Health & Fitness

Don’t allow anxiety to keep you awake all night


Fear of the unknown can keep you from sleep. FILE PHOTO | NMG

Qn: “I am unable to sleep well in my own house. I even changed my bedding and roof lighting but that does not seem to work yet I sleep so well in hotel rooms whenever I am out for business travels. What could be the problem?”

You do not give us enough information for us to begin to answer your question with confidence! If, for example, your home is next to a noisy road, or nightclub, then it is hardly surprising that away from all the noise, you are able to sleep. If, on the other hand, you have a bed that is either too hard (or too soft) for good sleep then no wonder, you sleep better elsewhere. Before seeking help for this problem, it is critical for you to examine the environment that you sleep in. minor adjustments to the bedroom, bed, or even the clothes you wear (or don’t wear!) might hold the key as to how you sleep.

We once saw a man who on the surface had a problem very similar to yours. At home he had serious problems falling off to sleep.

When he travelled on business (away from his wife) he was able to drink alcohol and he could sleep with ease. This situation was resolved when he travelled on a business trip with his wife. She did not allow him to drink, and so he did not sleep. The only reason the man slept was because of the alcohol.

When they presented this problem to the doctor, it turned out that the young man had an anxiety problem that had not been diagnosed and for which he was self-medicating with alcohol. Indeed, when he was eventually treated, the need for frequent trips out of town were much reduced.

In the course of the evaluation, the young travelling man was diagnosed with a generalized anxiety disorder. He had presented features of the condition which included fatigue, light headedness, irritability and a sense of heightened vigilance for things around him. He later explained that he had the sense of always being on an adrenaline rush. He was always afraid that something terrible was about to happen to him or the family and his heart rate was high all the time, with rapid and often shallow breathing. All his muscles felt tight, a fact that later explained the frequent “tension” headaches, backache and the classical “pain in the neck”. This set of symptoms enabled the doctor to arrive at the clinical diagnosis of Generalised Anxiety Disorder (GAD).

Like you, he had problems falling off to sleep and many thoughts raced through his mind, all related to fear of the unknown. When out of town, a few tots of whisky sent him to dreamland. In his inexperienced mind, the problem was the bed at home.

Following the diagnosis, he felt much relief and a treatment programme was put in place. There were a number of components to the therapy. The first involved a detailed account of his past history, including that of his parents and siblings and extended family. From the history, it became clear that a number of his family members had suffered similar symptoms and some had even gone on to abuse alcohol and had been to rehabilitation centres. One relative had died in a road accident while drunk and another was stabbed in a bar. The genetics of Generalized Anxiety Disorder and the complications that included insomnia and alcohol abuse led the young man to understand that he was not “a weak boy”. It is often said by patients that the act of giving him a “rational diagnosis” is most liberating! Doctors sometimes fail to understand how important this step (of explaining the diagnosis) is to the patient.

The second level of intervention included sessions of Cognitive Behavioural Therapy (CBT). Here, the young man was taken through sessions of self-examination and evaluation. He learnt about his thoughts and how thoughts and feelings follow each other.

He learnt how negative thoughts about the self could lead to negative self-image. In the end he learnt about personal rights including the right to receive care and to be happy. The young man was surprised that the thoughts in his head could have a direct impact on how he felt and behaved. Another level of liberation!

Medication was the third part of his management plan. During the period of treatment, the doctor regulated the medication and in the end he was well! We know that in the practice of mental health care, it is the combination of talking therapies and medication that works best in many conditions.