Many people suffer from sleep disorders that can range from insomnia to sleepwalking. However, there is a cure for each depending on its cause, which could either be a medical problem or a psychological one or both. "The number of sleeping hours a person gets differs from one person to another," comments Ahmed Ghareeb, a sleep consultant. "The average number of hours of sleep a person should get, as agreed on by scientists, is from six to eight hours," he adds, saying that some people could be satisfied with only four hours of sleep while others need ten. Children may sleep for 12 to 16 hours per day as they are in a phase of growth. Ghareeb says that a sleep disorder is easy to discover, if, for instance, a person has trouble going to sleep. "This is called insomnia, which is a disorder that many people suffer from. The problem of insomnia patients is that they go to bed but can stay awake for hours and are unable to start sleeping. An insomnia patient may suffer from exhaustion or even depression as a result. The main causes are stress and anxiety," he said. Other types of sleep disorder include jet lag if a person travels a lot and changes his or her biological rhythm, or a hereditary sleep disorder like the lack of some substances that initiate sleep. This usually appears from a young age. A child could have trouble at school simply because he has a sleep disorder. Another type of sleep disorder is when a person sleeps well but is still sleepy when he wakes up and has a tendency to sleep during the day, Ghareeb adds. illustration: Rana Amin "One of the most common sleep disorders is sleep apnea that adults, especially women aged from 40 to 50 years, suffer from. Its symptoms include snoring and in some cases intermittent breathing. A patient wakes up with a headache without getting much sleep, and this translates into exhaustion and nervousness during the day," he said, adding that factors that increase these symptoms include obesity and drinking alcohol, which weakens the muscles responsible for breathing. The most important thing is for people to discover their problem and try to solve it with a psychologist, says Ghareeb. In some cases, a patient might suffer from both a psychological and a physical condition that is preventing him from sleeping. "For instance, a person could be suffering from diabetes or hypertension and stress at work that makes him unable to sleep well," Ghareeb said. "We often see patients who struggle to sleep," commented clinical psychologist Nermin Hani, who is also an insomnia, anxiety, depression and post-traumatic stress disorder therapist. "A patient could be suffering from insomnia, but not know what his problem is. He either doesn't sleep at all, or he sleeps for intermittent hours, or he sleeps for a few hours, or sleeps for sufficient hours, but his sleep quality is not good," she said. Sleep clinics are not the first thing such a patient might resort to, trying other things like self-medication or watching television first. "To find out whether a patient suffers from a sleep disorder, we conduct a polysomnography sleep study in which we see everything that occurs during a patient's sleep. We see if the brain is sleeping well by doing an electro-encephalogram on a patient," says Ghareeb, who adds that a patient's breathing and motion is also monitored. "There is usually some starting point," Hani said. "For instance, I might ask a patient when the last time he was happy with his slee. He might answer 'before I went to university,' so I discover that he has a social phobia about meeting new people and as a result he has started to be worried and to develop insomnia symptoms." Sleepwalking and nightmares are categorised as parasomnia sleep disorders, which are mostly seen in children. Sleep is divided into two phases, non-rapid eye movement (REM) sleep and REM sleep. In adults, there is a REM sleep behavioural disorder in which people might shout out while sleeping. Such disorders are a result of hormonal imbalances, and they can be treated by suppressing the REM sleep, Ghareeb said. However, according to Hani more than 90 per cent of insomnia patients have a psychological problem. "When a patient comes to see me, I give him a short psycho-education course about sleep and I educate him about his problem since he mostly does not understand it. For instance, some patients at first resort to a magnetic resonance imaging test or a cardiogram because they suspect that they have a physical disease that is depriving them of sleep," she commented. "Then I start working with the patient and provide him with a comprehensive programme that targets behaviour, this accounting for 40 per cent of the problem. If for instance the problem started because of an exam he was worried about or because of the death of someone dear, it starts to be persistent. So, the first thing I do is to change his behaviour. Then we start cognitive behavioural therapy in depth, and the last session is prevention in which I teach him the factors that have cured his problem," she said. She gives patients guidelines to help them to maintain a healthy lifestyle and adds a practical example of one of her patients who managed to get rid of insomnia. "He had been suffering from insomnia for five years, but after two sessions he started to improve," she said. "During these sessions, we are trying to change the persistent ideas of our patients, like if they sleep for 10 to 12 hours this is good quality sleep, which is not necessarily true." Ghareeb says that seeking the cause of such problems is the key to curing them. "Treatment differs and depends on the cause. If a patient suffers from sleep apnea, for example, the most important thing is to attack the cause. If the problem is physical, he should follow a strict diet, exercise regularly and go to bed at regular hours. He should follow what is called 'sleep hygiene,'" he said. There are also mechanical solutions for severe apnea conditions like a device called a continuous positive airway pressure (C-PAP) device and a mandibular advancement device for less severe conditions. "n some cases, sleeping pills are prescribed by neurologists to help a patient start sleeping," says Ghareeb, adding that they may take time to work. Other patients may need pills that decrease nervousness. "In general, people should maintain a healthy lifestyle that includes sleeping and waking up early, eating healthily and avoiding alcohol and caffeine in the evening. These things will help to cure insomnia." "Intervention for a short sleeper who has been through a traumatic experience is composed of two steps to cure the trauma (a long-term intervention) and to cure the insomnia (a short-term intervention)," added Hani. "A long sleeper sleeps under any condition, whether he is upset or happy, since his coping mechanism makes him behave like that. A normal person sleeps to live; he does not live to sleep," she adds. "In Egypt, people tend to sacrifice sleep. They do not give it priority, which is bad because sleep is the key to many physical and psychological benefits. For instance, a person who wants to lose weight or wants to focus more should sleep better. Someone who has mild depression or anxiety symptoms should also sleep better because there are stages of sleep a person must go through to help to regulate his feelings," she concluded. Tips for good quality sleep Try to sleep at regular hours every day and to sleep early and to wake up early. Keep away from stressful situations and remember the proverb about "a healthy mind in a healthy body." Eat regular meals and eat in moderation. Do not eat directly before sleeping to avoid gastroesophageal reflux disorder, which increases breathing pauses during sleep. Exercise regularly, preferably in the morning or afternoon, not directly before sleep. Stay away from smoking and alcohol. Use tea and coffee in moderation in the morning, not in the evening, because they can cause hormonal imbalances. Insomnia patients should drink anise instead. Sleep in a dark or dimly lighted room to enable your body to rest and renew itself. Avoid looking at your mobiles before sleeping because it will make you alert. Priority should be for sleeping as much as your body needs and not only for a set number of hours.
*A version of this article appears in print in the 26 August, 2021 edition of Al-Ahram Weekly
