Like one in 5 who see their GP, I can’t sleep

Ev­ery week Dr Martin Scurr, a top GP, an­swers your ques­tions

Daily Mail - - Good Health -

SINCE last De­cem­ber I’ve had vir­tu­ally no sleep, which is depressing. Some­times I man­age to fall asleep at 5am, but I need to get up by 6am. I’ve tried med­i­ta­tion, yoga, Pi­lates and I’ve con­sid­ered hyp­no­sis. I know about sleep hy­giene and am try­ing cog­ni­tive be­havioural ther­apy. I’ve been pre­scribed short cour­ses of sleep­ing tablets — great for a week, then it’s back to square one. Is there any­thing new I can try? Gill Wittmann, Leeds.

WHAT you have is chronic in­som­nia, which not only ham­pers one’s abil­ity to func­tion ef­fec­tively dur­ing the day, but can pro­foundly af­fect health. In­deed, in­som­nia has been linked to a raised risk of car­dio­vas­cu­lar prob­lems, such as high blood pres­sure and heart at­tacks, as well as de­pres­sion and anx­i­ety.

In­som­nia is a com­mon com­plaint, af­fect­ing nearly a fifth of pa­tients seen by GPs. And it be­comes more preva­lent with age — just 12 per cent of el­derly pa­tients have nor­mal, sat­is­fy­ing sleep pat­terns, one study found.

Ear­lier in my ca­reer the so­lu­tion was al­ways a pre­scrip­tion for sleep­ing tablets. But these haven’t lived up to their prom­ise — they pro­vide some hours of sleep but with­out cur­ing the fun­da­men­tal prob­lem, and can lead to de­pen­dence.

I re­gret to report that there are no new drugs that might help you. But we know there are var­i­ous strate­gies — of­ten used at spe­cialised sleep clin­ics — that are ex­tremely worth­while over time, although these must be prac­tised dili­gently.

These treat­ments are cen­tred on chang­ing be­hav­iour. One of the most im­por­tant is good ‘sleep hy­giene’, and I will ex­plain the rules for the sake of other read­ers.

In­di­vid­u­ally each rule may seem ob­vi­ous, but to­gether they will prove suc­cess­ful.

THE rules are: sleep as much as you need to feel rested, then get out of bed; do not force sleep — if you can’t sleep, then get up; avoid tea or cof­fee af­ter lunchtime; avoid al­co­hol in the hours im­me­di­ately be­fore bed­time.

Give up smok­ing, as nico­tine is a stim­u­lant; do not go to bed hun­gry; en­sure the bed­room is dark, quiet, nei­ther too cool nor too warm (the ideal tem­per­a­ture is around 18 de­grees); make a list of tasks and con­cerns be­fore you set­tle down to sleep so wor­ries don’t keep you awake; ex­er­cise daily; do not use any screen de­vice be­fore bed be­cause the light can sup­press the re­lease of the sleep hor­mone mela­tonin.

Even if fol­low­ing these rules has not yet helped, con­tinue to ad­here to the full list metic­u­lously, and con­sider fur­ther mea­sures.

One op­tion is re­lax­ation ther­apy, although it seems this has not proved help­ful for you so far. My ad­vice is to try us­ing a phone app such as headspace, which pro­vides guided med­i­ta­tion ses­sions, for ten min­utes each day, once again mak­ing this a long-term strat­egy.

Another re­lax­ation tech­nique is biofeed­back — where sen­sors are placed on the skin to record mus­cle ten­sion or brain rhythms; this in­for­ma­tion is then dis­played on a screen, and with prac­tice you learn to slow your breath­ing and so re­lax. There are biofeed­back units you can buy for home use.

Sleep re­stric­tion, which is taught by ther­a­pists at sleep clin­ics, may also be use­ful. It in­volves es­ti­mat­ing the num­ber of hours that you ac­tu­ally sleep, then re­duc­ing your to­tal time in bed each night to this av­er­age sleep length, with firmly en­forced bed­time and awak­en­ing times.

Once sleep im­proves, the amount of time per­mit­ted in bed can be grad­u­ally in­creased.

Cog­ni­tive be­havioural ther­apy (CBT), a talk­ing ther­apy which is usu­ally given in com­bi­na­tion with other tech­niques, can also help — here a skilled ther­a­pist helps you deal with the anx­i­ety and neg­a­tive thoughts that ac­com­pany in­som­nia. The chronic in­som­nia that you de­scribe mer­its the at­ten­tion of a spe­cial­ist sleep clinic, and hope­fully your GP will re­fer you.

If not, then the least I would sug­gest is that your cog­ni­tive ther­a­pist is spe­cialised in treat­ing a long-term sleep disor­der. MY MOTHER, 75, was sent for a full blood test at hos­pi­tal fol­low­ing a high blood pres­sure read­ing. The re­sults high­lighted only a B12 de­fi­ciency. Fol­low­ing a sec­ond test, she has been told she will need another blood test and to avoid all potassium-rich foods.

As a suf­ferer of dry mac­u­lar de­gen­er­a­tion, her diet is rich in potassium — broccoli, spinach and tomato, as ad­vised by her con­sul­tant. How can some­one with a de­gen­er­a­tive con­di­tion bal­ance such con­flict­ing re­quire­ments?

Andy Dixon, Prestatyn, Den­bighshire. The prob­lem is lack of in­for­ma­tion, and I hope I can re­as­sure you, although some fur­ther clar­i­fi­ca­tion is needed.

Fol­low­ing her di­ag­no­sis of dry age-re­lated mac­u­lar de­gen­er­a­tion (where the mac­ula — the cen­tral area of the retina — be­comes dam­aged, lead­ing to loss of cen­tral vi­sion), your mother was wisely ad­vised to eat a diet pro­vid­ing plen­ti­ful quan­ti­ties of vi­ta­mins A, C, and E, along with zinc, cop­per, lutein and zeax­an­thin. These nat­u­ral sub­stances are proven to be ben­e­fi­cial for the con­di­tion.

She ob­vi­ously fol­lows this dili­gently, and I sense it is a blow to be told to limit potassium, a min­eral that is found in much of her diet. I sus­pect that a slightly high potassium level was found on the sec­ond blood test, lead­ing to the writ­ten ad­vice. how­ever, a high potassium level may be an er­ror.

ONE pos­si­ble, and com­mon, rea­son for this is a de­lay in the blood sam­ple be­ing de­liv­ered to the lab­o­ra­tory — potassium is re­leased from blood cells as they rup­ture and die, which the cells in the sam­ple would have done over time.

Fur­ther­more, in a pa­tient with nor­mal kid­ney func­tion, ex­cess potassium in the diet is rapidly lost from the sys­tem in the urine.

You have no rea­son to sus­pect that your mother has poor kid­ney func­tion as her first test re­sults were nor­mal, apart from B12 de­fi­ciency — and blood tests car­ried out be­cause of high blood pres­sure will cer­tainly have checked kid­ney func­tion.

I ex­pect that the next test will show a nor­mal potassium level and your mother can con­tinue to en­joy her healthy diet.

It would be un­usual for B12 de­fi­ciency to be due to poor diet — some­one would have to be on an ex­tremely lim­ited, strictly ve­gan diet for two or three years (the nu­tri­ent is found in meat, fish, dairy, and eggs).

This find­ing there­fore begs the ques­tion as to whether she has per­ni­cious anaemia, where the stom­ach stops pro­duc­ing in­trin­sic fac­tor, which aids the ab­sorp­tion of vi­ta­min B12 in our food. Treat­ment is a reg­u­lar in­jec­tion of the vi­ta­min — but no doubt your GP will ad­vise her on this.

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