INSOMNIA...ITS A BITCH...

I so need to have the above T-shirt!!  Lately, I've been having trouble sleeping.  Working the night shift has never been a problem because I don't function before 3pm, anyway. What does my opening sentence have to do with the other?  Seems a little random, huh?  Some people can't work nights because they just don't sleep during the day.  I am not one of those people and usually have no trouble sleeping once my head hits the pillow.

Lately, that has changed.  Probably due to the extra stresses in my life.  Well, there's no probably about it!!  I know my sleepless days are related to my stress.  As a medical professional, I have tried all of the reasonable non-pharmacological tricks of trying to stay asleep--like no caffeine after 3 am, for instance--but to no avail.

Next, I tried some simple over the counter stuff ie, benadryl or a mixture of melatonin & ginger root--but to no avail.

So, what's next?  Prescription sleep aids?  I tend to shy away from meds.  I just don't like to swallow pills.  Don't tell anyone, but I'm the biggest weeny on the face of the earth when it comes to taking pills or getting shots.  When I hand a patient a cup full of meds and he/she swallows them down like a smooth shot of bourbon I actually want to gag.  Ewww! 

Lord help me if I ever require medication to survive, because I will be one of those "non compliant" patients I sometimes read about simply because I forget to take the medication.  Oh, I start out okay...I may remember to take my vitamin or an antibiotic for the first couple of days...then I just forget.  

But...I digress.  Sorry.  Where was I going with this?  Oh, the insomnia!  See?  It's affecting me already! LOL.  But seriously, I thought I would actually look up insomnia and see what else I could do about it before making that doctor's appointment to see if he will give me a sleeping pill.  So, I thought I would share with you what I found out. Hope this helps anyone going through what I'm going through.

According to Google Health, Insomnia is defined as:

--difficulty getting to sleep or staying asleep, or having non refreshing sleep for at least 1 month.Okay, so that said, I've learned that insomnia is often caused by one of the following:



Stress
 
Anxiety
 
Depression
 
Medication
 
Caffeine
 
Nicotine
 
Alcohol
 
Certain medical conditions (like lung disease, congestive heart failure, diabetes, or arthritis)
 
Change in your work environment/schedule
 
Poor sleep habits. This is an interesting one because I learned that habits that help promote good sleep are called "sleep hygiene." Poor sleep hygiene includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of your bed for activities other than sleep or sex.
 
'Learned' insomnia. This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they're away from their usual sleep environment or when they don't try to sleep, such as when they're watching TV or reading.
 
Eating too much late in the evening.
 
After reviewing the causes for insomnia, I realized that stress may not be my only reason for not sleeping.  I also am guilty of "poor sleep hygiene" because I do have irregular sleep habits because of my work schedule which consists of 60 hour work weeks of 7pm to 7am shifts.  Caffeine could be aggravating things, too.  I have been drinking more coffee...
 
Google Health recommends the following to help treat insomnia:
 
~Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and rising time — promotes sound sleep and daytime alertness.  (Or, in my case, I hope it will promote nighttime alertness). If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.
 
~Behavior therapies~  



Behavioral treatments teach you new sleep behaviors and ways to make your sleeping environment more conducive to sleep. Studies have shown behavior therapies are equally or more effective than  chugging down sleeping pills. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.


Behavior therapies include:

■Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.


■Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.  Sounds cool, huh?  I wondered as I read about this how hard these techniques are to learn...


■Cognitive therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive therapy can be taught through one-on-one counseling or in group sessions.


■'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.  Okay...I can do that! LOL


■Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.


■Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside for 30 minutes or obtain light via a medical-grade light box.


***Medications***


Taking prescription sleeping pills, such as Ambien,  Lunesta, Sonata or Rozerem, also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep.  And believe me when I say, people who are not used to taking sleepers and get one while in the hospital do some pretty strange things...Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems. 

Infact, I had this argument with a doctor the other night who wanted to order my elderly patient something to sleep and I told him he was welcome to order it, but I wouldn't be giving the medication unless the patient already took it at home.  It has been my experience that elderly patients have a higher risk of being harmed when they take sleepers in the hospital which leads to agitation, increased confusion and higher risks of harm by falling.  Below is a simplified kind of cheesy photo, but what it doesn't show~Like a patient in an ICU may have a lot of IV's and most definitely a foley catheter in his bladder.  So, the blood and urine is usually all over the place!  Not a pretty sight, and definitely not fun cleaning the mess up. 

He looked at me and said, "Well, I hope you are never my nurse."  And I replied, "You'd rather I pump you full of meds that could cognitively impair your judgement to the point of where you don't know where you are, you rip out your IV and foley catheter because you don't know why they are in place.  Then you bleed all over and pee all over...And I have to change your sheets and give you a bath?  Not to mention, put the IV's and foley back in place!"  He grimaced and said, "I see your point."

Tee hee....Nurses are always right!!!!   We just let the doctors think they are!  LOL


Now I would be remiss if I didn't advise you that doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use.

If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone, doxepin or Remeron.

Over-the-counter sleep aids contain antihistamines that can induce drowsiness. But antihistamines may reduce the quality of your sleep, and they can cause side effects such as daytime sleepiness, dry mouth and blurred vision.

I'm so glad I decided to do this post...cuz as a good nurse often does, I'm going to fix myself and save the $15 copay to my primary care physician (whom I've been meaning to change--but since I hardly ever go to him, I haven't bothered).


I know I need to do the following:

Cut down on my coffee and energy drink intake...


Regulate my sleep habits, so the pattern is more regular and not so interrupted...

And increase my daily exercise routine so that I can relieve my stress.

And, I'm definitely going to try some of those behavioral therapies listed above...

Happy Thursday! Only two more days before Christmas!!

Signing off with a funny "beefcake" pic today...
Kathleen