Postnatal Depression
This is for anyone who suffers from postnatal depression (PND for short). We hope it will also be helpful to family and friends and to anyone who wants to know more about this problem.
What is PND?
Postnatal Depression is what happens when you become depressed after having a baby. Sometimes, there may be an obvious reason, often there is none. It can be particularly distressing when you have so looked forward to having your baby through the months of pregnancy. You may feel guilty for feeling like this, or even feel that you can't cope with being a mother. It can last for weeks or several months. Mild PND can be helped by better support from family and friends; more severe PND will need extra help from your GP, health visitor or, in some cases, mental health professionals.
How common is it?
Around 1 in every 10 women has PND after having a baby. If untreated, it can last for months, or sometimes longer.
What does it feel like to have PND?
Depressed
You feel low, unhappy and wretched for much or all of the time. You may feel worse at particular times of the day, like mornings or evenings. Sometimes, there are good days that make you hope that it is over. It can be very disappointing when they are followed by bad days. It can sometimes seem that life is not worth living.
Irritable
You may get irritable with other children and, occasionally, with your baby. You are most likely to get 'ratty' with your partner, who may well wonder what is wrong.
Tired
All new mothers get pretty weary, but depression can make you feel so utterly exhausted that you feel physically ill.
Sleepless
When, at last, you get to bed you find you can't fall asleep. You wake at the crack of dawn, even if your partner has fed the baby overnight.
Not hungry
Depressed mothers usually haven't the time or the interest to eat, and this can make you feel irritable and run down. On the other hand, if you find yourself eating for comfort, you may feel guilty and uncomfortable about getting fat.
Unable to enjoy anything
You find that you can't enjoy or be interested in anything. This may be especially true of sex. Some women get interested in sex again before the 6 week postnatal check-up, but PND usually takes away any desire or enthusiasm. Your partner may seek the comfort and excitement of intercourse, but you don't. This can put a further strain on the relationship. There are, of course, many other reasons for you to lose interest in sex after having a baby – it may be painful, you may be too tired, or you may be just trying to adjust to having a child.
Unable to cope
PND can make you feel that you have too little time, do nothing well, and that you can't do anything about it. It can be hard to establish a new routine to cope with the baby, as well as everything else.
Guilty
Depression alters your thinking, making you see things in a negative light. This can produce feelings of guilt and self-blame that you are responsible for your illness, or of no help to your family.
Anxious
You may find that you are afraid to be alone with your baby. You may worry that he or she might scream, or choke, or be harmed in some way. Instead of feeling close to your baby, you may feel detached. You can't work out what your baby is feeling, or what your baby needs.
Even if you have strong loving feelings for your baby, you can still feel anxious. Most new mothers worry about their baby’s health, but PND can make this overwhelming. You worry that you might lose your baby through infection, mishandling, faulty development or a 'cot death'. You worry about 'snuffles', or how much weight has been (or not been) gained. You worry if your baby is crying or is too quiet (has the baby stopped breathing?). Sometimes, you may even worry that you might harm your baby. You may find that you need reassurance all the time from your partner, the health visitor, the GP, your family or a neighbour.
You may also worry about your own health. You may feel panicky – your pulse races, your heart thumps and you may feel that you have heart disease or are on the brink of a stroke. Your tiredness may make you wonder if you have some dreadful illness, or if you will ever have any energy again.
Even the most capable person can feel frightened and unable to cope with all this, wanting desperately to cling to their partner.
Baby Blues
On the third or fourth day after having a baby, about half of new mothers feel a bit weepy, flat and unsure of themselves. This is known as the 'Baby Blues', and it passes after a few days.
Puerperal Psychosis
This is a serious condition, which needs urgent support and treatment. It affects around 1 in
500 women, usually within days or weeks of childbirth. You may have rapid mood swings, strange or bizarre beliefs or hear voices and can behave in odd and unpredictable ways – if so, you will need medical help and support. This may have to be in hospital, where you can have your baby with you while you recover. It is more likely to happen if you have:
a family history of puerperal psychosis
a family history of bipolar (manic-depressive) illness
a previous episode of puerperal psychosis or bipolar disorder.
It is important to let your doctors and midwives know about any of these factors while you are pregnant because your treatment can reduce the risk of it happening. Although it is a serious condition, the proper treatment will mean that you can make a full recovery.
Depression in pregnancy
It’s important to know that depression can occur during pregnancy as well. This is more common than people think, and can be helped in much the same way as with postnatal depression.
What about men?
Although PND is much more common in women, it can affect men as well. The birth of a new baby can be stressful for both parents. Fathers may have difficulty coping with the new situation – both the practical problems of looking after a new baby, but also the fact that their partner is giving all their attention to the baby. PND in either partner can put a strain on the parents' relationship.
When does PND happen?
Most cases of PND start within a month of the birth, but it can start up to six months later.
What causes PND?
We don't know enough about why women get PND to be sure who will or won't suffer from it. There is probably no single reason, but a number of different stresses may add up to cause it. We know you are more likely to have PND if you:
have had depression (especially PND) before
do not have a supportive partner
have a premature or sick baby
lost your own mother when you were a child
have experienced several stresses in a short period of time.These could be things like a bereavement, you or your partner losing a job, or housing and money problems.
In spite of this, you can still have PND when none of these things have happened and there is no obvious reason. On the other hand, having these problems does not necessarily mean that you will get PND.
What about hormones?
Levels of oestrogen, progesterone (and other hormones to do with conception and birth) drop suddenly after the baby is born. How exactly they affect your mood and emotions is not clear. No real differences have been found in the hormone changes of women who do and do not get PND and research does not suggest that this is a major reason for depression. Hormone changes may be more important in the ‘baby blues’ and puerperal psychosis.
Do women with PND harm their babies?
This is very rare – although depressed mothers often worry that it might happen. It can help to talk these feelings over with your health visitor or doctor.
Occasionally, through utter tiredness and desperation, you might feel like hitting or shaking your baby. Many mothers (and fathers) occasionally feel like this, not just those with PND. In spite of having these feelings at times, most mothers never act on them. This is also true in PND.
What can be done?
The first thing is to recognise the depression for what it is. In the past it has often been overlooked or dismissed as the 'baby blues'.
You may not realise what is wrong and feel ashamed to admit that you are less than thrilled by being a mother. You may worry that, if you do, your baby may be taken away. This is very unlikely. Your doctor, health visitor or midwife want to help you get better so you can enjoy and care for your baby.
People are now generally more aware of depression, so PND shouldn't be missed so often. A questionnaire, such as the Edinburgh Postnatal Depression Scale, can help health visitors and GPs to spot PND.
Ways of helping yourself
Say how you feel:
If you feel miserable, irritable, incompetent, frightened and not all that keen on your baby, then tell someone. Many other women have felt like this. If you don't feel you can talk to your family or friends, talk to your health visitor or GP. They will know that these feelings are common and will know how to help.
Don't let the diagnosis frighten you. At least you know what is wrong, and that it is a problem that many other mothers have shared, and that you will get better in time. It can help your partner, friends and family to know this so they can understand what you are going through and know how to help.
Ways for other people to help
Ways for other people to help
Don't be shocked or disappointed if your wife, partner, sister or girlfriend confesses that she has felt awful since the birth of her baby. Take the time to listen and make sure that she gets the help she needs.
Try not to be shocked or disappointed by a diagnosis of PND – it can be well treated and your loved-one can get back to normal.
Do all you can to help with the practical things that need to be done, while your partner does not feel up to doing them – shopping, feeding and changing the baby, or housework. It may be difficult for a while, but it is worth it.
Make sure that you are clear about what is happening and that you get advice on how to help, especially if you are the mother's partner.
Make sure that you have some support yourself. If this is your first baby, you may feel pushed to one side, both by the baby and by your partner's needs. Try not to feel resentful. Your partner needs your support and encouragement. Practical help with the baby, sympathetic listening, patience, affection and being positive will go a long way. Your partner will appreciate this even when she’s feeling b
What if I don't want treatment?
Most women will get better without any treatment after a period of weeks, months or sometimes longer. However, this can mean a lot of suffering. PND may spoil the experience of new motherhood, and strain your relationship with your baby and partner. So the shorter it lasts, the better. It's important to get help as soon as possible to relieve the depression and to support your developing relationship with your baby. This will help your baby’s development in the long run.
What about talking treatments?
It can be a great relief just to talk to a sympathetic, understanding, uncritical listener – this could be a friend, a relative, a volunteer or a professional. Many general practices now have a counsellor and trained health visitors who can help treat PND.
There are more specialised psychological treatments. Cognitive Behavioural Therapy can help you to understand and resolve the depression by examining how you think about yourself, the world and other people.
Psychotherapy can help you to understand the depression in terms of what has happened to you in the past.
These can be arranged through your GP, with a community psychiatric nurse, a psychologist or a psychiatrist.
Are there problems with these treatments?
These treatments are usually very safe, but they can have unwanted effects. Talking about things may bring up bad memories from the past and this can make you low or distressed. Other people have found that therapy puts a strain on their relationship with their partner.
Make sure that you can trust your therapist and that they have the necessary training. Another problem with talking therapies is that they are still hard to get in some areas. There are long waiting lists, so you may not get any treatment for quite a while.
What about tablets?
If you have a more severe depression, or it has not improved with support and reassurance, one of the antidepressant drugs will probably help. Antidepressants take two weeks or so to start working and should be taken for four to six months after you start to feel better.
How do they work?
It is not entirely clear, but antidepressants affect the activity of two chemicals in the brain, serotonin (also called 5HT) and noradrenaline.
Do antidepressants have side effects?
Modern antidepressants are relatively safe. They may cause nausea or an increase in anxiety in the early stages, but these usually wear off. Others can make you sleepy or give you a dry mouth. Make sure that your doctor knows if you are breast-feeding. For many antidepressants, there is no evidence that they cause problems for breastfed babies, so it is usually possible to breastfeed while taking them. However, this is your decision – your doctor can help with information and advice.
Some people get withdrawal symptoms when they stop these medicines, so it's best to reduce slowly.
Hormones have been suggested as a treatment for PND. However, there is little evidence that they work, and they have their own dangers, particularly if you have had thromboses (blood clots in the veins) of any sort.
Are there alternatives?
There is some evidence that regular exercise can boost your mood and help you to feel less isolated. It can be helpful to do this with other people.
So which treatment is best?
Everyone can try the simple measures outlined in this leaflet. Talking treatments and antidepressants are equally effective, but antidepressants are more likely to be recommended if the depression is severe or has gone on for a long time. They also work a bit quicker than talking treatments.
Talking treatments and antidepressants can be given together. Your GP or health visitor will be willing to give advice. It is also sometimes helpful to talk over the options with your family or a close friend. It is important that you feel comfortable with the choice of help or treatment.
Mothers with special needs
Mothers who have a history of mental health problems or physical or learning disability do face additional problems, or, equally challenging, additional scrutiny. They should
get extra help and support to keep mother
and baby well.
Self-help
We don't yet know enough about PND to prevent it in the first place, but certain principles make sense:
DON'T try to be 'superwoman'. Try to do less during your pregnancy and make sure that you don't over-tire yourself. If you are at work, make sure you get regular meals and put your feet up in the lunch hour.
DON'T move house (if you can help it) while you are pregnant or until the baby is six months old.
DO make friends with other couples who are expecting or have just had a baby; among other things, this could lead to a baby-sitting circle.
DO find someone you can talk to. It helps so much to have a close friend you can turn to. (If you can't easily find someone, try the National Childbirth Trust or MAMA – their local groups are very supportive both before and after childbirth).
DO go to ante-natal classes – and take your partner with you.
DO keep in touch with your GP and your health visitor if you have suffered PND before. Any signs of PND can be recognised early and you can start treatment at once.
After the baby has arrived:
DO take every opportunity to get your head down. Try to learn to cat-nap. Your partner can give the baby a bottle-feed at night. If you like, you can use your own expressed breast milk for this.
DO get enough nourishment. Healthy foods like salads, fresh vegetables, fruit, fruit juices, milk and cereals are all good for you, packed with vitamins and don't need much cooking.
DO find time to have fun with your partner. Try to find a baby-sitter and get out together for a meal or to see friends.
DO let yourself and your partner be intimate if you can – at least kiss and cuddle, stroke and fondle. This will comfort you both and help bring about the return of full sexual feelings sooner. Do not feel guilty if this takes some time.
DON'T blame yourself or your partner: life is tough at this time, and tiredness and irritability on both sides can lead to quarrels. 'Having a go' at each other may weaken your relationship when it needs to be at its strongest.
DON'T be afraid to ask for help when you need it. If you have learnt about PND from ante-natal classes (and leaflets like this), you may spot the warning signs before anyone else.
Tuesday, November 18, 2008
Saturday, November 8, 2008
Difficilty in sleeping -Sleeping disorder
About this leaflet
This leaflet is for anyone who has trouble with their sleep, or who lives with somebody who can't sleep well. It includes both common problems with sleep, and some of the more unusual difficulties that people may have. There are some simple tips on how to sleep better, and some information to help you decide if you need professional help.
Introduction
We don't usually need to think very much about our sleep - it's just a part of life that we take for granted. When we can't sleep, though, it can be a real problem. In fact, most of us will find it hard to sleep at some point in our lives. We have a word for it - insomnia. It's often just for a short time, perhaps when we're worried or excited. After a few days, things settle down and we get back to sleeping normally. However, we need sleep to keep our minds and bodies healthy. If we carry on sleeping badly, we start to notice the effects.
What is sleep?
Sleep is the regular period in every 24 hours when we are unconscious and unaware of our surroundings. There are two main types of sleep:
§ Rapid Eye Movement (REM) sleep
It comes and goes throughout the night, and makes up about one fifth of our sleep time. During REM sleep, our brain is very active, our muscles are very relaxed, our eyes move quickly from side to side and we dream.
§ Non-REM sleep
The brain is quiet, but the body may move around. Hormones are released into the bloodstream and our body repairs itself after the wear and tear of the day. There are 4 stages of non-REM sleep:
1. The muscles relax, the heart beats slower and body temperature falls - "pre-sleep".
2. Light sleep - we can still be woken easily without feeling confused.
3. "Slow wave" sleep - our blood pressure falls, we may talk in our sleep or sleep walk.
4. Deep "slow wave" sleep - we become very hard to wake. If we are woken, we feel confused.
We move between REM and non-REM sleep about five times throughout the night, dreaming more as we get toward the morning.
During a normal night, we will also have short periods of waking. These last 1 or 2 minutes and happen every 2 hours or so. We aren't usually aware of them. We are more likely to remember them if we feel anxious or there is something else going on - noises outside, our partner snoring etc.
How much sleep do we need?
This depends mainly on how old we are.
§ Babies sleep for about 17 hours each day.
§ Older children only need 9 or 10 hours a night.
§ Most adults need around 7-8 hours sleep each night.
§ Older people need the same amount of sleep, but will often only have one period of deep sleep during the night, usually in the first 3 or 4 hours, after which they wake more easily. We also tend to dream less as we get older.
There are also differences between people of the same age. Most of us need 7-8 hours a night, but some (a few) people can get by with only 3 hours a night. It's not helpful to regularly sleep more than 7-8 hours each night.
The short periods of being awake feel much longer than they really are. So it's easy to feel that we are not sleeping as much as we actually are.
What if I don't sleep?
It's easy to worry when you can't sleep. The occasional night without sleep will make you feel tired the next day, but it won't harm your physical or mental health.
However, after several sleepless nights, you will start to find that:
§ you are tired all the time
§ you drop off during the day
§ you find it difficult to concentrate
§ you find it hard to make decisions
§ you start to feel depressed.
This can be very dangerous if you are driving or operating heavy machinery. Many deaths are caused each year by people falling asleep at the wheel while driving.
Lack of sleep may also make us more vulnerable to high blood pressure, obesity and diabetes.
Sleep problems in adult life
Sleeping too little (Insomnia)You may feel that you aren't getting enough sleep or that, even if you do get the hours, you don't get a good night's rest.
There are many everyday reasons for not sleeping well:
§ the bedroom may be too noisy, too hot or too cold
§ the bed may be uncomfortable or too small
§ you partner may have a different pattern of sleep from yourself
§ you may not have a regular routine, or may not be getting enough exercise
§ eating too much can make it difficult to get off to sleep
§ going to bed hungry can make you wake too early
§ cigarettes, alcohol and drinks containing caffeine, such as tea and coffee
§ illness, pain or a high temperature.
Some more serious causes include:
§ emotional problems
§ difficulties at work
§ anxiety and worry
§ depression - you may wake very early in the morning and not be able to get back to sleep
§ thinking over and over about day to day problems.
Can medication help?
People have used sleeping tablets for many years, but we now know that they:
§ don't work for very long.
§ Leave you tired and irritable the next day.
§ lose their effect quite quickly, so you have to take more and more to get the same effect.
§ some people may become addicted to them. The longer you take sleeping tablets, the more likely you are to become physically or psychologically dependent on them.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, it is best to cut down the dose slowly after discussing it with your doctor.
In some cases, antidepressant tablets may be helpful.
Over the counter medicationYou can buy several remedies at your chemist, without the need for a prescription. These products will often contain an anti-histamine, like you find in medicines for hay-fever, coughs and colds. These do work but they can make you sleepy well into the next morning. If you do use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - as your body gets used to the substance, you need to take more and more to get the same effect. It is best not to take anti-histamines for a long time.
Psychological TreatmentsA technique called cognitive behavioural therapy has been shown to be helpful. It involves looking at unhelpful ways of thinking that can make you more anxious, and so interfere with your sleep.
Things to avoid
§ Alcohol. Everybody knows that alcohol can help you to fall asleep. The problem is that you will usually wake up half-way through the night. If you drink alcohol regularly to help you sleep, you will find that you need to drink more and more to get the same effect. If you drink regularly and you stop drinking suddenly, you may find it hard to sleep for a week or two.
§ Slimming tablets make it hard to sleep, as do street drugs like Ecstasy, cocaine and amphetamines.
Helping yourself
Here are some simple tips that many people have found helpful.
Do's...
§ Make sure that your bed and bedroom are comfortable - not too hot, not too cold, not too noisy.
§ Make sure that your mattress supports you properly. It should not be so firm that your hips and shoulders are under pressure or so soft that your body sags. Generally, you should replace your mattress every 10 years to get the best support and comfort.
§ Get some exercise. Don't overdo it, but try some regular swimming or walking. The best time to exercise is in the daytime - particularly late afternoon or early evening. Exercising later than this may disturb your sleep.
§ If something is troubling you, and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow.
§ If you can't sleep, get up and do something you find relaxing. Read, watch television or listen to quiet music. After a while you should feel tired enough to go to bed again.
Don'ts...
§ Don't go without sleep for a long time - go to bed when you are tired and stick to a routine of getting up at the same time every day, whether you still feel tired or not.
§ Caffeine hangs around in your body for many hours after your last drink of tea or coffee. Stop drinking tea or coffee by mid-afternoon. If you want a hot drink in the evening, try something milky or herbal (but check there's no caffeine in it).
§ Don't drink a lot of alcohol. It may help you fall asleep, but you will almost certainly wake up during the night.
§ Don't eat or drink a lot late at night. Try to have your supper early in the evening rather than late.
§ If you've had a bad night, don't sleep in the next day - it will make it harder to get off to sleep the following night.
If you try these tips and you still can't sleep, go and see your doctor. You can talk over any problems that may be stopping you from sleeping. Your doctor can make sure that your sleeplessness is not being caused by a physical illness, a prescribed medicine, or emotional problems. There is some evidence that cognitive behavioural therapy (see above), can be helpful if your sleeplessness has gone on for a long time.
Sleeping at the wrong time - Shift Work and ParenthoodYou may have to work at night and to stay awake when you would normally be asleep. If you only have to do this from time to time, it's quite easy to adjust. It is much more difficult if you have to do this more often. Shift workers, doctors and nurses working all night, or nursing mothers may all have this problem. They find themselves sleeping at times when they ought to be awake. This is similar to jet lag, where rapid travel between time zones means that you find yourself awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early, at the same time every morning. It doesn't matter how late you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
Sleeping too muchYou may find that you often fall asleep during the day at times when you want to stay awake. The commonest reason is not getting enough sleep at night.
However, you may find that you are still falling asleep in the daytime even after a week or two of getting enough sleep at night. Sometimes, a physical illness can be responsible - diabetes, a viral infection, or a thyroid problem.
There are other conditions which make people sleep too much:
Narcolepsy (Daytime sleepiness)This is uncommon condition that has often not been recognised by doctors.
There are two main symptoms:
§ you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
§ you suddenly lose control of your muscles and collapse when you are angry, laughing or excited - this is called cataplexy.
You may also find that you:
§ can't speak or move when falling asleep or waking up - (Sleep Paralysis)
§ hear odd sounds or see dream-like images (Hallucinations)
§ "run on auto-pilot" - you have done things, but can't remember doing them, as if you had been asleep
§ wake with hot flushes during the night.
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin.
Treatment consists of taking regular exercise and having a regular night time routine. Depending on the pattern of your symptoms, medication may be helpful - an antidepressant or a drug which increases wakefulness, such as Modafinil.
Sleep Apnoea (Interrupted Sleep)
§ You snore loudly and stop breathing for short periods during the night. This happens because the upper part of your airway closes.
§ Every time you stop breathing, you wake suddenly and your body or arms and legs may jerk.
§ You are awake just for a short time before falling off to sleep again.
§ This often happens several times during the night. So, you feel tired the next day, often with an irresistible urge to go to sleep. You may also have a dry mouth and a headache when you wake up in the morning.
It is more common in:
§ older people
§ the overweight
§ smokers
§ those who drink a lot of alcohol.
Sometimes, the problem is noticed more by their partner than by the sufferer. Treatment usually involves correcting the parts of your lifestyle that may be making the problem worse - cutting down smoking and drinking, losing weight, and sleeping in a different position. If your apnoea is very bad, it may be necessary to wear a Continuous Positive Airway Pressure mask. This fits over your nose and supplies high pressure air to keep your airway open.
Other problems with sleeping
At some point in their life, about 1 in 20 adults have night terrors, and 1 in 100 report that they sleep-walk. Both these conditions are more common in children.
SleepwalkingIf you sleepwalk, you will appear (to other people) to wake from a deep sleep. You will then get up and do things. These may be quite complicated, like walking around or going up and down stairs. This can land you in embarrassing (and occasionally dangerous) situations. Unless someone else wakes you up, you will remember nothing about it the next day. Sleepwalking may sometimes happen after a night terror (see below).
A sleepwalker should be guided gently back to bed and should not be woken up. It may be necessary to take precautions to protect them or others from injury. You may need to lock doors and windows, or lock away sharp objects, like knives and tools.
Night terrors can occur on their own, without leading to sleepwalking. Like a sleepwalker, a person with night terrors will appear to wake suddenly from a deep sleep. They look half-awake and very frightened, but will usually settle back down to sleep without waking up completely. All you can do is sit with them until they fall asleep again.
Night terrors are different from vivid dreams or nightmares as people don't seem to remember anything about them the next morning.
NightmaresMost of us have had frightening dreams or nightmares. They usually happen during the later part of the night, when we have our most vivid and memorable dreams. They do not normally cause problems unless they happen regularly, usually because of an emotional upset. Nightmares often follow a distressing or life-threatening event, such as a death, a disaster, an accident or a violent attack. Counselling may be helpful.
Restless Legs Syndrome (RLS)
§ You feel you have to move your legs (but also, sometimes, other parts of the body ).
§ You may have uncomfortable painful or burning feelings in your legs.
§ These feelings only bother you when you are resting.
§ They are generally worse at night.
§ They are relieved by movement, such as walking or stretching, for as long as you carry on doing it.
You may not be able to sit still in the daytime, making it difficult to work, and may be unable to sleep properly.
Sufferers usually first seek help in middle age, although they may have had symptoms since childhood. It seems to run in families.
RLS usually occurs on its own. It can occasionally be caused by a physical illness, such as iron and vitamin deficiencies, diabetes or kidney problems. It can also happen in pregnancy.
If it is not caused by another physical illness, treatment depends on how bad it is. In mild RLS, the symptoms can usually be controlled by simple steps designed to help you sleep better.
In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and painkillers.
.
Useful reading
Get a Better Night's Sleep (Positive Health Guides), Ian Oswald and Kirstine Adam, Optima.
Insomnia: Doctor I can't sleep, Adrian Williams, Amberwood Publishing.
References
Sleep Disorders (1988) Williams R.L., Karacan I. & Moore C.A. John Wiley & Sons ISBN 0471837210.
Over-the-counter medicines and the potential for unwanted sleepiness in drivers: a review (2001) Horne, J.A. & Barrett, P.R. Department of Transport: HMSO.
Valerian for insomnia: a systematic review (2000) Stevinson C. & Ernst E. Sleep Medicine, 1: 91-99.
Behavioural and pharmacological therapies for late-life insomniacs (1999) Norin C.M. et al JAMA, 281: 991-999.
Management of insomnia (1997) Kupfer D.J. & Reynolds C.F. New England Journal of Medicine, 336: 341-346.
Impact of sleep debt on metabolic and endocrine function (1999) Spiegel, K., Leproult, R & Van Cauter, E. The Lancet, 354, 1435-1439.
Non-pharmacological interventions for insomnia: a meta-analysis of treatment efficacy (1994) American Journal of Psychiatry, 151, 1172-1180
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
This leaflet is for anyone who has trouble with their sleep, or who lives with somebody who can't sleep well. It includes both common problems with sleep, and some of the more unusual difficulties that people may have. There are some simple tips on how to sleep better, and some information to help you decide if you need professional help.
Introduction
We don't usually need to think very much about our sleep - it's just a part of life that we take for granted. When we can't sleep, though, it can be a real problem. In fact, most of us will find it hard to sleep at some point in our lives. We have a word for it - insomnia. It's often just for a short time, perhaps when we're worried or excited. After a few days, things settle down and we get back to sleeping normally. However, we need sleep to keep our minds and bodies healthy. If we carry on sleeping badly, we start to notice the effects.
What is sleep?
Sleep is the regular period in every 24 hours when we are unconscious and unaware of our surroundings. There are two main types of sleep:
§ Rapid Eye Movement (REM) sleep
It comes and goes throughout the night, and makes up about one fifth of our sleep time. During REM sleep, our brain is very active, our muscles are very relaxed, our eyes move quickly from side to side and we dream.
§ Non-REM sleep
The brain is quiet, but the body may move around. Hormones are released into the bloodstream and our body repairs itself after the wear and tear of the day. There are 4 stages of non-REM sleep:
1. The muscles relax, the heart beats slower and body temperature falls - "pre-sleep".
2. Light sleep - we can still be woken easily without feeling confused.
3. "Slow wave" sleep - our blood pressure falls, we may talk in our sleep or sleep walk.
4. Deep "slow wave" sleep - we become very hard to wake. If we are woken, we feel confused.
We move between REM and non-REM sleep about five times throughout the night, dreaming more as we get toward the morning.
During a normal night, we will also have short periods of waking. These last 1 or 2 minutes and happen every 2 hours or so. We aren't usually aware of them. We are more likely to remember them if we feel anxious or there is something else going on - noises outside, our partner snoring etc.
How much sleep do we need?
This depends mainly on how old we are.
§ Babies sleep for about 17 hours each day.
§ Older children only need 9 or 10 hours a night.
§ Most adults need around 7-8 hours sleep each night.
§ Older people need the same amount of sleep, but will often only have one period of deep sleep during the night, usually in the first 3 or 4 hours, after which they wake more easily. We also tend to dream less as we get older.
There are also differences between people of the same age. Most of us need 7-8 hours a night, but some (a few) people can get by with only 3 hours a night. It's not helpful to regularly sleep more than 7-8 hours each night.
The short periods of being awake feel much longer than they really are. So it's easy to feel that we are not sleeping as much as we actually are.
What if I don't sleep?
It's easy to worry when you can't sleep. The occasional night without sleep will make you feel tired the next day, but it won't harm your physical or mental health.
However, after several sleepless nights, you will start to find that:
§ you are tired all the time
§ you drop off during the day
§ you find it difficult to concentrate
§ you find it hard to make decisions
§ you start to feel depressed.
This can be very dangerous if you are driving or operating heavy machinery. Many deaths are caused each year by people falling asleep at the wheel while driving.
Lack of sleep may also make us more vulnerable to high blood pressure, obesity and diabetes.
Sleep problems in adult life
Sleeping too little (Insomnia)You may feel that you aren't getting enough sleep or that, even if you do get the hours, you don't get a good night's rest.
There are many everyday reasons for not sleeping well:
§ the bedroom may be too noisy, too hot or too cold
§ the bed may be uncomfortable or too small
§ you partner may have a different pattern of sleep from yourself
§ you may not have a regular routine, or may not be getting enough exercise
§ eating too much can make it difficult to get off to sleep
§ going to bed hungry can make you wake too early
§ cigarettes, alcohol and drinks containing caffeine, such as tea and coffee
§ illness, pain or a high temperature.
Some more serious causes include:
§ emotional problems
§ difficulties at work
§ anxiety and worry
§ depression - you may wake very early in the morning and not be able to get back to sleep
§ thinking over and over about day to day problems.
Can medication help?
People have used sleeping tablets for many years, but we now know that they:
§ don't work for very long.
§ Leave you tired and irritable the next day.
§ lose their effect quite quickly, so you have to take more and more to get the same effect.
§ some people may become addicted to them. The longer you take sleeping tablets, the more likely you are to become physically or psychologically dependent on them.
Sleeping tablets should only be used for short periods (less than 2 weeks) - for instance if you are so distressed that you cannot sleep at all.
If you have been on sleeping tablets for a long time, it is best to cut down the dose slowly after discussing it with your doctor.
In some cases, antidepressant tablets may be helpful.
Over the counter medicationYou can buy several remedies at your chemist, without the need for a prescription. These products will often contain an anti-histamine, like you find in medicines for hay-fever, coughs and colds. These do work but they can make you sleepy well into the next morning. If you do use them, take the warnings seriously and don't drive or operate heavy machinery the next day. Another problem is tolerance - as your body gets used to the substance, you need to take more and more to get the same effect. It is best not to take anti-histamines for a long time.
Psychological TreatmentsA technique called cognitive behavioural therapy has been shown to be helpful. It involves looking at unhelpful ways of thinking that can make you more anxious, and so interfere with your sleep.
Things to avoid
§ Alcohol. Everybody knows that alcohol can help you to fall asleep. The problem is that you will usually wake up half-way through the night. If you drink alcohol regularly to help you sleep, you will find that you need to drink more and more to get the same effect. If you drink regularly and you stop drinking suddenly, you may find it hard to sleep for a week or two.
§ Slimming tablets make it hard to sleep, as do street drugs like Ecstasy, cocaine and amphetamines.
Helping yourself
Here are some simple tips that many people have found helpful.
Do's...
§ Make sure that your bed and bedroom are comfortable - not too hot, not too cold, not too noisy.
§ Make sure that your mattress supports you properly. It should not be so firm that your hips and shoulders are under pressure or so soft that your body sags. Generally, you should replace your mattress every 10 years to get the best support and comfort.
§ Get some exercise. Don't overdo it, but try some regular swimming or walking. The best time to exercise is in the daytime - particularly late afternoon or early evening. Exercising later than this may disturb your sleep.
§ If something is troubling you, and there is nothing you can do about it right away, try writing it down before going to bed and then tell yourself to deal with it tomorrow.
§ If you can't sleep, get up and do something you find relaxing. Read, watch television or listen to quiet music. After a while you should feel tired enough to go to bed again.
Don'ts...
§ Don't go without sleep for a long time - go to bed when you are tired and stick to a routine of getting up at the same time every day, whether you still feel tired or not.
§ Caffeine hangs around in your body for many hours after your last drink of tea or coffee. Stop drinking tea or coffee by mid-afternoon. If you want a hot drink in the evening, try something milky or herbal (but check there's no caffeine in it).
§ Don't drink a lot of alcohol. It may help you fall asleep, but you will almost certainly wake up during the night.
§ Don't eat or drink a lot late at night. Try to have your supper early in the evening rather than late.
§ If you've had a bad night, don't sleep in the next day - it will make it harder to get off to sleep the following night.
If you try these tips and you still can't sleep, go and see your doctor. You can talk over any problems that may be stopping you from sleeping. Your doctor can make sure that your sleeplessness is not being caused by a physical illness, a prescribed medicine, or emotional problems. There is some evidence that cognitive behavioural therapy (see above), can be helpful if your sleeplessness has gone on for a long time.
Sleeping at the wrong time - Shift Work and ParenthoodYou may have to work at night and to stay awake when you would normally be asleep. If you only have to do this from time to time, it's quite easy to adjust. It is much more difficult if you have to do this more often. Shift workers, doctors and nurses working all night, or nursing mothers may all have this problem. They find themselves sleeping at times when they ought to be awake. This is similar to jet lag, where rapid travel between time zones means that you find yourself awake when everybody else is asleep.
A good way to get back to normal is to make sure that you wake up quite early, at the same time every morning. It doesn't matter how late you fell asleep the night before. Use an alarm clock to help you. Make sure that you don't go to bed again before about 10 pm that night. If you do this for a few nights, you should soon start to fall asleep naturally at the right time.
Sleeping too muchYou may find that you often fall asleep during the day at times when you want to stay awake. The commonest reason is not getting enough sleep at night.
However, you may find that you are still falling asleep in the daytime even after a week or two of getting enough sleep at night. Sometimes, a physical illness can be responsible - diabetes, a viral infection, or a thyroid problem.
There are other conditions which make people sleep too much:
Narcolepsy (Daytime sleepiness)This is uncommon condition that has often not been recognised by doctors.
There are two main symptoms:
§ you feel sleepy in the daytime, with sudden uncontrollable attacks of sleepiness even when you are with other people
§ you suddenly lose control of your muscles and collapse when you are angry, laughing or excited - this is called cataplexy.
You may also find that you:
§ can't speak or move when falling asleep or waking up - (Sleep Paralysis)
§ hear odd sounds or see dream-like images (Hallucinations)
§ "run on auto-pilot" - you have done things, but can't remember doing them, as if you had been asleep
§ wake with hot flushes during the night.
The cause for this has recently been found - a lack of a substance called orexin, or hypocretin.
Treatment consists of taking regular exercise and having a regular night time routine. Depending on the pattern of your symptoms, medication may be helpful - an antidepressant or a drug which increases wakefulness, such as Modafinil.
Sleep Apnoea (Interrupted Sleep)
§ You snore loudly and stop breathing for short periods during the night. This happens because the upper part of your airway closes.
§ Every time you stop breathing, you wake suddenly and your body or arms and legs may jerk.
§ You are awake just for a short time before falling off to sleep again.
§ This often happens several times during the night. So, you feel tired the next day, often with an irresistible urge to go to sleep. You may also have a dry mouth and a headache when you wake up in the morning.
It is more common in:
§ older people
§ the overweight
§ smokers
§ those who drink a lot of alcohol.
Sometimes, the problem is noticed more by their partner than by the sufferer. Treatment usually involves correcting the parts of your lifestyle that may be making the problem worse - cutting down smoking and drinking, losing weight, and sleeping in a different position. If your apnoea is very bad, it may be necessary to wear a Continuous Positive Airway Pressure mask. This fits over your nose and supplies high pressure air to keep your airway open.
Other problems with sleeping
At some point in their life, about 1 in 20 adults have night terrors, and 1 in 100 report that they sleep-walk. Both these conditions are more common in children.
SleepwalkingIf you sleepwalk, you will appear (to other people) to wake from a deep sleep. You will then get up and do things. These may be quite complicated, like walking around or going up and down stairs. This can land you in embarrassing (and occasionally dangerous) situations. Unless someone else wakes you up, you will remember nothing about it the next day. Sleepwalking may sometimes happen after a night terror (see below).
A sleepwalker should be guided gently back to bed and should not be woken up. It may be necessary to take precautions to protect them or others from injury. You may need to lock doors and windows, or lock away sharp objects, like knives and tools.
Night terrors can occur on their own, without leading to sleepwalking. Like a sleepwalker, a person with night terrors will appear to wake suddenly from a deep sleep. They look half-awake and very frightened, but will usually settle back down to sleep without waking up completely. All you can do is sit with them until they fall asleep again.
Night terrors are different from vivid dreams or nightmares as people don't seem to remember anything about them the next morning.
NightmaresMost of us have had frightening dreams or nightmares. They usually happen during the later part of the night, when we have our most vivid and memorable dreams. They do not normally cause problems unless they happen regularly, usually because of an emotional upset. Nightmares often follow a distressing or life-threatening event, such as a death, a disaster, an accident or a violent attack. Counselling may be helpful.
Restless Legs Syndrome (RLS)
§ You feel you have to move your legs (but also, sometimes, other parts of the body ).
§ You may have uncomfortable painful or burning feelings in your legs.
§ These feelings only bother you when you are resting.
§ They are generally worse at night.
§ They are relieved by movement, such as walking or stretching, for as long as you carry on doing it.
You may not be able to sit still in the daytime, making it difficult to work, and may be unable to sleep properly.
Sufferers usually first seek help in middle age, although they may have had symptoms since childhood. It seems to run in families.
RLS usually occurs on its own. It can occasionally be caused by a physical illness, such as iron and vitamin deficiencies, diabetes or kidney problems. It can also happen in pregnancy.
If it is not caused by another physical illness, treatment depends on how bad it is. In mild RLS, the symptoms can usually be controlled by simple steps designed to help you sleep better.
In more severe RLS, medications may help. These include medications used in Parkinson's disease, anti-epileptic medications, benzodiazepine tranquillisers and painkillers.
.
Useful reading
Get a Better Night's Sleep (Positive Health Guides), Ian Oswald and Kirstine Adam, Optima.
Insomnia: Doctor I can't sleep, Adrian Williams, Amberwood Publishing.
References
Sleep Disorders (1988) Williams R.L., Karacan I. & Moore C.A. John Wiley & Sons ISBN 0471837210.
Over-the-counter medicines and the potential for unwanted sleepiness in drivers: a review (2001) Horne, J.A. & Barrett, P.R. Department of Transport: HMSO.
Valerian for insomnia: a systematic review (2000) Stevinson C. & Ernst E. Sleep Medicine, 1: 91-99.
Behavioural and pharmacological therapies for late-life insomniacs (1999) Norin C.M. et al JAMA, 281: 991-999.
Management of insomnia (1997) Kupfer D.J. & Reynolds C.F. New England Journal of Medicine, 336: 341-346.
Impact of sleep debt on metabolic and endocrine function (1999) Spiegel, K., Leproult, R & Van Cauter, E. The Lancet, 354, 1435-1439.
Non-pharmacological interventions for insomnia: a meta-analysis of treatment efficacy (1994) American Journal of Psychiatry, 151, 1172-1180
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
Too worried or always worried
Anxiety Disorders
Introduction
Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.
People often call this feeling stress but the word 'stress' can be used to mean two different things - on the one hand, the things that make us anxious and on the other, our reaction to them. This makes it a confusing word and so it will not be used in this leaflet.
When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry, if it is a sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, we call it fear.
Normally, both fear and anxiety can he helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However, if the feelings become too strong or go for too long, they can stop us from doing the things we want to and can make our lives miserable.
A phobia is a fear of particular situations or things that are not dangerous and which most people do not find troublesome.
Symptoms: Anxiety
In the mind:
Feeling worried all the timeFeeling tiredUnable to concentrateFeeling irritableSleeping badly
In the body:
Irregular heartbeats (palpitations)SweatingMuscle tension and painsBreathing heavilyDizzinessFaintnessIndigestionDiarrhoea
These symptoms are easily mistaken by anxious people for evidence of serious physical illness - their worry about this can make the symptoms even worse. Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite and see the future as bleak and hopeless.
Phobias
A person with a phobia has intense symptoms of anxiety, as described above. But they only arise from time to time in the particular situations that frighten them. At other times they don't feel anxious. If you have a phobia of dogs, you will feel OK if there are no dogs around, if you are scared of heights, you feel OK at ground level, and if you can't face social situations, you will feel calm when there are no people around.
A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this will actually make the phobia worse as time goes on. It can also mean that the person's life becomes increasingly dominated by the precautions they have to take to avoid the situation they fear. Sufferers usually know that there is no real danger, they may feel silly about their fear but they are still unable to control it. A phobia is more likely to go away if it has started after a distressing or traumatic event.
Are they common?
About one in every ten people will have troublesome anxiety or phobias at some point in their lives. However, most will never ask for treatment.
Causes
Some of us seem to be born with a tendency to be anxious - research suggests that it can be inherited through our genes. However, even people who are not naturally anxious can become anxious if they are put under enough pressure.
Sometimes it is obvious what is causing anxiety. When the problem disappears, so does the anxiety. However, there are some circumstances that are so upsetting and threatening that the anxiety they cause can go on long after the event. These are usually life threatening situations like car crashes, train crashes or fires. The people involved can feel nervous and anxious for months or years after the event, even if they have been physically unharmed. This is part of what we now call post-traumatic stress disorder.
Sometimes anxiety may be caused by using street drugs like amphetamines, LSD or Ecstasy. Even the caffeine in coffee can be enough to make some of us feel uncomfortably anxious!
On the other hand, it may not be clear at all why a particular person feels anxious, because it is due to a mixture of their personality, the things that have happened to them, or life-changes such as pregnancy.
Seeking help
If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.
However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are 'mad'. In fact, people with anxiety and fears hardly ever have a serious mental illness. It's much better to get help as soon as you can rather than suffer in silence.
People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a door-bell ringing or a car's horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. Although friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable.
Anxiety & phobias in children
Most children go through times when they feel very frightened about things. It's a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.
Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.
If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask the family doctor to look into it.
Helping people with anxiety and phobias
Talking about the problem This can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.
SeIf-help groups: These are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping. These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences.
Learning to relax: It can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see below). It's a good idea to practice this regularly, not just when we are in a crisis.
Psychotherapy: This is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.
If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse or counsellor.
Medication: Drugs can play a part in the treatment of some people with anxiety or phobias.
The most common tranquillisers are the Diazepam-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.
Antidepressants: can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of the draw-backs is that they usually take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation.
Beta blockers are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety and can be taken shortly before meeting people or before speaking in public.
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
Introduction
Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.
People often call this feeling stress but the word 'stress' can be used to mean two different things - on the one hand, the things that make us anxious and on the other, our reaction to them. This makes it a confusing word and so it will not be used in this leaflet.
When our anxiety is a result of a continuing problem, such as money difficulties, we call it worry, if it is a sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, we call it fear.
Normally, both fear and anxiety can he helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. However, if the feelings become too strong or go for too long, they can stop us from doing the things we want to and can make our lives miserable.
A phobia is a fear of particular situations or things that are not dangerous and which most people do not find troublesome.
Symptoms: Anxiety
In the mind:
Feeling worried all the timeFeeling tiredUnable to concentrateFeeling irritableSleeping badly
In the body:
Irregular heartbeats (palpitations)SweatingMuscle tension and painsBreathing heavilyDizzinessFaintnessIndigestionDiarrhoea
These symptoms are easily mistaken by anxious people for evidence of serious physical illness - their worry about this can make the symptoms even worse. Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite and see the future as bleak and hopeless.
Phobias
A person with a phobia has intense symptoms of anxiety, as described above. But they only arise from time to time in the particular situations that frighten them. At other times they don't feel anxious. If you have a phobia of dogs, you will feel OK if there are no dogs around, if you are scared of heights, you feel OK at ground level, and if you can't face social situations, you will feel calm when there are no people around.
A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this will actually make the phobia worse as time goes on. It can also mean that the person's life becomes increasingly dominated by the precautions they have to take to avoid the situation they fear. Sufferers usually know that there is no real danger, they may feel silly about their fear but they are still unable to control it. A phobia is more likely to go away if it has started after a distressing or traumatic event.
Are they common?
About one in every ten people will have troublesome anxiety or phobias at some point in their lives. However, most will never ask for treatment.
Causes
Some of us seem to be born with a tendency to be anxious - research suggests that it can be inherited through our genes. However, even people who are not naturally anxious can become anxious if they are put under enough pressure.
Sometimes it is obvious what is causing anxiety. When the problem disappears, so does the anxiety. However, there are some circumstances that are so upsetting and threatening that the anxiety they cause can go on long after the event. These are usually life threatening situations like car crashes, train crashes or fires. The people involved can feel nervous and anxious for months or years after the event, even if they have been physically unharmed. This is part of what we now call post-traumatic stress disorder.
Sometimes anxiety may be caused by using street drugs like amphetamines, LSD or Ecstasy. Even the caffeine in coffee can be enough to make some of us feel uncomfortably anxious!
On the other hand, it may not be clear at all why a particular person feels anxious, because it is due to a mixture of their personality, the things that have happened to them, or life-changes such as pregnancy.
Seeking help
If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.
However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are 'mad'. In fact, people with anxiety and fears hardly ever have a serious mental illness. It's much better to get help as soon as you can rather than suffer in silence.
People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a door-bell ringing or a car's horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. Although friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable.
Anxiety & phobias in children
Most children go through times when they feel very frightened about things. It's a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.
Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.
If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask the family doctor to look into it.
Helping people with anxiety and phobias
Talking about the problem This can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.
SeIf-help groups: These are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping. These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences.
Learning to relax: It can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see below). It's a good idea to practice this regularly, not just when we are in a crisis.
Psychotherapy: This is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.
If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse or counsellor.
Medication: Drugs can play a part in the treatment of some people with anxiety or phobias.
The most common tranquillisers are the Diazepam-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.
Antidepressants: can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of the draw-backs is that they usually take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation.
Beta blockers are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety and can be taken shortly before meeting people or before speaking in public.
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com
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