Of all the conditions that make for human efficiency and well being, sleep is one of the most important. A whole array of symptoms may occur when human beings are deprived of sleep, ranging from the obviously increasing fatigue and irritability, to difficulties with concentration and coordination, and delusions and hallucinations.

Although the effects of serious sleep deprivation are not in doubt, it Is difficult to define exactly what normal sleep involves and how much of it we actually need. We probably all know someone who is able to function perfectly well on three or lour hours of sleep, whilst others who sleep for long hours never seem to obtain the maximum benefit from it and always seem to lack energy and vitality. So, how can we try and make sense of this?

Western science has focussed on the brain zones that are involved in day and night rhythm, and on the brain activity, as registered by an EEG (electro-encephalogram), during sleep. This established that there are two different brain wave patterns, identified as REM and nonREM. REM stands for rapid eye movement, indicating a state of absolute relaxation as measured in the body's musculature.

This type of research may establish that an individual is not getting enough REM sleep time. It may even show up low levels of certain neuropeprides (brain chemicals) that are known to induce sleep, such as serotonin and norepinephrine. It will, however, not deliver answers to the question why a person begins to suffer from insomnia, or why there is such a wide gap between the hours and quality of sleep on the one hand and the symptoms displayed by different individuals on the other. But before we delve into the deeper background of sleep disorders and shed some light on the reality behind the obvious, I will give you an overview of the traditional way in which derangements of sleep have been categorised.

Allopathic Classification

Insomnia

This word signifies want of sleep and is used popularly to indicate any impairment in the duration, depth or restorative properties of sleep.

Two classes of insomnia may be defined: one in which there appears to be a primary disturbance of the normal sleep mechanism, the other in which sleep impairment is secondary to another disease or condition.

The term primary insomnia should be reserved for those persons who throughout their lives have never enjoyed restful slumber, and in whom none of the usual symptoms of neurosis, depression, or other psychiatric or medical diseases can be identified.

Sleeplessness is commonly recorded in the histories of patients suffering from psycho-neurosis and psychosis. Illnesses in which anxiety and fear are prominent symptoms usually result in difficulty in falling asleep and light, fitful or intermittent sleep. Also, disturbing dreams are frequent and may awaken the patient.

Disturbances in the transitional period of sleep

As sleep conies on, certain nervous centres may be excited to a burst of insubordinate activity. The result is a sudden start that arouses the incipient sleeper It may involve one or both legs or the trunk, less often the arms.

Sleep palsies

Everyone is familiar with the phenomenon of a leg 'going to sleep'. This is essentially caused by pressure on nerves in superficial places and a similar thing can develop during sleep. This condition usually lasts only a few minutes to hours, but if the compression is prolonged, the nerve may be severely damaged.

Nightmares and night terrors

Awakening in a state of terror has happened to nearly everyone. Children are especially susceptible. Fever disposes to it, as may many other conditions such as indigestion.

Nightmares differ from night terrors only in the greater intensity of the anxiety. In addition there is more vocalisation and motor activity, even to the point of running as if pursued.

Somnambulism and sleep automatism

This condition occurs more often in children than in adults. After being asleep for a time, the patient arises from the bed, walks about the house, and may turn on a light or perform some other familiar act. There is no outward sign of emotion; the eyes are open, and the sleeper is guided by vision. If spoken to, there is no response. Sometimes strange phrases or sentences are muttered over and over again. The following morning there is usually no memory of the episode.

Nocturnal epilepsy

Occasional abnormalities of the brain waves of the type seen in epilepsy tend to occur in epileptic patients during or shortly after the onset of sleep. Not infrequently an individual, subject to grand mal attacks, will have them only at night during sleep.

Nocturnal jerks of the legs are another troublesome symptom because they inter fare with sleep night after night; This condition differs from the restless leg syndrome in that involuntarily movements occur.

In general there are three varieties of wakefulness.

One type is the inability to fall asleep. Individuals affected by this type have become more and more tense during the day and are unable to relax. After about 1 to 3 hours the individual sinks into an exhausted, deep sleep which continues throughout the night. For these patients any fairly quick-acting hypnotic (sleeping tablet) given 15 to 30 minutes before going to bed is useful in inducing and maintaining sleep.

The second type of insomnia is exhibited by patients who are able to go to sleep but who awaken in 2 or 3 hours and lose sleep in the middle of the night. They awaken during the period when sleep normally lightens, and some are alternately awake and asleep all the rest of the night. Often these are sick persons with a debilitating or painful illness which generates more pain and restlessness as muscles relax and leave painful areas unsplinted. In others, fever, sweats, shortness of breath, or other distressful symptoms develop and demand attention. Heavier and longer lasting hypnotics as well as appropriate analgesics (pain killers) are the drugs of choice here.

The third type is seen in patients who go to sleep promptly and sleep well most of the night, only to awaken too early in the morning. Most of these individuals are older persons who turn night into day. In this category also fall those individuals who are under great tension, worry or anxiety, or are overworked and exhausted. Heavy hypnotics and barbiturates are the drugs mostly used for this condition.

Allopathic Summary

1.     In almost all insomnia eases there is a whole list of Other symptoms or conditions.
2.     Treatment is aimed at numbing the brain during the specific time of the night one is awake.
3.     There is no definition of what constitutes insomnia.

Sleeping, and more specifically, a total rest period has everything to do with the rhythm of night and day. As the day turns into night, the diurnal animals get ready for bed. Their internal clock is winding down and allows them to relax and eventually to fall asleep. This happens because their internal clock is attuned with the natural energies on which they feel, and the evening has a lower energising effect than noon. There is less and less activity, a growing tiredness and weariness, and an internal tendency to have a rest.

The relationship between the kinds of sleep we are having and the way we feel afterwards is obviously more connected to the quality of sleep than to the number of hours we sleep. The fact that some people are perfectly all right with hardly any sleep at all and others are struggling with even more than a fair share of sleeping hours is indicative of an important individual factor. In other words, numbers and averages are no help to any individual who wants to understand why he or she personality does not feel rested in the morning.

In ancient cultures it has always been known that insomnia is the most typical sign of nervous distress. The ancients considered nerve impulses to be a kind of air traveling through the body, an energy that moves through the brain and the nerves, controlling both voluntary and involuntary functions. Derangements of this 'air' flow always involve some weakness, disturbance or hypersensitivity of the nervous system. Furthermore, nervous system disorders are also linked with mental disorders; the mind and nerves are directly connected to each other, Symptoms that relate to mind disturbances are linked to physical ailments, which include malfunctioning of the nervous system. As causes for insomnia they list stress, anxiety, excessive thinking, taking drugs (prescription or others) or stimulants (coffee, tea. sugar), too much travel, and overwork. These are the more specific causes, which should he added to the more general ones of malnutrition and poor digestion, inappropriate diet for one's constitution, lack of emotional nourishment, lack of routine in life, and frequent exposure to cold.

General Treatment

First of all, let me stress that all treatment should be individually adjusted, just remember that no two people are the same and therefore it does not make any sense that everyone should have exactly the same treatment. However, we can outline the main direction a therapy approach for insomnia will rake for most people.

• Diet should emphasise heavy nourishing foods, which include fresh dairy (full fat), whole grains and root vegetables. Coffee, tea and other stimulants, including stimulant herbs such as ginseng, chilies, turmeric, should be avoided. Warm milk with a little nutmeg can be taken an hour before sleep.
• Mental activity should be avoided in the evening, including leading, listening to loud music, watching stimulating films, etc. Sleep hours should be readjusted, so that one retires early (around 10pm) and rises early (by 6am).
• Warm sesame oil can he applied to the feet, the top of the head or forehead, or to the whole body, followed by a warm shower.
• Yoga or Tai Chi should be practised, but no aerobic exercises should be done. Release all your worries and tensions of the day before going to sleep. The bed and the sleeping room should be a place of peace, comfortable, clean and well kept. Calming breathing exercises can be practised at the time of going to sleep.
• Western herbs that are useful for insomnia are valerian, skullcap, hops, passionflower and camomile. One or two teaspoons of valerian powder in a cup of warm water is usually effective in mild conditions. Skullcap and other cooling nerviness are more helpful taken with the warmer ones, nutmeg or valerian, as their cold and light nature can aggravate the already existing imbalances.

There is no easy answer and there is no magic pill to ward off the ill-effects of insomnia. As it is one symptom out of a whole collection indicating an imbalance in the way we live our lives, the only real long-term answer lies in making those all-important changes to our life style. It is only then that the system is allowed to change its habits. TT

© Patrick Quanten MD Independent Health Adviser

Reproduced with the kind permission of Today's Therapist