Insomnia

Everyone experiences restless nights from time to time, nights when sleep is elusive. This is normal. But, when a person can’t sleep night after night and the lack of sleep prevents the person from functioning properly during the day, it is a problem and is called insomnia. The severity of the insomnia is assessed with regard to the symptoms experienced during the day, and not with regard to what happens-or-not during the night. Thus insomnia cannot be measured in terms of hours of sleep. If the person has no symptoms during the day, then the lack of sleep is just fine. All of us have our own needs when it comes to sleep. While some of us require at least 8 hours of sleep, others get along just fine on 4. Usually as people age they need less and less sleep. Typically, the perception of not having slept all night is due to frequent awakenings rather than a real lack of sleep. Insomnia has many possible causes including acute stress, a change in the environment, illness, cramps, strong emotion, jetlag, and a frequent need to urinate. In most cases, the cause of insomnia can be established and dealt with.

Types of insomnia:

Temporary insomnia

Lasts a few days; usually caused by normal life stress or illness.

Short-term insomnia

Lasts from a few weeks to a month or two; usually caused by severe stress, such as the death of a loved one, divorce, or job loss.

Chronic insomnia

Also called long-term insomnia, may last several months or even years. Most often caused by depression, but also by substance abuse (alcohol, stimulant drugs), or certain chronic illnesses, such as chronic pain.

TRUE OR FALSE

Everyone needs 8 hours of sleep.

FALSE. Many adults need only 4 to 6 hours of sleep a night, while others need 10. When calculating how much sleep you are getting, do not forget to include naps.

Insomniacs have difficulty falling asleep.

SOMETIMES. Some people have difficulty falling asleep, some have frequent sleep interruptions during the night, and others just wake up too early in the morning. Only when the person has difficulty functioning properly during the day can this be called insomnia.

People should try to sleep for a longer period when they want to catch up on their sleep.

FALSE. There is no way to catch up on lost sleep. The purpose of sleep is to regenerate and repair. There is nothing to gain by sleeping more than 10 to 12 hours at a time. In fact, sleep that lasts more than 12 hours is usually less effective. It is better to get up and take a nap during the day, if necessary, than to sleep more than 12 hours.

Tips for beating insomnia.

Here are a few suggestions to help you sleep better:
  • drink a glass of warm milk before going to bed;
  • exercise regularly but not late in the evening;
  • engage in relaxing activities, such as reading or listening to music, prior to bedtime;
  • make the bedroom quiet, dark, and comfortable;
  • go to bed only when tired;
  • wear a mask or use earplugs;
  • do not stay in bed if you can’t fall asleep;
  • go to bed and get up at about the same time every day;
  • adopt a simple bedtime routine to prepare for sleep;
  • avoid alcohol before bedtime;
  • avoid caffeine or other stimulants in the evening;
  • avoid daytime naps. If necessary, nap for no more than 30 minutes, early in the afternoon;
  • eat lightly before going to bed;
  • check with your pharmacist to determine if your medication is the source of your sleep problems.
All of these measures can help you fall asleep. Some of them may appeal more to you than others. As a last resort, you can always count sheep: this monotonous task occupies the brain and can help get rid of unpleasant thoughts.

Sleep Medication

While there are several drugs (hypnotics) that can help you find sleep, these agents cannot fix the root of the problem. Some hypnotics and relaxation products (tablets or herbal tea) are available without a prescription. They promote relaxation but do not necessarily induce sleep. They are usually not recommended because they tend to disrupt sleep patterns. The most effective and safe products are available with a prescription. They are used over short periods of time and the smallest possible dose is prescribed. They are safe and effective for occasional use only. Sleep aids should not be used every night and for prolonged periods (more than 3 weeks). They are useful only when the problem is temporary. For chronic insomnia, the first step is to investigate for the cause. Meanwhile, you may need to learn some relaxation techniques, start an exercise program, but avoid using sleep aids excessively

Macular Degeneration

Macular degeneration is an eye disease that usually strikes older adults. It affects more than one million Canadians and is the leading cause of vision loss in the elderly. The inside of the eye is lined with a light-sensitive membrane called the retina. The retina consists of specialized cells that detect colour and contrast. The macula is a small area at the centre of the retina responsible for central vision and fine detail vision. As its name implies, macular degeneration involves the deterioration of the macula. This leads to blurred central vision and can make certain activities such as reading and driving impossible. Although the disease can severely damage vision, it rarely leads to complete blindness since it does not affect peripheral vision (aroud the center). Persons with macular degeneration could, for example, see the numbers on a clock, but would be unable to distinguish the hands. There are two forms of macular degeneration: Dry Dry macular degeneration is the most common form and accounts for 80 to 90% of all cases. The loss of central vision is gradual and occurs over several years. It is often the result of a thinning of the macula or pigment deposits (coloration) on the macula. Wet Although less common, wet macular degeneration is characterized by the sudden and severe loss of central vision. In this case, abnormal blood vessels develop under the macula. The vessels then leak fluid or blood which partially destroys the light-sensitive cells in the macula. The macula can heal itself but scar tissue forms on the macula creating a black spot or “blind spot”.

Persons at Risk

Macular degeneration is associated with the normal aging process. That being said, any person over the age of 50 years, particularly women, are “at risk”. Other risk factors include family history of macular degeneration, diabetes, high blood cholesterol, hypertension, eye disease and smoking.

Symptoms

The symptoms associated with macular degeneration are limited to vision. Initially, the disease only affects one eye. This can delay diagnosis since the healthy eye generally compensates for the loss of vision in the affected eye. This can go on for several years before both eyes are finally affected. There is no pain associated with macular degeneration. The most common symptoms are:
  • blurred, washed out central vision
  • drop in sharpness
  • reduced colour perception
  • blind spot or black spot in the centre of the visual field
  • difficulty seeing far · straight lines that look wavy or distorted (wet form)

Diagnosis

It is recommended that all those over 50 years of age go for an eye examination at least once every two years. Screening for macular degeneration can be done by an optometrist or an ophthalmologist. If detected early, it is possible to slow the progress of the disease and even stop it in the case of the wet form of the disease. Two tests are commonly used to diagnose macular degeneration. The first one, known as the Amsler grid, is used to assess whether straight lines are distorted and if there is a blind spot or black spots in the field of vision. This test can also be used for follow-up purposes (see Amsler Grid published by Vigilance Santé). The second test is an examination called ophthalmoscopy. This test involves the use of eye drops to dilate the pupil which allows the specialist to examine the interior of the eye.

Treatment

There is currently no treatment available to restore lost visual acuity (sensitivity). Medications may be taken to slow the progress of macular degeneration. Taking certain vitamins and minerals also seems to slow the progression of the disease. Additionally, laser surgery can stop the progression of wet macular degeneration. Otherwise, individuals with this eye disease must learn to live with limited vision. There are vision rehabilitation clinics specialized in helping those with macular degeneration learn how to live with low vision and remain independent. To find a clinic near you, contact the Canadian National Institute for the Blind (CNIB).

For more information or for support

The Information Service of the Canadian Ophthalmological Society www.eyesite.ca Canadian National Institute for the Blind (CNIB) www.cnib.ca