I’ve tried everything but I still can’t sleep

I SLEEP only two to three hours a night and often wake up in between. I have tried relaxation exercises, reading, walking and even sleeping pills, but nothing works. Can you recommend anything to help? I am 47.

FOR any doctor, one of the most common and most difficult questions to answer is how to restore patients with insomnia to a healthy sleep pattern.

Sleep is a process every bit as vital as good nutrition and, in most cases, it takes a long time to arrive at the point where you realise that lack of sleep has become a defined problem.

There are occasions of acute crisis in life which cause sleeplessness, such as broken relationships, bereavement and unemployment.

Such events often coexist with disrupted sleep as they lead to a surge in stress hormones, which interrupt the normal processes that lead to a good night’s rest.

But more commonly, insomnia is caused by the long-term accumulation of life events, including the combined strains of work and running a home, or perhaps parenting teenagers or caring for elderly parents.

The fact that it has taken you years to get to this point suggests it will take some time to train yourself out of this state — and training is what it will take.

As you have already found, sedation drugs are either ineffective or only useful for a few days — the artificiality of sleep obtained in this way is an unhealthy option and can be a pathway to drug dependency.

I suggest you try cognitive behavioural therapy for insomnia (CBTi), which involves a combination of practical steps and talking therapy to help reprogramme your brain to adopt good sleeping habits.

Research confirms that this treatment is effective, though it will take at least three months for you to feel any effects.

Part of the training will involve a degree of sleep deprivation, in which you will not be allowed to go to bed until 11pm and then not allowed to spend more than five hours in bed, working up to a point when you will be permitted, eventually, seven hours.

It is possible to follow CBTi courses online. But the severity of your current sleep pattern suggests it might be better to obtain a referral to a sleep clinic from your GP, where a specialist can take you through the steps.

I have one further thought, given that you are 47. One of my colleagues has fallen out of her usual, contented sleep pattern into severe insomnia. She asked me if I thought it might be related to the emerging menopause. I reminded her that oestrogen is a vital component of brain chemistry in women, so fluctuating levels can have an impact on sleep.

My colleague started on hormone replacement therapy and, within a month, her previous sleep pattern was restored.

This is very much something to consider and maybe ask your GP about, if it’s relevant.

I’m only 29 but I keep feeling this pounding sensation in my chest, as if my heart is skipping six or seven beats every minute. I used to smoke ten cigarettes a day, but I quit last year. Also I’ve been preparing for work exams so have been stressed and I drink two cups of coffee daily. I’m very concerned. Should I see a cardiologist?

Your symptoms should be investigated, but do not be alarmed as the cause is unlikely to be serious heart disease given your relatively young age.

The sensation you describe is in fact due to extra beats occurring (known as ectopic beats, or extra systoles). It’s the gap before the next heartbeat, a compensatory pause, that you’re noticing.

See your GP and — after explaining your medical history — you will undergo an electrocardiogram (ECG), where leads will be attached to your arms, legs and chest to obtain an electrical recording of your heart’s activity.

This will help your doctor to identify the type of disturbance. Often patients find the symptoms come and go and, as luckwill have it, the readings are normal during the ECG.

If this happens, usually you’d then undergo a 24-hour ECG recording with a portable device. Sometimes 48-hour or even sevenday recordings are needed.

Smoking, stress and excesscaffeine may all be contributors toectopic beats, so you must remain off tobacco permanently and not increase your coffee intake.

But, importantly, the abnormal rhythm needs to be captured on an ECG for a correct assessment before you make drastic changes.

If your GP concludes it requires further investigation, you will be referred to a cardiologist.

Most ectopic beats are harmless and lifestyle adjustments — such as taking regular exercise an dting enough sleep — will be the focus, along with strategies to help you cope with the pressures of life.