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CAN’T SLEEP: How many of us have had sleepless nights due to bouts of insomnia, sleep apnea or other problems?
iStock photo CAN’T SLEEP: How many of us have had sleepless nights due to bouts of insomnia, sleep apnea or other problems?

Most of us have had times in our life when, for some reason, you just can’t sleep.

Sleep deprivation and disorders are more common than we realize and are triggered by a variety of physical, mental and emotional factors.

One of the most important things you can do to prevent such disorders is to make sure you go to bed at a similar time each night, and wake up at a regular time in the morning.

Determine how many hours of sleep you need each night, as everyone is different.

Also avoid stimulants such as caffeine, alcohol or exercise close to bedtime and make sure your environment is conducive to sleep — away from light and noise, for example.


Dr Keith Chiappa, chief of medicine and a neurologist at Bermuda Hospitals Board, said: “It’s important to realize that everyone has an amount of sleep time they need in order to be at their best performance during the day.

“It’s not the same for everyone and usually varies between six and eight hours. Some people can do well on six hours while others need eight hours.

“The important thing about sleep is to try to keep it on as regular a cycle as possible. Everyone does better if they go to sleep at a similar time each night and then get up at the same time in the morning.

“It may be best for you to go to bed at 11pm and get up at 5am, but if you don’t feel at your best then maybe that’s not enough, so try getting up later such as at 6am or 6:30am. Learn what works for you and try to stick with it.”

Dr Chiappa said: “Sleep deprivation is a very general term and has many different causes. For some reason a person doesn’t get enough sleep, or they go to sleep at the wrong time and then can’t sleep.

“You might not sleep for a variety of reasons. It could be the environment, your partner may snore, or you may have a sleep disorder.

“You may have factors in your life which keep you up at night, such as a new baby or an elderly parent you are looking after. There are lots of different reasons from medical to social, why people are sleep deprived.

“There are many different causes of insomnia. You may have things happening in your life which you think about and which keep you awake, or you could be in physical pain from a disease or injury.

“Sometimes people take caffeine or alcohol at the end of the day, and they can interfere with your sleep.

“Or people may get over-stimulated too close to going to bed, for example, by exercising late.

“Eating a heavy meal late at night can also keep you awake, or perhaps it’s too noisy or there’s too much light in the room.

“Certainly, any emotional or other stress can keep you awake, as your mind thinks about different things.”

Dr Chiappa researched the human sleep cycle for his 1987 book The Eeg (electroencephalogram) of Drowsiness.

He said: “Falling asleep is a complicated process as there is a centre in the brain stem which has access to all the thinking areas. Not far from the centre, which keeps us awake, is the part which controls our circadian (biological) rhythms.

“For example, if you put people in a cave with no clues to the passage of time in the outside world, then people will go into a 24-hour cycle of being active and asleep.

“So there’s a timekeeper in our bodies. When it becomes time to sleep, it shuts down the part of our brain that keeps us awake and ramps up the centre that controls sleep.

“In between we are drowsy. All of these phases can be accurately recorded with brainwave recordings.”

Anyone who has trouble sleeping should see a doctor before it becomes a more serious medical problem.

“Sleep deprivation is connected to chronic health problems such as hypertension, kidney and heart disease, and depression,” said Dr Chiappa.

“Prolonged excessive blood pressure (hypertension) can damage the kidneys, heart and brain. It can be a major contributor to heart attacks and strokes.

“Chronic sleep deficiency is also related to obesity, depression and diabetes.

“In the short-term, sleep deprivation affects mood, performance and concentration, increases irritability and anxiety.

“Neurologists are often the first person a patient will see with a sleep disorder. They can examine the patient and send them on.

“At BHB right now we have no sleep disorder specialists, so if a physician identifies a person as needing further investigation for a sleep disorder, we will refer them overseas.

“But first of all, if someone complains of problems sleeping or excessive daytime sleepiness, we will probe a little further with questions, looking for contributing factors.

“Depending on the results we may then refer the patient on for further evaluation.

“If someone was overweight with a history of excessive snoring then they may have disruptive sleep apnea.

“Breathing problems during sleep can lead to high blood pressure, heart disease, depression and diabetes, so the primary care physician should always be aware of the role which sleep disorders can play in these diseases.

“If a patient already has a problem with hypertension, sleep apnea will only make this worse and harder to treat.”

Dr Chiappa said the scale of the problem of sleeping disorders in Bermuda was contingent on other health problems.


“At the first level it’s probably average but at the second level, Bermuda has an obesity epidemic which leads to diabetes and hypertension,” he said.

“Diabetes is one of the major causes of disruptive sleep apnea. This condition is caused because the muscles at the back of the throat relax as your sleep. The tissue at the back of the mouth then falls into the breathing passages.

“It’s that obstruction to breathing that we hear as snoring. So someone who is overweight is more likely to have this problem.

“There are two ENT (Ear, Nose and Throat) surgeons on the island who can help with sleep disorders such as this — Dr Robert Vallis and Dr Wesley Miller.

“Sleep apnea is first assessed by CPAP
(Continuous Positive Airway Pressure). This involves wearing a tight-fitting mask while you are asleep. A machine by the bed raises the air pressure in the mouth, helping to keep the airways open. It’s a non-invasive treatment which works well.

“Sometimes a simple procedure like people learning to sleep on their side can also be helpful.

“If none of these work then surgery then may be considered, to remove tissue from the back of the throat.”

Dr Chiappa said: “At BHB we’ve been trying to set up a sleep clinic but there’s been some start-up problems which we haven’t been able to solve yet, so we are presently referring people overseas. The clinic is a work in progress.

“I don’t have any specific natural remedies I can recommend for sleep disorders.

“Drugs, such as sleeping pills, may be used as a short-term solution with insomnia as they may work for a short period of time, but eventually they lose their effectiveness.

“So it is always best to diagnose the cause of insomnia and to treat the cause.

“Sleep disorders need to be diagnosed and then followed up with the appropriate treatment.

“For example, if someone is over-stimulating themselves with caffeine or alcohol at night then it doesn’t make sense to treat that with a sleeping pill.”