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Health Focus
Sleep disorder - cause and treatment
20 Feb 2018

 What are physiological, mental, and psychological consequences of reversing the order of the circadian clock?

Humans possess a central timing system. In the absence of time cues, the dominant component of this system free runs with a period of 24.2 h, giving rise to a so-called circadian rhythm. Normally, this rhythm is synchronized to a 24-h cycle, predominantly by natural light–dark cycles and, to lesser extent, by cycles of rest and activity or feeding and fasting. Symptoms usually occur for several days and include disturbed sleep, excessive daytime sleepiness, generalised fatigue, somatic symptoms, and cognitive dysfunction. Gastrointestinal symptoms, such as decreased appetite or constipation are related to food consumption out of alignment with the predominant circadian timing system. Specific other complaints include a poor mood and underlying psychiatric disorders can exacerbate. Cognitive functions that may be impaired include introspection, emotional regulation, and decision-making.

What are the best ways to restore the natural sleeping cycle to the body, especially for those used to staying up late and those who suffer from insomnia? And how long do they take on average?

All patients with insomnia should receive therapy for any underlying medical condition, psychiatric illness, substance abuse, or sleep disorder that may be precipitating or exacerbating the insomnia. They should also receive general behavioural suggestions, particularly advice regarding sleep hygiene and stimulus control. For those who continue to have insomnia that is severe enough to require an intervention, we suggest cognitive behavioural therapy for insomnia as the initial therapy rather than medication. Patients given behavioural plus pharmacologic therapy should continue behavioural therapy for at least six to eight weeks. In patients who respond to therapy, the medication can be tapered while continuing the behavioural therapy. Patients whose symptoms recur may require evaluation in a sleep disorders center, prior to the institution of long-term therapy. Long-term treatment with medication is not the optimal treatment strategy for patients with insomnia.

What are some common reasons for insomnia in case the person wakes up in the regular time?

Short-term insomnia is also called adjustment insomnia, acute insomnia, stress-related insomnia, or transient insomnia. While it does not cause the severe health deteriorations seen with chronic insomnia it does affect the well-being. Symptoms may be temporally related to an identifiable stressor, such as seen in people who during the holy month of Ramadan sleep after sun rise and wake up a little before sunset so that they do not struggle with fasting. Short-term insomnia is expected to resolve when the stressor abides. To return their sleeping cycles to normal these individuals may adapt to good sleeping habits. These include:

  • Sleep only as much as necessary to feel rested and then get out of bed.
  • Maintain a regular sleep schedule (the same bedtime and wake time every day).
  • Do not force sleep.
  • Avoid caffeinated beverages after lunch.
  • Do not go to bed hungry.
  • Adjust the bedroom environment (light, noise, temperature) so that you are comfortable before you lie down.
  • Deal with concerns or worries before bedtime. Make a list of things to work on for the next day so anxiety is reduced at night.
  • Exercise regularly, preferably four or more hours before bedtime.
  • Avoid prolonged use of phones or reading devices ("e-books") that give off light before bed. This can make it harder to fall asleep.

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