Welcome to Insomnia and Sleeplessness

It was a very busy day.  I looked at my appointment list, and was surprised to see  Ben (not his real name), a 27 year-old fit young  man, truck driver, was fitted into seeing me-”pain” attached beside his name. 

I saw him a few times for the last few weeks and a few days ago cleared him from workcover for soft tissue injury to his left arm and a sprained neck, after he rolled his truck.  He was very grateful as I gave him 2 weeks off for rehabilitation with the help of competent physiotherapist to manage his injury.

I am usually very quick to respond when dealing with acute pain.  I jumped the queue, and called his name.
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I gave a dirty look to my colleague that night when she turned up about half an hour late to the meeting.  When I went to work earlier than usual the next morning to work, I saw her sitting inside her room staring into space.  Since I had about 15 minutes, I sat down and wanted to have some social chat with her.  “Good morning, gee, we are early today.”  “Swee, my father passed away last night.”  My jaws dropped. “I am so sorry to hear that.”
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A 33 year-old slim cachetic, puffy eyed, strong smell of tabacco lady came in today requesting me to help her to quit her 21-year of marijuana use.  She is spending about $270 per week to buy marijuana.  She wakes up at 6am and the first thing she is does is to smoke her marijuana, until 6pm at night.  She has been having recurrent chest infection, daily sputum production, very tired, but difficulty to fall asleep at night, paranoid and unable to look after her 2 young kids.  She tried to move from where she lived for 3 months and did quit her marijuana, but this causing tremendous withdrawal symptoms and badly treated her children in that 3 months period.  Unfortunately, she reverted to smoking marijuana after 3 months.  She went to see counsellor, psychologist, psychiatrist and hospital, none of the measures helped her. 
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A universal complaint among shiftworkers are difficulties in initiating and maintaining sleep. This leads to related fatigue and mood problems, especially when sleep and work are mismatched to the normal schedule of sleep and activity.

Symptoms include:

1) Insomnia during the major sleep period, or

2) excessive sleepiness during the major waking period (when working nightshift or frequently changing shiftwork).
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Most working class people often built up a sleep debt during the week and tried to catch u on the weekend, leading to the type of lethargy experienced when adjusting to daylight savings.   Therefore, sleeping in on weekend can get the working week off to a bad start. 

According to a research conducted by Professor Leon Lack, psychologist of Flinders University of Adelaide, “The feelings of sleepiness and fatigue the next couple of days were significant in comparison with people who maintained their regular wakeup times on Saturday and Sunday mornings.”

Delayed waking was associated with a 42-minute delay in dim light melatonin onset and an eight-minute increase in time to fall asleep compared to keeping habitual wake-up times.  This is because sleeping in on the weekend people delay the body clock by about 45 minutes.  It is recommended only sleeping in for half and hour on weekends.

The soldiers returning from the war in Iraq may be well physically, however, most people who survived the war are at risk of suffering from post-traumatic stress disorder(PTSD).

PTSD is characterised by the development of a long-lasting anxiety response following a traumatic or catastrophic event.  Typically individual experiences or witnesses a traumatic event such as actual or threatened death, serious injury to oneself or another person, or a threat to the personal intergrity of oneself or others.  The individual’s response involves helplessness, intense fear, or horror. 
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Smokers usually find it hard to quit smoking.  When they try to give up smoking, they often have the craving, anxiety, distress, aggression, disturbed sleep and even depression.

Nicotine replacement therapy in the forms of nicotine patches, chewing gum and inhalers are available for the purpose of smoking cessation.  However, how much is the safety maximum amount of nicotine in our body?
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Bedwetting causes fatigue, disruption to family sleep, stressful event and fear of underlying pathology for parents and adult sufferers.

Nocturnal enuresis impacts the daily life of 61% of children. 1.5% of 13-year-olds and  adolescents rate nocturnal enuresis as significant event in their life. This can persist into adulthood, with 0.5% of adults with nocturnal enuresis, which can be associated with a high incidence of depression, lower self-esteem and sleep disturbances.
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How many sleepless nights do you have worrying about you might be pregnant? A survey in Scotland involving nearly 4000 women found high rates of unplanned pregnancies, even among women who decided to go ahead and have baby.  Other study in Edinburgh hospital involved 2900 women found that only 65% of these women had intended to become pregnant.  Interestingly, only 1% of all the women had used emergency contraception (oral levonorgestrel).  On a study with 900 women attending for abortion, 9 out of 10 of these pregnancies were unintended, yet only 12% of the women had used emergency contraception.
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Sleepless night, burning pain, extreme sensitive touchy skin and  depression are often the common complaints in shingle sufferers.  This is supported by Dr Janet McElhaney, geriatrician from University of British Columbia in Canada, who said that the debilitating effects of postherpetic neuralgia often led to reduced mobility and impacted on family, work and social life, resulting in depression or psychological and cognitive impairment. 

Depression is a common accompaniment of chronic pain syndrome as in shingle sufferers, both need to be treated.  After 10 days of being confined to bed, older people lose 44% of their functional muscle strength and 9% of their muscle mass.