A neurologist at the College of Medical Sciences, University of Maiduguri, Borno State, Prof Yakub Nyandaiti, talks about how wrong eating habits can cause insomnia and how the disorder can be managed
What is Insomnia and how will you describe the condition?
Well, in a layman’s language, insomnia is when somebody has difficulty initiating or maintaining sleep or the person actually slept enough but felt that he hasn’t had enough sleep. That’s insomnia in a layman’s language.
What causes this condition?
They can be divided into primary and secondary causes. In a person, insomnia can be due to secondary causes if the person has other core morbid conditions. For instance, if one has pain, the person can’t sleep well. Others are arthritis, stress and reactions in the body when one is taking some medication, alcohol, and so on; then it can also likely be due to depression. These are the secondary causes. The secondary causes are usually due to other background medical conditions. Assuming one is asthmatic, has difficulty in breathing, or has other complicating medical conditions, the person may find it difficult to sleep.
For the primary causes, it is due to factors that are not associated with medical conditions. When you say primary, meaning no other cause again is attributed to it. It’s not because of pain. Examples are noise, temperature, and so on.
Are there different types of insomnia?
What are they?
There are many classifications. Just like I said, it can be classified into either primary or secondary, and it can be defined just the way I defined it. The first has to do with difficulty in initiating sleep, that is, sleep onset insomnia; then, we have the second, which is called sleep maintenance insomnia. If the person has difficulty going to sleep, that is a kind of insomnia of sleep onset, and if the person actually wakes up frequently at night. It can also be a mixed feature of insomnia, that is difficulty falling asleep and maintaining sleep, and it can be paradoxical insomnia. In paradoxical insomnia, the sufferer underestimates the time they sleep.
What’s the average sleep time that is expected of an individual in a day?
Adults usually should sleep between seven to nine hours a day. In children, it should be more than nine hours and as one grows older, it can become less than that nine hours. So, we can say in neonates, toddlers and children, as much as 12 hours or more.
Who is more at risk of this condition?
Insomnia can also be acute and more people are affected by this. For instance, if one has what is called jet lag, meaning one takes a flight to a place with a different time zone, one will have a change in their sleep pattern. People whose rooms are noisy too are more at risk. Change of room, change of environment and some form of stress also pose a risk. People who experience all of these are likely to have insomnia. There is a stage when it gets into chronic insomnia, which is difficulty in falling asleep for a long period. People experiencing pain, arthritis, being asthmatic or having cancer, people with heart burns, or someone, who just lost a loved one, are bound to develop insomnia.
Apart from the inability to fall asleep, are there other symptoms that come with insomnia?
The initial symptom of insomnia is that one cannot actually fall asleep, but in the daytime, the sufferer feels sleepy, feels fatigued and has difficulty concentrating. Those are the major symptoms that someone with insomnia presents. They feel tired, sleepy, lack concentration, experience loss of memory, and so on.
Is there a different way of diagnosing it?
The diagnosis is usually what the patient presents to us. The patient usually comes to us and tells us that they have difficulty in sleeping, that they have to lie down on their bed for several hours before they can sleep or they say that they wake up several times at night and feel exhausted during the daytime or they actually sleep but still feel that they have not slept enough or feel tired throughout the day and feel sleepy, having fatigue, loss of concentration and impaired memory or judgment.
What are the complications that come with the condition?
The complications are many. One can become anxious, there is a risk of high blood pressure, and one may become depressed. In women, there is a risk of falling, impairment of memory, having slow reaction time, which may lead to accidents, and one cannot concentrate on work, they feel sleepy throughout the day, have fatigue and are tired.
Accidents are actually very serious issues that come as a result of having a slow reaction. Also, depression, a high risk of health challenges like blood pressure can actually rise. One can have difficulties and risk being obese and trouble keeping focus at work. So, if one has a job with high demands on memory, concentration and the like, the person will have a big challenge to cope with.
Are there habits people keep that stimulate insomnia?
Yes, if one does a lot of eating late at night, takes a lot of coffee, does not have regular exercise, keeps noisy rooms and takes phones to bed, keeps lights in the room and does not have a regular sleep pattern, these habits can affect sleep. Also, taking heavy meals at night, any drink that contains caffeine or nicotine, or alcohol, can actually interrupt one’s sleep pattern.
People who live in megacities like Lagos sleep for fewer hours than is required and it has become a routine, and has formed a new lifestyle and pattern. What risks are they exposing themselves to in the nearest future?
Well, just like we listed above, they are exposing themselves to high blood pressure, obesity, risk of having slow reaction time and the possibility of accidents, becoming anxious, having trouble staying focused and their memory might be affected. These are all part of the complications that they will have.
Is it a condition that can be hereditary?
Well, for those that may be due to some of the secondary causes, if one inherited things like obesity, diabetes and so on, or one has arthritis, which can be familial, they can cause insomnia. So, it could be these familial things that make one predisposed to developing a sleep disorder, but the primary one, like taking coffee and the likes, has nothing to do with one’s genetics.
It is said that people who don’t sleep well or sleep for sufficient hours usually snore when they are eventually able to sleep. Is there any link between snoring and insomnia?
Yes, there are people who snore, but another disease or entity can lead to that. That is called sleep apnea syndrome. It is another medical condition that may lead to insomnia. It is one of the secondary causes that can lead to insomnia. Those who are obese have the tendency of developing sleep apnea syndrome, which may lead to insomnia and the snoring that they normally have.
How can this condition be managed?
In the initial state, if it is an acute one, there is what we usually call cognitive behaviour therapy. We usually advise the patient to have a regular sleep pattern, avoid eating at night, avoid caffeine and coffee, and do some exercises for maybe two to four hours at night before going to sleep. Avoid going to bed with phones, make the room environment very conducive for sleeping, engage in regular exercise and avoid alcohol late at night.
There are medical reports that state how long the body can go without food or water before it dies. Does that also apply to sleep? How long can a person go without sleep?
I can’t answer that question because some people can come to you and tell you that they have not slept for three months and there’s no way you can prove that, but certainly if one doesn’t sleep for some hours, it can actually cause some confusion in the brain. Some of my patients have actually come to me to tell me that they have not slept for three, four, or five weeks, but I cannot believe it anyway. That is what they tell us, but that is what we call paradoxical insomnia because the patient feels that what they are having is a misperception of sleep or the sleep state. As a neurologist, I know that the brain cannot withstand hypoxia (oxygen deficiency) for a few minutes or cannot even withstand the shortage of blood supply for a few minutes for sleep.
Is there a preventive measure to it?
The prevention is the same as the treatment or management. Most forms of the acute state do not require treatment and the chronic one may exclude other causes. For the treatment, if a person is asthmatic and cannot sleep at night, treat asthma. If the person is having pain and the pain prevents him from going to sleep, treat that. If someone is diabetic and wakes up several times at night to urinate and cannot concentrate and sleep, treat diabetes. If it’s through sleep apnea syndrome, the same applies.
For the habit-associated ones, encourage the person to exercise, avoid taking heavy meals late in the day, make sure that the room is comfortable, dark, quiet, not too hot, not too cold, then if they can relax before going to bed, they can take a small book and read, listen to music, make sure that the room is meant for sleep. These are the things that are needed to prevent it. Not all cases of insomnia require medication. Only a few will require that and it’s usually those that are chronic insomnia. At night, one can snack before going to bed instead of taking pounded yam or other heavy meals. That may help.