It’s like a thief in the night, robbing people of the one thing they need as much as food to function.
Insomnia plagues as many as one in three adults worldwide and 10 to 15% suffer chronically or severely. The condition is considered severe when you have trouble getting to sleep or staying asleep more than three nights a week for three months or longer – and it can have a major impact on your daily life.
Difficulty concentrating, irritability, mood changes, depression, memory issues, an increase in mistakes and accidents – all these and more are a result of a lack of sleep. Between seven and eight hours is generally considered “getting enough sleep”, although the amount needed varies from person to person, says Dr Irshaad Ebrahim, a specialist neuropsychiatrist in sleep disorders from Cape Town. Some can function fine on five hours a night, others need their eight hours. “But it’s the quality of sleep that’s more important than the quantity,” Ebrahim says.
Sleep is divided into five cycles: stages 1 to 4, or non-REM (rapid eye movement) sleep, followed by REM sleep.
Stages 1 and 2 are light enough for you to be woken by a knock on the door.
Stages 3 and 4 are considered deep or slow-wave sleep, and are essential to waking up feeling that you’ve had a good rest.
To get to REM, the last stage, you have to go through the full cycle of non-REM. If you’re interrupted at any stage – by a poke in the ribs, for example – the cycle loops back to stage 1. If you’re feeling wiped out in the morning, you probably haven’t had a chance to reach stages 3 and 4. Too little REM and your mind starts to play tricks on you.
In That Memory Book, author Cathryn Jakobson Ramin describes slow-wave sleep as a time when the brain extracts meaning from the information that comes at it during the day.
“Because the brain is able to run through events that occurred during the day and look for interesting juxtapositions, slow-wave sleep enhances creativity,” she says.
“REM sleep is the clean-up crew, brought in to sweep up the detritus after slow-wave has finished its gig. In REM sleep, the brain examines the just-processed material, deciding what to keep and what to toss. If there’s been little or no slow-wave sleep, the cleaners can make a bad mistake, carting tomorrow’s carefully prepared speech off in a dustbin.”
Poor sleep is usually a symptom of a psychological problem often related to trauma, severe stress, burnout or depression, says Elise Beeby, a Cape Town clinical psychologist and hypnotherapist.
“The main symptom to treat is the anxiety. Underlying the anxiety is anger or fear that causes a feeling of powerlessness or helplessness.
“If this is the case, you have to accept that these feelings have become unmanageable. Seek help – go for counselling and address your problems. Don’t avoid them,” she advises.
“Once you’ve unlocked the deeper issues and diffused them, better sleep should soon follow.”
Many of the sleeping pills prescribed in South Africa contain the substance Zolpidem.
These so-called “Z-drugs” link with the neurotransmitter GABA to “shorten” the period just before you fall asleep.
GABA stands for gamma-aminobutyric acid. It’s an amino acid that functions as the primary inhibitory neurotransmitter for the central nervous system. In other words, it helps calm you down.
Zolpidem works fast: you’re usually lights out within 15 to 20 minutes. But while Zolpidem may help insomnia, its ability to induce amnesia can be a problem.
The package insert warns amnesia can occur several hours after taking the pill. These drugs are supposed to act for only about four hours, so they should get you through the midnight hours and you shouldn’t wake up feeling foggy.
But there’s a danger you could “wake up” before the effect has waned – and not recall a thing later.
Raiding the fridge is common. Night driving has also been reported: one man woke up in his car with the bumper on the seat next to him. Another woman woke to find all the containers for her allergy medication empty: she’d accidentally taken it all.
Although sleeping pills can help you through a bad patch, they’re not a good idea in the long term. They’re intended to be taken for a few weeks only to get over a bout of insomnia and not as a nightly sleep aid. If they’re taken too regularly the body can become dependent on them.
If you find you can’t get to sleep without a pill, seek professional help.
There are also many homeopathic and non-prescription remedies that could help you sleep, so speak to your local health store or pharmacist.
Hanan Bushkin, a psychologist at the Anxiety and Trauma Clinic in Johannesburg, believes cognitive behavioural therapy (CBT), although not a quick fix, is so effective that for most people it works better than sleeping pills – with no side effects.
“The success of CBT is based on the central theme that sleep problems can be treated only by addressing the underlying causes which, in most cases, are negative thoughts and/or habits. Both of these are learned and can therefore, with the aid of specialised techniques, be unlearned.”
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