Tag: sleep problems

Sleep problems
Sleep needs vary from person to person and fluctuate between four and eleven hours a night. About 10% of the population needs an average of 6.5 hours a night and about 15% needs more than 9 hours. Sleep as many hours as you need to be fit and rested the next day.

Children usually need a little more sleep, while the elderly usually get by on a little less.
Even sleeping badly for several nights in a row is not really harmful to your health.
Everyone sometimes has trouble falling asleep or sometimes sleeps less well or has trouble getting out of bed in the morning. Often this has to do with an unusual or painful event during the day – a death, an argument, a setback or a happy event – with a particularly stressful activity or simply because something has literally remained in the stomach after a meal that is too heavy for the going to sleep, or vice versa because one goes to bed with an empty stomach.

Some women sleep a little less well every month around their periods. And even after a long plane trip, which disrupts our biological clock, temporary sleeping problems can occur.

Usually these kinds of sleeping problems disappear spontaneously after a few days if the cause has disappeared or been forgotten, and there is no need to worry about it. On the contrary, if you worry too much and get worked up about that sleep problem, you risk making things worse.

One only speaks of insomnia when someone has trouble falling asleep for days (more than 3 weeks) for no apparent reason or wakes up regularly at night, and when this also has repercussions during the day (one feels tired and agitated, concentration problems, possibly headache, etc.). In such cases, it is recommended to consult a doctor.

sleep hygiene

• Go to bed at the same time as much as possible and get up at the same time. This helps to develop a regular sleep-wake rhythm and improves the quality of sleep.
• Provide a quiet sleeping environment. Reserve the bedroom for sex and sleep, not for watching TV or body building. Also ensure a good quality mattress and pillow.
• Ventilate the bedroom regularly and ensure a temperature of around 18°C.
• Your daytime activities strongly influence your night’s sleep: ensure a good alternation between exertion and relaxation. Vigorous activities just before bedtime can hinder falling asleep.
• Both hunger and a full stomach can hinder you from falling asleep. In the evening, limit the use of stimulants with stimulating substances such as tobacco, coffee, cola, etc. Those who use a lot of alcohol in the evening will fall asleep faster, but sleep less deeply and wake up earlier.
• If you feel like you can’t get to sleep, get up and do something else until you get sleepy.
• Don’t take your problems to bed: make sure you somehow keep them out of the bedroom, eg by talking or writing about them.
• Relaxation exercises can promote falling asleep. If relaxation exercises do not work if you have to perform them on your own, you can follow a course or temporarily join a yoga association, for example.

Non-drug treatment of insomnia
There are several methods of treating insomnia, ranging from relaxation techniques to simple psychotherapy. Studies have shown that they are effective for falling asleep faster and sleeping longer.

Your doctor can help you with this or refer you, if necessary, to more specialized behavioral therapists in or outside the Centers for Mental Health Care.

Benzodiazepines
If the doctor nevertheless decides to prescribe a sedative, preference is given to a benzodiazepine with a medium duration of action (alprazolam, bromazepam, brotizolam, clotiazepam, loprazelam, lorazepam, lormetazepam, oxazepam and temazepam), in low doses and for a maximum of one week.

Almost all studies indicate that benzodiazepines are effective for 1 week. From the second week their effect diminishes. It was established that when suddenly stopping after a few weeks insomnia occurs again and even more strongly (rebound effect).
In the studies comparing benzodiazepines with non-pharmacological interventions, benzodiazepines have the advantage of having an immediate effect, but the disadvantage of having no effect after 1 week, exhibiting undesirable effects, and withdrawal symptoms occurring upon discontinuation. Behavioral therapy is superior from the second week, shows a stronger effect in the following weeks (training effect) and has no side effects.

Unwanted Effects
The sedative (calming) effect of benzodiazepines can be bothersome and can be dangerous, eg when driving vehicles. When used as a sleep aid, a residual effect (“hangover”) can occur, which makes you feel sleepy for several hours after waking up.
At high doses, exaggerated and long-lasting effects may occur, especially in the elderly and in combination with alcohol or some other drugs. This is one of the causes of nighttime falls in the elderly, resulting in hip fractures.

Also, so-called paradoxical reactions can occur with increased insomnia, anxiety and even aggression.

With chronic use, tolerance to the effect and side effects of the benzodiazepines develops, with the result that one has to take an increasingly higher dose to achieve the same effect. After a few weeks of ingestion, psychological and physical dependence or addiction develops. Withholding symptoms may occur.

Other sleeping aids

• Several new drugs have recently come onto the market: zolpidem, zopiclone and zaleplon . They are no more effective than benzodiazepines and have similar unwanted effects.
• The older products type barbiturate and derivatives, such as meprobamate, are not recommended because of their potentially serious side effects and rapid development of habituation and dependence.

Anxiety Problems
Recently, many systematic reviews have been published that compare the different therapies. – Cognitive behavioral therapy is preferred
for all forms of anxiety . A referral to a behavioral therapist is necessary for most forms. Light forms can be treated by the GP himself.

• In very acute forms of anxiety, benzodiazepines can be prescribed, together with cognitive behavioral therapy. This has the advantage that an immediate effect is obtained with the benzodiazepines. After 1 to 2 weeks, the benzodiazepine should be discontinued because of the risk of dependence. Since anxiety is a permanent disorder, also during the day, the choice for a long-acting benzodiazepine is obvious. Diazepam is the reference product here.
• If cognitive behavioral therapy is not possible or does not provide sufficient results, it may be necessary to prescribe medicines for a long time. In that case, antidepressants will usually be prescribed.

Tapering off benzodiazepines
• Long-term use of benzodiazepines can lead to undesirable effects such as memory disorders, concentration and coordination disorders, dizziness, depression, emotional poverty, increased anxiety, and psychological and physical dependence.
• People taking benzodiazepines for a long time may experience withdrawal symptoms when they stop taking them.
• The acute symptomsare psychological (nervousness, insomnia, hallucinations, concentration problems, aggression, …) and/or physical (headache, tics, tremor, sweating, tingling, gastrointestinal problems, …). Almost all acute withdrawal symptoms are an expression of anxiety. Certain symptoms are particularly characteristic of benzodiazepine withdrawal, most notably hypersensitivity to various stimuli (sound, light, touch, taste, smell) and disturbances in perception (eg feeling of floor vibrating, feeling that the wall or floor is tilted). • Long-term effects
occur in a minority of patients, estimated at 10 to 15 %which only disappear after a few months or even years. The main long-lasting symptoms are anxiety, insomnia, depression, various sensory and motor symptoms, gastrointestinal and memory and cognitive impairments.
Stopping benzodiazepines should therefore be done under the supervision of a doctor. The chance of success is difficult to predict. Young age is a favorable factor, while long duration of intake, high dose, and the severity of the complaints for which the benzodiazepine was started are rather negative factors.
• There is no doubt that chronic benzodiazepine withdrawal should be gradual , with progressive dose reduction over a number of months.
Sudden or too rapid withdrawal, especially when high doses have been used, can provoke severe withdrawal symptoms (convulsions, psychotic reactions, acute anxiety) and increase the risk of prolonged symptoms. The speed of tapering must be determined individually. The rate depends on several factors such as dose and type of benzodiazepine, duration of use, lifestyle, past experience.