Like one in 5 who see their GP, I can’t sleep
Every week Dr Martin Scurr, a top GP, answers your questions
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.