Chronic insomnia affects approximately 30% of the general population. It is a particularly common occurrence among women and the elderly. With rare exception, insomnia is a symptom of a problem, not the problem itself. Some of the situations associated with insomnia include:

• Medical conditions such as gastroesophageal reflux, restless leg syndrome, sleep apnea, and chronic pain.
• Psychiatric disorders, especially depression, which may be present in up to 40% of people with insomnia.
• Working nights or rotating shifts.

Insomnia is not an innocuous issue. People with persistent sleep disturbance are more prone to accidents, have higher rates of work absenteeism, report a decreased quality of life, and utilize the health care system more often.

For many people, the underlying cause for disturbed sleep has to do with poor sleep habits, such as staying up too late, drinking too much alcohol or caffeine, or napping during the daytime. "Sleep hygiene" is the term applied to measures to improve the quality or quantity of sleep. The following are tips to help enhance your sleep hygiene:

• Avoid prolonged napping during the day. For those people who experience an afternoon "slump", a short nap during this time is reasonable. Napping too long, however, may make getting to sleep or staying asleep in the evening more difficult.
• Stimulants, such as caffeine, nicotine, and alcohol should be avoided too close to bedtime. Coffee, tea, cola, cocoa, chocolate and even some non-prescription drugs contain caffeine. Like caffeine, nicotine is a central nervous system stimulant that tends to increase heart rate and blood pressure as well as stimulate brain activity in ways that are incompatible with sleep. While alcohol has an initial sleep-inducing effect, once the alcohol is metabolized, the mind can become aroused resulting in awakening or a poor quality of sleep.
• Exercise regularly. Engaging in vigorous exercise within two hours of bedtime can be counter-productive, however, because it tends to activate the nervous system. For some people a relaxing exercise, such as yoga done before bedtime helps to initiate a restful night's sleep.
• Avoid eating large meals close to bedtime. Although a light snack before sleeping can be beneficial, consuming large meals too close to bedtime can increase the risk of heartburn during the night. In order to reduce awakening from the need to urinate, avoid drinking fluids a couple of hours before retiring to bed.
• Avoid watching TV, eating, or discussing emotional issues in bed. Associate going to bed with going to sleep.
• Make sure that the sleep environment is relaxing. A comfortable mattress is one of the keys to a good night's sleep. Find a comfortable temperature setting for sleeping. A cool bedroom is often the most conducive to sleeping.
• Block out distracting sounds and light. Use of earplugs or machines that generate "white noise" can help with distracting sounds. Excessive light can be diminished with the use of "blackout" shades on the windows or by wearing eyeshades.
• Receive natural daylight regularly. Daylight helps regulates our circadian rhythm and tell us when it's time to be awake or asleep. Being in natural sunlight for at least 30 minutes each day will help keep our biological clocks properly adjusted.

Sound sleep is important to health and well-being. If your sleep is continually disrupted and you lack initiative and energy during the day, you should seek professional help. Feel free to contact us at eDoc to help sort out the general nature and severity of a sleep problem.