep or too much sleep; either way regular sleep is disrupted and the reason for this is that depression is marked by imbalances in brain chemicals that prevent minimum relaxation for sleep to occur
• Stimulants – prescription drugs such as anti-hypertensives, anti-depressants, and corticosteroids can interfere with normal sleep. Some weight loss drugs have caffeine and caffeine-like products which should have you staring into space through out the night; the nicotine in cigars or cigarettes stimulate
• Medical conditions that cause chronic pain – in particular, late stage arthritis that makes trying to sleep an ordeal because joints hurt; some neuropathies or nerve derangements from diabetes can cause discomfort and loss of sleep; cancer pain is indescribable
• Eating too much at night – Gorging makes lying down uncomfortable and can even cause heartburn (food and digestive juices backflow).
• Sleep apnea – a condition where breathing stops temporarily during sleep giving the person a sensation of drowning and of course, sudden awakening

Signs and Symptoms.  Insomnia can present as inability to get enough sleep at night; waking up in the middle of the night; waking up too early; waking up tired instead of rested; daytime fatigue; and daytime irritability. It also follows that energy levels are down in the daytime and that moods suffer immensely. How to Cope. Chronic sleeplessness makes medical problems even worse. These include high blood pressure, heart disease, and diabetes. Remember that sleep ought to be restorative. The body that is already sick to begin with further deteriorates without deep rest. Since sleep patterns are disrupted, some people fall asleep through out the day - on the wheel. The results are tragic. Sleeping pills can be abused. But people with occasional and temporary insomnia respond well. Sometimes the doctor will give an antidepressant or an antihistamine that causes drowsiness. The tried and tested tips for combating insomnia are:

• Limit caffeine, nicotine, even alcohol. Alcohol interferes with REM (rapid eye movement) or the dream state which makes sleep unrestful
• Check medications, if taking any that cause sleeplessness; see if there are substitutes or if you can taper dosage
• Exercise at least five to six hours before bedtime; vigorous exercise before bedtime will keep you awake
• Stick to a sleep schedule: try to sleep and wake up on a pre-determined time
• Avoid tryingto sleep; if you can’t sleep, get up and read or do something and only return to bed when drowsy. Get up, however, at the same time.

Alternative Medicine. By far the most popular alternative option is melatonin. International flight attendants swear by it. After all, these long haulers understand what erratic hours are all about. One also is almost sure of insomnia among the thousands working in call centers locally. Here the graveyard shift is a way of life. Melatonin is said to cure insomnia and prevent jet lag. However, experts agree that more research is needed. Some herbal teas like chamomile claim to have relaxing properties but it’s probably the ritual of making and sipping tea that does the trick. The demands of daily life can and does push us to sleeplessness. Temporary insomnia happens all the time. But chronic insomnia, this is something to worry and do something about. Our lives depend on restful sleep. E-mail: [email protected]