The required number of hours
Sleep is a basic human need. It functions to restore normal activity levels and normal balance among the parts of the nervous system and it allows for repair processes to occur as in protein synthesis (Kozier, 2004). Lack of sleep is said to cause an emotionally irritable, poorly concentrated individual that experiences decision making difficulty.
The required number of hours of sleep per day varies with age. A newborn is expected to sleep for 16 to 18 hours a day, an infant 22 hours a day, a toddler 10 to 12 hours per day and preschool children need 11 to 12 hours of sleep per day (Kozier, 2004).
As the individual grows older, he is required to sleep less. School aged children is required 8 to 12 hours of sleep, adolescents 8 to 10 hours, young adults 7 to 8 hours, middle aged adults 6 to 8 hours and elders only 6 hours (Kozier, 2004). The circadian rhythm, the most familiar rhythmic biologic clock that is responsible for our sleep-wake patterns, follows a dark-light pattern with the suprachiasmatic nucleus as its pacemaker (Bullock, 2000).
The suprachiasmatic nucleus is found in the anterior hypothalamus and is stimulated by the receptors in the retina of our eyes. Melatonin, which has regulatory effects on the SCN, is secreted by the pineal gland and its secretion is stimulated by the dark and is suppressed by light (Bullock, 2000). Melatonin promotes sleep in this way, and fewer hormones secreted, as in the elderly, will be one of the many causes for insomnia (Bullock, 2000). There are several factors that can cause sleep pattern disturbance aside from a decrease in melatonin.
Sleep pattern disturbances can be caused by external or internal factors and these disturbances can only be classified as a medical condition when they chronically interrupt sleep (Bullock, 2000) or when the inability to sleep well at night causes impaired daytime functioning (Atkinson, 2000). Sleep pattern disturbances have been grouped into four categories by the Association of Sleep Disorders Center, namely, disorders of initiating and maintaining sleep, disorders of excessive somnolence, disorders of sleeping-waking schedule and dysfunctions associated with sleep, sleep stages or partial arousal (Atkinson, 2000).
Disorders of initiating and maintaining sleep include insomnias, which is the inability to sleep and maybe exhibited by difficulty falling asleep, there are recurrent awakenings, and early morning awakening without being able to go back to sleep (Atkinson, 2000). Reasons for the cause of insomnia is still not known, as some claim that this is a symptom of a disease or just a perception of individuals who feel that they have not gotten enough sleep because of some factors they claim to have experienced. Insomnia can be attributed to various factors that could either be pathologic or psychological.
Pathologic causes include disease process, pain, obstructive uropathy, hyperthyroidism, congenital heart failure, respiratory disease, arthritis, and hormonal imbalance (Atkinson, 2000). Psychologically, anxiety, obsessive worrying, chronic stress and depression can bring about insomnia (Atkinson, 2000). As much as possible, interventions for insomnia remain to be nonpharmacologic, but if the individual is experiencing sleeplessness that is ruining his daytime activities, a doctor will prescribe selected sedative-hypnotic medications.
Although effective, these medications should not be used as often and several considerations should be noted. These medications produce a central nervous system depression and produces an unnatural sleep, it may resolve insomnia for tonight, but may disturb sleep the following night and cause daytime drowsiness (Kozier, 2004). Some medications are antianxiety medications which decrease the arousal ability of the individual taking it; these are also contraindicated to be taken by pregnant women because of the congenital anomalies that they may cause (Kozier, 2004).
These medications also vary in their onset and duration of action and continuous use can lead to tolerance or to drug dependency (Kozier, 2004). Sudden cessation of these medications can result in withdrawal symptoms and even death, thus before withdrawal of medications, the dose should be gradually tapered to about 25% to 30% weekly. Examples of these medications are Chloral hydrate (Noctec), Ethchlorvynol (Placidyl), Flurazepam (Dalmane), Glutethimide (Doriden), Lorazepam (Ativan), Melatonin, Temazepam (Restoril), Triazolam (Halcion), Zaleplon (Sonata), and Zolpidem (Ambien) (Kozier, 2004).
Alternative treatment for insomnia have been preferred over the pharmacologic therapy because alternative treatment is natural, hence less side effects are experienced and the individual will be able to have control over his sleep-wake cycle. Nonorthodox, unconventional, alternative, complementary, are a number of terms used to denote non-medical treatment that has been used since early times for a variety of diseases. Complementary and alternative medicine is defined as being identified through a social process as those practices that do not form part of the dominant system for managing health and disease (Kozier, 2004, p.
224). Before considering any therapy, be it alternative or pharmacologic, the individual is advised to consider techniques on promoting rest and sleep. A person who is suffering from insomnia should establish a regular sleep-wake pattern, this means that he should try to go to sleep at the same time everyday and wake up at the same time also. This is to prevent disruptions in the biologic clock (Kozier, 2004). He should also try to eliminate lengthy naps in between sleeps, and if ever necessary should limit this to only thirty minutes per day at the same time everyday (Kozier, 2004).
He should get ample exercise or physical activities during the day to lower stress but this should not be done two hours before bedtime. The individual should also avoid dealing with personal problems or office work before going to sleep and instead should establish a routine before sleep such as reading a book, listening to music or drinking a glass of warm milk (Kozier, 2004). Finally, to establish a sleep pattern the person is asked to only use the bed for sleeping, so that he would associate it with sleep, and that if still not drowsy, pursue some relaxing activity (Kozier, 2004).
The environment also plays a role in helping the individual fall asleep. There should be appropriate lighting, temperature and ventilation as per the person’s desire, noise should be kept to a minimum and if extraneous noise is present, it should be blocked with soft music (Kozier, 2004). With regards to food consumption and diet, the individual should not take a heavy meal 3 hours before bedtime and to decrease fluid intake 2 to 4 hours prior to going to sleep but if it cannot be helped, void before sleeping (Kozier, 2004).
Several drugs can disrupt sleep by delaying its onset, decreasing sleep time, and cause nightmares and should be avoided before sleeping, examples are alcohol, amphetamines, antidepressants, beta-blockers, bronchodilators, caffeine, decongestants, and steroid (Kozier, 2004). Caffeine – containing foods and beverages include coffee, soda, tea and chocolate and should not be taken 4 hours before bedtime. Promoting comfort and relaxation may be helpful.
The individual should wear loose-fitting nightwear, have taken a bath and does not feel sweaty and hot, make sure the bed linen is soft, smooth, clean and dry, and a back massage may be done, which is a type of touch therapy (Kozier, 2004). There are several healing modalities that are being implemented to help alleviate insomnia, and this includes touch therapy, mind-body therapy, and aroma therapy. Touch therapies, which include massage, foot reflexology, acupressure, and reiki, may stimulate the production of healing-promoting chemicals by the immune or limbic system (Kozier, 2004).
Massage assists in relaxation and blood circulation improvement (Kozier, 2004). Physically, it promotes muscle relaxation by helping in release of lactic acid that is formed during strenuous activities and exercise, it improves blood and lymph flow, stretches joints, and helps in body toxin release and immune system stimulation (Kozier, 2004). It also has mental and emotional benefits like anxiety relief and it provides a sense of relaxation and well-being (Kozier, 2004).
There are three kinds of massage strokes, namely effleurage (stroking), friction pressure and petrissage which is kneading or large quick pinches of the skin, subcutaneous tissues and muscles (Kozier, 2004). Mind-body therapies utilize the individual’s focus on realigning or creating balance in mental processed to bring about healing (Kozier, 2004). Progressive relaxation is most helpful in insomnia because it reduces increased level of stress and chronic pain by enabling the individual to wield control over the body’s responses to anxiety and tension (Kozier, 2004).
There are three requisites though, to be able to make use of this technique. There should be correct posture, the person’s mind should be at rest and the environment should be noise free as possible and the technique is to make the individual tense and relax his muscles alternately and then focus attention on the differentiating feelings of each action (Kozier, 2004). This can result to decreased oxygen consumption by decreased metabolism, heart and respiratory rate, and decreased blood pressure (Kozier, 2004).
Aromatherapy, which is defined clinically as the controlled use of essential oils for specific measurable outcomes by Kozier, can be used by massaging into the body, added to water that is used when bathing, inhaled or applied as hot or cold compresses. The oils used in this therapy are distilled from a variety of substances such as flowers, roots, wood resins, leaves, lemon or orange rinds, barks, etc. When inhaled, the oil’s aroma is detected by olfactory receptor cells in our nares.
The stimuli received will travel along the olfactory nerve or the cranial nerve I, the stimuli will then be received by the olfactory bulb and will be sent to the brain. The essential oil aroma is thought to play a role in emotions, memory and a variety of body functions including the heart rate, blood pressure, breathing and immune response (Kozier, 2004). There are 300 essential oils being used and some of these are lavender for headache relief, stress and insomnia, peppermint for nausea relief, aid in respiration an antipyretic, and sandalwood for chapped skin, depression, and stress (Kozier, 2004).
There are also some herbal preparations that can be used for insomnia. Hops and valerian are used to induce sleep by nervous system relaxation, as recommended by the website Holistic online. There are ways by which we can combine both the conventional treatment and the alternative therapies to reduce insomnia. One way is to do the techniques on promoting rest and sleep, while on low-dosed medication. In a way, this might still be useful in eventually lowering and then eliminating drug use while still maintaining a normal sleep-wake pattern.
Although plausible, it is still best advised to not take pharmacologic therapy when necessary. There is to some extent a risk on using sedative-hypnotic drugs, as mentioned earlier. This can cause drug dependency, withdrawal symptoms if stopped abruptly without tapering the dose gradually, and can disrupt the sleep-wake pattern by causing excessive sleep and daytime drowsiness. It should also be noted that these drugs can be expensive and if needed on a daily basis may become a burden to healthcare cost budgets.
The benefit of course is that you will be able to sleep, after a few minutes once the drug is taken. As to the nonpharmacologic treatment suggestions, there are no risks, as long as the person who would want to try out these therapies has an open mind and is willing to subject himself to these procedures. Health wise, the therapies do not present any danger to the individual being subjected to the procedures unless pregnant, has allergies to the essential oils or herbs, has fractures, skin conditions or disease processes.
If the person has insomnia as a symptom to an underlying disease, he should immediately heed the physician’s advice. I do not see alternative treatment as a threat to the medical community, nor a competition. These two have very different procedures and are based on different dogmas that they should not be compared to each other. Although it cannot be helped, people should always be open-minded about these things, because they are at times useful, and have been subjected to numerous tests to be proven safe and effective.
Of course, if one is in doubt of the nature or cause of their insomnia, one should head to the nearest clinic or to the family physician before taking these alternative treatments into consideration. Once there is no underlying pathology, then before taking sleeping pills to make the dilemma go away, nonpharmacologic therapy should and is highly recommended to be done. There is no harm to it, and it might just help. It costs less and can be done right at home without spending gas to go some place else. But if all else fails, then it is suggested to take the sleeping pills as prescribed by the physician.
References Atkinson, R. L. , Atkinson R. C. , Smith E. E. , Bem, D. J. , & Nolen-Koeksema, S. (2000). Hilgard’s Introduction to Psychology. USA: Thomson. Bullock, B. and Henze, R. (2000). Focus on Pathophysiology. Philadelphia: Lippincott Williams & Wilkins. Holistic Online. (1998-2007). Herb and Herbal Therapies. Retrieved January 25, 2008, from http://holisticonline. com/Remedies/Sleep/sleep_insomnia_herbs. htm Kozier, B. Erb, G. , Berman, A. , & Snyder, S. (2004). Fundamentals of Nursing. USA: Pearson Education. .