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28 WWW. UNWLA.ORG “НАШЕ ЖИТТЯ”, БЕРЕЗЕНЬ 2013 A Good Night's Sleep by Ihor Magun, MD, FACP If you are under the assumption that you alone are su ffering from insomnia, you are misi n- formed . In fact, thirty to fift y percent of the pop u- lation has some form of a sleep issue and about ten percent, mostly women, have a persistent problem . Disorders of sleep are very common , but understanding the problem and heeding sound medical a dvice can help . Insomnia is defined as inadequate sleep even though you have the opportunity to get the sleep you need. Medically it is classified according to the sleep disruption/duration. The nature of the s leep disruption/duration det ermines the choice of specific treatments. The subdivisions are as follows: difficulty falling asleep (sleep initiation), awakening after falling asleep (sleep maintenance), early morning awakenings (sleep offset insomnia) , or persistent sleepiness desp ite sleep of adequate duration (non - restorative sleep). Many individuals have a c ombination of these issues , b ut the most co m- mon problem is sleep maintenance. In terms of its d uration , insomnia is cla s- sified as transient (one week or less), short - term (o ne to three weeks) , and chronic (three weeks to years). In a se tting of excitement or stress from external events, an occasional night of poor sleep is typical and usually does not have any lasting consequences. Persistent insomnia can lead to many adver se consequences that impact our daily function and behavior. These include day time somnolence, fatigue, poor attention and conce n- tration, anxiety, mood disorders, depression, as well as a greater chance for headaches and acc i- dents to occur. According to e pidemio logy studies, ind i- viduals typically sleep between seven and eight hours. Aging itself has little effect on the amount of sleep an individual needs; however , significant changes do occur during the normal aging pr o- cess. While the amount of sleep n eeded by an i n- dividual remains stable, deep sleep de creases. The famous statement “sleeping like a baby” refers to the deep sleep that diminishes as we age. In other words , our arousal thresholds are lower, so exte r- nal factors such as noise can easily dis turb and awaken us from a less deep sleep. S l eep is regulated by two mechanisms : circadian rhythms and homeostatic sleep drive. Circadian rhythms are co ntrolled by cells in the brain — referred to as “ the circadian clock .” This clock is influenced by our visual exposure to li ght and its regulation is mediated by m elatonin. This clock mediates signals throughout the brain to maintain wakefulness in the face of a n increa s- ing sleep drive. The homeostatic sleep drive is the body's natural urge for sleep, dependent on the hours we were awake. The longer we are awake, the sleep i- er we will feel, and it appears that a chemical, adenosine, play s an important role in the fo r- mation of sleepiness in the brain. Sleep is at its best when the sleep drive is high a nd the circad i- an clock alertness is declining. W hen this pattern is not followed, insomnia can occur. A s we age , the cir cadian signal can become weaker and the rhythm cycle shifts earlier. This can translate to earlier bedtime and earlier awakenings. There are many medications available to address the issue of insomnia. They are available both over the counter a nd by prescription. The choice of medication and treatment recommend a- tions are beyond the scope of this article; these are things you should discuss with your physician. However, before you make an appointment, you might want to give the following recommend a- tions a try. Have a regular time you go to sleep and maintain this time seven days a week. T his also refers to regular wake - up times. U se your bed only for sleep and avoid distractions such as tel e- vision . Make your sleep environment conducive to sleep — limit noise, light and keep the temperature adjusted to the set ting you feel is best for you. Limit alcohol intake prior to sleep and , of c ourse, avo id caffeine. (Note that c ertai n teas and other beverages may contain caffeine). Do not go to sleep after a large meal or extensive exercise . Let go of anxieties or issues encountered during the day before retiring to sleep. Do not watch the cl ock. If you cannot sleep, get out of bed and r e- turn only when you feel sleepy. During this time , do not engage in activities that lead to more wak e- fulness. If you have medical issues which can be the cause of sleep disorders, like sleep apnea, res t less l eg syndrome , or pain issues, address th e- se problems with your physician. Lastly , if you have many issues on your mind, keep a pad next to the bed and write down what is keeping you from getting the rest you d e- serve. Write down your chores, concerns , or ideas that may be preventing you from falling asleep. You may want to write down one additional fact — go to sleep , and you will be able to face the next day refreshed and ready to tackle anything that comes your way. Pleasant dreams!
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