Sleep trouble? Here’s how to get the nappiest health

Bengaluru resident Neeraj Jha, 35, could not get a good night’s sleep for months. He would sleep for a maximum of two hours but was never able to fall asleep until early morning.

“I would run pillar to post to find out how I could sleep but everything went in vain. I had even taken pills for the same, but it did not help and that had bad reactions like irritability and headaches on me. Later, I found that the solution was in changing few lifestyle issues, which fixed my problems slowly,” Jha told Happiest Health.

How to stop taking sleeping pills?

If you have difficulty in falling or remaining asleep, or if you wake up with in the middle of the night and find it difficult to return to sleep, causing clinically significant distress or impairment in activities, at least three nights per week for three months or more, you could be said to be suffering from insomnia disorder.

But pills or medications should be the last thing you should think of, say experts.

According to a study by University of Washington’s Eliza L Sutton, MD, cognitive behavioural therapy for insomnia is the preferred treatment approach because of its efficacy, safety and durability of benefit, but pharmaceutical treatments are widely used for insomnia symptoms. It was published in the Annals of Internal Medicine in March 2021.

“When somebody is having insomnia, the pill is only a temporary solution,” said Dr Vivek Anand Padegal, director, pulmonology and sleep medicine, Fortis Hospital, Bengaluru. “The bad news is that it will stop working. We will not know what the underlying issue is. There are some things that cause these sleep issues. Recently, we have seen how the Covid-19 pandemic has wrecked the lives of people, and issues like anxiety, depression and circumstances at home have opened a lot of things.”

Habits govern sleep

About the habits that go into sleep, Dr Padegal said, “Firstly, the varied sleep cycle. Our sleep schedules have completely got disrupted. Everyone is like in their college days now — partying, waking up late and running late to college. Time zones again disturb the sleep schedules, and these erratic hours will give you insomnia.

“The other area that is concerning is the use of social media. We are in the social era where even the e-books that we read at night will affect our sleep — like the blue light emitting from gadgets like Kindle [and] phones, and that is not good.”

Dr Soumya Das, consultant, pulmonology, Manipal Hospitals, Kolkata said that what we drink, what we eat and how we follow out daily routine matters a lot when it comes to having a good sleep. “We do not become conscious of our sleeping pattern — like we go to bed late on weekends, we sleep early on weekdays. These irregular patterns matter a lot when one does not get proper sleep,” says Dr Das.

How to get off sleeping pills?

“When you are not getting sleep, it automatically affects the daytime activities or functions,” said Dr Padegal. “People will feel sleepy, tired and distracted. If the daytime activities are not affecting them, then they are doing fine. For example, an 80-year-old sleeps five hours a night and it is absolutely dining. But if a youngster who works heavily during the day sleeps five hours a night, then there’s a problem. The repercussion of it is that they feel sleepy the whole day.”

He said if the problem is acute and it never really happened, then assurance is the first line of treatment for people who complain of a lack of sleep. “We advise them about sleep-hygiene practices to follow – like not to expose themselves to blue light and to keep their room at a good temperature. We sometimes give them a questionnaire that indicates a lot of sleep patterns that they can be identified with.”

How to stop taking sleeping tablets?

• Eating late: Experts say many people eat late at night and the gap between eating lunch and dinner has changed. Eating too late and going to bed immediately after dinner must be avoided
• Exercising before going to bed: Exercise only when you can. Dr Padegal says exercise gives an adrenaline rush that will not allow you to sleep immediately. Exercising should be done at least two to three hours before sleeping
• Avoid beverages: Beverages like tea, coffee and diet colas should be avoided before dinner or going to bed
• Alcohol: Consumption of alcohol affects the sleep pattern. Dr Padegal says you cannot sleep on days that you drink heavily. It might become the stimuli that will not allow you to sleep

Behavioural changes that can be practised

Some simple techniques can help how to stop sleeping pills. “We ask people to practise this monotonous activity where one counts sheep and goes on and on to fall asleep,” says Dr Padegal.

“Another way is to practice pranayama (a breathing exercise) which can be done by sitting and meditating. This revs down your body and helps the air pass-way in the nostrils for you to get good sleep. There are relaxation techniques wherein you exercise by rotating your forearms and breathing through your mouth and nose alternatively.”

Dr Das suggested wearing a comfortable dress, preferably a cotton dress, when going to bed. “We need to avoid all gadgets at least forty minutes before going to bed,” the doctor said. “Always remember that consumption of alcohol just before going to the bed will not help, and if someone is consuming, going to bed should always be two hours later. As the old saying goes, the bed is only for sleep and sex.”

If you do not fall asleep within 20 minutes after going to bed, then you must get out of bed and relax. “We should keep a track of what is happening to us when we wake up,” says Dr Das. “If there are no fresh vibes and you still feel a lack of sleep, you should consult a doctor.”

Dr Das also warned about obstructive sleep apnoea, where the airway in the nose is blocked and leads to snoring. “Snoring is also a sign that there is an obstruction,” the doctor says. “The breathing stops and starts suddenly, and one becomes a nocturnal person. At this stage people need to take help because it is not always about medicine.”

Treatments

Talking about the line of treatment for someone who complains of a lack of sleep, Dr Shantanu Tandon, senior consultant, ENT, Sakra World Hospital, Bengaluru, says, “A good relaxed clinical assessment with a physician to rule out medical/psychiatric disorders will be carried out. [Also,] ruling out any obstruction in the upper airway by an ENT to make sure the patient doesn’t suffer from sleep apnoea, making sure there are no maladaptive behaviours (major life change, illness or traumatic event) that prevent good sleep, and trying to maintain a regular sleep schedule — that is, trying to sleep and wake up at a fixed time.”

Dr Padegal said over 60-70 per cent of people who visit him for consultations regarding sleep issues get better when they change their behaviour. “Only chronic insomnia needs a different treatment line which needs a few medications only for some time. There are short-duration medications and long-duration medications that will be prescribed. Even then, the behaviour must be changed.”