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Insomnia – I can’t get no sleep..!
From time to time, we all have difficulty sleeping and this can cause us problems in functioning when we need to be awake. Being tired can make you grumpy, irritable and forgetful; it can hamper your learning and concentration and could put you at risk of harm through inattention in critical situations, like behind the wheel of a car. Over time, lack of sleep can cause severe physical lassitude and lead to unpleasant symptoms such as digestive problems, constipation and a higher susceptibility to viruses and infections.
Happens to us all...
In the general population, it is estimated that insomnia affects around a third of adults. It can be a short term problem, or for some, can be a feature of their lives for months or even years. There are numerous possible causes; sometimes the insomnia itself is the problem that causes other symptoms, this is known as Primary Insomnia. In Secondary Insomnia, it is a feature of other conditions, such as stress, pain, mental ill health or heart and circulatory problems.
A suggested 9.2 per cent of people with learning disability have significant sleep problems. These were found to be associated with variety of conditions and causes.
Where challenging behaviour is present, a chicken and egg situation arises; the challenging behaviour, perhaps in the form of agitation, self injury or destructiveness might well occur in the night and give rise to wakefulness. This sleep disturbance would then be likely to cause tiredness and irritation during the day, giving rise to potential further challenges.
To try to address this, working to reduce the arousal triggers of the person as bedtime approaches, removing noises and dimming lights can all help to create a better environment for quiet and rest. Or consider the possible causes for nighttime challenges; do the staff make it hard to relax by having lights on and TV noise? Is the noise of others causing upset? Or, conversely, is the person used to sleeping with a light on?
Often, people with challenging behaviour are prescribed sedative or tranquillising medication and these drugs can influence sleep rhythm and patterns adversely. Sleep disturbances are also a feature for those using psychotropic, antiepileptic and/or antidepressant medication. Obviously, nocturnal seizures will affect the natural sleep of the sufferer and the risk of seizures going unnoticed may mean staff are more vigilant (and therefore more noisy!)
Restrictions on the airway either due to facial abnormalities, obesity or postural problems, such as those seen in Down’s Syndrome or those with physical deformities, can give rise to disturbed and interrupted sleep. Snoring and snuffling can be disruptive to sufferers and others around them; consider their sleeping posture or perhaps a device to open the nasal passage or raise the bite. Improving the airway can make significant difference to sleep quality.
A significant number of people with learning disability have also got an unrecognised visual impairment. For people with sight loss and severe vision problems, the inability to distinguish light and dark can create upsets in the natural waking and sleeping flow; they simply do not get the same triggers as the rest of us do when its time to go to sleep. Using the drug Melatonin can help to address this problem.
This blog post has been prompted by my own severe jet lag; right now I could “sleep on a clothesline” as my granny used to say. But if you are one of those people who can’t always get a good nights rest, consider those who may not be able to articulate their insomnia and look for ways you can help.
Here’s a start:
Ginny Tyler – QCS Learning Disability Expert Contributor