Do You have a Sleeping Problem? The few times I have experienced insomnia, it certainly wasn’t fun at all and left me drained the following day. On a Brown bear hunt on the peninsula of Alaska a good while ago, I had the fortunate blessing to be able to harvest a true 9’10’’ behemoth. After all the exhilaration began to subside and the picture taking was over the issue at hand started to settle in. The obvious fact was that we would be skinning him right there where he lay in the stream he fell in as we couldn’t move him. The next sobering thought was when my guide, Tim, informed me that spending the extra hour taking every ounce of flesh off the hide and skull would prove to worth every second spent doing it. The trip back to camp was a steady steep climb back up the mountain that formed one side of the Kejuliak basin. It took us the better part of 2 ½ hours to run down it as fast we could in good daylight and the light was fading fast. Well to make a long story short it took over 11 hours to pack all our gear, the wet hide and skull back to camp. We frequently took turns swapping out the nearly 200 pound pack with the bear in it and the other pack with all of our gear, rifles and emergency equipment in it till we finally stumbled in to camp and just collapsed from sheer exhaustion. That was the first time I was ever too tired to eat and experienced being to tired to be able to get to sleep. I had heard about it but never thought it was a reality. Well, Tim and I stared at the top of the condensation soaked tent from our sleeping bags all night long, totally exhausted and not able to fall a sleep. We finally passed into a coma as the sun started coming up the next morning. After we finally awoke, we dragged around badly the rest of the day and it took a good night sleep to get back to near normal. That was just one night so I can only imagine how one feels if they suffer from insomnia with any degree of chronicity. We see and treat a lot of patients in the office with this complaint so it is a very common disorder. You are certainly not alone if you experience this problem with any degree of regularity. It can really affect your life but unfortunately a lot of people that suffer from it learn to live with it and really don’t know how much better they would feel if that problem was alleviated. Insomnia can be broken down into two kinds right off the bat. The first is when folks have problems getting to sleep. Treatment if needed is relatively easy as a short acting sedative of some sort is usually sufficient. All the over the counter sleep aid preparations just contain Benadryl which makes most people sleepy as a side effect and lasts 4 to 6 hours so it is marketed exploiting that side effect. However, it does not work on everyone and in some, actually makes things worse. Most of the older prescription medications were some type of short acting sedatives that was gone in two hours or so. The reason they need to be short acting is the fact that sedatives disrupt your dream cycle, the REM sleep stage, and although you could be technically a sleep you certainly will not wake up rested. Rather, you will feel like you have a hang over the next morning. This type of insomnia is why a lot of suffers have a night cap before retiring, gaining the same type of result as the medications. But it often requires larger amounts of alcohol to obtain the same effect if used nightly so this isn’t the best thing to do every evening. The second type of insomnia is where one can get to sleep but wakes up in a short period of time and can’t get back to sleep or wakes up frequently. This was a little more difficult to treat in the past, than it is now because of the same reason as given above. You must maintain the integrity of your REM sleep or you will quickly become a walking zombie. So that meant all long acting sedatives were a no-no. We only had a few options that could be taken safely for long periods of time without causing any addictive problems. Benadryl was again, high on the list. Now though, some of the leading pharmaceutical companies have developed very safe and effective medications that can be taken long term if needed and actually treat both types of insomnia making our jobs as doctors much easier. Everyone reading this has heard of Ambien, and the newest one is Lunesta. There is also a new type of medication called Rozerem which is a non-sedative melatonin receptor stimulator. These prescription medications do their job very well with minimal side effects. There are positives and negatives to each of these and a frank discussion with your doctor that includes rebound and dependence is in order prior to initiating treatment. Of course there are numerous other factors and causes of insomnia that need to be considered, modified and/or treated before medications as those listed above are prescribed. First in line to consider is the ingestion of caffeine related products or other stimulants late in the day or prior to bedtime. This includes some of the weight loss medications and ADD treatment meds. Large intakes of fluids before retiring promises having to get up sometime prior than anticipated. Also for those men who have to get up three or more times at night to urinate, you should be evaluated for benign prostatic hypertrophy (BPH) as the etiology of your frequent night time arousals. Another common cause that we see is when those lucky enough to lead leisurely lives take mid-day naps and thus really don’t need a normal amount of sleep at night so early morning awakenings are common and frankly expected. Also, those that lead very sedentary lives also tend to have many fold more problems with their sleep architecture so regular aerobic exercise is in order. Lastly, there are a whole host of medical conditions that are classified as sleeping disorders such as Obstructive Sleep Apnea, Sleep Disorder Breathing, Restless Leg Syndrome and Periodic Limb Movement Disorder just to name a few. Basically, if your spouse says you stop breathing while you sleep, you snore like a freight train which causes him/her to change bedrooms or you chronically flail your legs around when falling or while asleep, you most likely need to evaluated by a certified pulmonologist that specializes in sleep medicine. They will order a sleep study for you that will give them the correct diagnosis which will lead to an effective remedy. The test is painless but requires that you spend one night in a sleep lab hooked up to their monitoring equipment. We are writing this article while on a 18 hour flight back from Africa so Jetlag is trying to take it’s affect, although unsuccessfully, but that is another article which we will get too. We hope this has helped some of you to understand the issues around insomnia and give you some direction on how to combat it. As usual be safe and enjoy the outdoors.