Ask the doctor: How can I beat insomnia?

Some mental illnesses can cause insomnia (Photo: Shutterstock)

What are the recommended sleep hours?

Generally, for adults, we advise that it be between seven and eight hours, but for younger ones like those below two years, they can sleep for up to 10 hours. Those between two and 13 years can sleep eight to nine hours and can take a nap of about two hours during the day. School-going children can sleep for between eight and nine hours.

I have been experiencing difficulty sleeping. What are the possible reasons?

Insomnia is lack of adequate sleep, or rather, not being able to sleep for between seven to eight hours as expected in adults due to various reasons that interrupt sleep. Sleep is a natural process in that after a long day, we get tired and as we go towards evening, there are chemicals in the brain that change and make one to feel sleepy. Many things, however, can interrupt this. For example, working on a shift job, where someone reports to work at night. The sleep patterns change, and might not easily adjust.

Those who have travelled may also be affected by jet lag. Illnesses, either mental or medical, may affect sleep.

There are people who have anxiety, psychosis or bipolar disease, which are mental illnesses that can cause insomnia. Medical conditions that cause pain, back-ache or some discomfort, medicine that keeps someone alert, use of substances like khat (miraa), among other stimulants will affect sleep.

Other causes include people with sleeping disorders such as snoring or sleep apnea, which is a shortage of breath while asleep.

How can I beat insomnia and maintain good sleep hygiene?

Sleep hygiene is maintaining habits that promote a clear sleeping pattern. Heavy eating towards sleeping time is discouraged. Eat at least three hours to bedtime and avoid coffee and other beverages that will affect sleep. Alcohol is discouraged, as it affects the quality and quantity of sleep. Do not carry laptops and mobile phones to bed. Exercise stimulates the brain and allows the body to rejuvenate, a process that soothes sleep.

We should invest in sleep, just as much as we invest in electronics, phones and clothing. Our bodies can only function when re-energised through proper sleeping patterns. If you have had persistent sleeping problems for at least two months, seek professional help. 

Children below two years can sleep for up to 10 hours (Photo: Shutterstock)

My cousin was diagnosed with narcolepsy. He can fall asleep anywhere at any time. What is this?

This is a neurological disorder that affects a person’s ability to sleep. This results in excessive sleeping patterns that come abruptly at any time of the day or night. For example, someone can be walking, eating or driving then they suddenly fall asleep. These people experience some muscle paralysis that may be accompanied by hallucinations. It can be frightening. This condition is mostly attributed to biological factors. The condition can show up at the ages of above 15 years, which requires close monitoring of a child, for earlier diagnosis so that appropriate medical support and guidance by experts is given to avert risk like causing an accident.

What is the appropriate duration of a nap?

A nap by adults during the day is discouraged, more so for those with normal sleeping patterns. In adults, a nap is not useful, because our brains are programmed to sleep at night and be awake during the day.

Apart from children and individuals with hyposomnia, where their sleeping patterns are interrupted and they therefore need more sleep, naps will just make you lazy.

If one has to nap, make it for 30 minutes. But again, this might result in a regular napping pattern, which is not encouraged.

Does having a scheduled sleep pattern help in any way?

When a baby is born, their brains are not trained to sleep at night only. However, as they grow, there is a chemical in their brains that adjusts, and with time, they learn that sleeping time is at night. Adults must, therefore, train their brains that there is sleeping time and waking time for about seven to eight uninterrupted hours, to enable the body to rejuvenate. This applies in children as well. Sleep should gradually be planned, for example, by switching off TV sets, reducing lights in the bedroom, putting off the internet and if possible, switching off mobile phones to train the brain. Those who cannot sleep 30 minutes after getting to bed should ensure they get tired during the day and set their alarm to wake up after seven or eight hours. Sleep hygiene comes up with discipline, and the brain will be alert for the day’s activities. Sleeping is important to rejuvenate body organs, and for emotional and mental health. Invest in a comfortable sleeping place and bed. If a human being stays awake for about two weeks, they can die.

Since I began working from home, my sleep patterns have gone wild. How do I maintain a healthy sleeping pattern?

Apply the same discipline you did when working in an office. Shower and dress up, take breaks and sleep at the appropriate time. Create a working environment that prepares your body to be active and resort to sleep at sleeping time.

What is a circadian rhythm?

This is a natural process in the brain that regulates the sleep-wake cycle. The hypothalamus sends a signal informing the brain that it is time to sleep during the night and be awake during the day. However, changes in location, like long distance travels from Kenya to the USA, will affect it as the brain adapts to different time zones and environments.

What causes jet-lag and how do you manage it?

Jet-lag is a sleeping disorder, more so from traveling in different time zones by flight. The brain’s rhythm does not change immediately; as such it confuses the body. An individual should adjust to the location naturally, but some might take a hot shower after alighting from a flight, and use drugs to enhance sleep.

Snoring is due to obstruction of the airways that should be examined by a doctor (Photo: Shutterstock)

What causes sleep apnea and why do children die from this?

Apnea occurs when the muscles in the back of the throat relax too much to block airways, resulting in shortness of breath. This can result in abrupt death. Luckily, most people with such a condition immediately wake up, because of a feeling of being choked or strangled. It could be hereditary or due to conditions like obesity. Apnea has no cure, and people with it are advised to lose weight or undergo surgery to remove excess tissues from the throat.

What causes sleepwalking and sleep talking?

This is because of what is termed parasomnias that involve unusual behaviours when people fail to have adequate sleep and they are partially awake. Muscles in such people can be active and responding to sensation but not fully awake. They can wake up to go wash dishes in the kitchen, go outside their houses and even have conversations with other people, but surprisingly, they will not know, because their brains are not active.

What causes nightmares and bad dreams?

This is a bigger group of parasomnias that could be due to psychological distress, anxiety, and trauma. A victim can dream of being involved in a tragic road accident, that someone has died, that they are fighting with militia among other scary encounters. With nightmares, details of the dream are well remembered. That is not the case with bad dreams, where no single thought can be figured out. With bad dreams, someone will not know, but those close to them may remember perhaps because they were shouting or crying.

Is it true that people that are overweight or obese sleep more than slimmer ones?

There is no science that links sleep to someone’s body size, though bigger people carry excess weight that makes them more tired, promoting sleep.

Why do some people snore while sleeping?

Snoring is due to obstruction of the airways that should be examined by an Ear and Nose and Throat surgeon to establish the cause. Snoring is a serious sleep condition that has even resulted in broken marriages. It should be looked into by seeking a solution either from medical or psychology experts.

By Dr Edith Kwoba as told to Mercy Kahenda. Dr Kwoba is a consultant psychiatrist at Moi Teaching and Referral Hospital, Eldoret