Title: Difficulty with sleep
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 2 - Ethiopia (Full)

Difficulty with sleep

Figure 16.3 A woman who is unable to sleep at night.

Sleep problems are common: in the USA 1 in 10 people have chronic insomnia. This is when a person has difficulty getting enough good quality sleep (Figure 16.3). Not everybody needs the same amount of sleep, but most adults seem to need between 7 and 9 hours of sleep in order to function properly. Children need more sleep and older people don't need so much sleep.

From your general knowledge, can you think of five reasons why somebody might have problems sleeping?

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Common causes of sleeping problems include: bad sleeping habits, undetected mental illness (depression, anxiety, psychosis), social problems (e.g. somebody has died, not enough food for the family), stimulants or other drugs (coffee, alcohol, khat, prescribed medications), a physical health problem (e.g. painful conditions, diabetes, breathing problems, epilepsy), late pregnancy, having a young child, something in the environment (uncomfortable sleeping place, cold, noisy).

Sleep problems can be very frustrating and distressing. People with sleep problems are more likely to be involved in road accidents because they are tired and don't concentrate properly. Sleep problems can also lead to mental illness or make mental illnesses worse. People may try to treat their sleep problems through self-medication, either with sedative medication (usually diazepam) or alcohol. Sedative medication is medication that makes a person feel sleepy. Both alcohol and diazepam can lead to addiction and, instead of solving the sleep problem, can make it worse. Because of all these reasons, it is important to take sleep problems seriously. Simple advice can be very helpful.

If somebody tells you that they have a sleep problem, you need to do the following:

- Try to work out whether there is an obvious reason for it.
- Screen for depression (see Study Session 12) or anxiety (Section 16.2). If present, refer for treatment.
- Ask the person about their use of alcohol, khat and coffee. If present, explain that these stimulants may be affecting their sleep and advise them to cut down or stop.
- If you think they have got into bad sleeping habits, you can use the advice in Table 16.2 on sleep hygiene — that is, getting into good sleep habits.

Table 16.2 Advising people on good sleep hygiene.

Do's | Don'ts
Go to bed and get up at regular times

Make sure you have regular exercise

Take time to talk with family and relax before trying to sleep

If you are worried about something, write it down/tell somebody about it and deal with it in the morning
Sleep during the day

Eat a heavy meal just before bed

Drink coffee in the afternoon or evening

Chew khat

Smoke a cigarette

Use alcohol to help you sleep