Sleep disorders - An Africa Perspective: Treatment

 

 

Introduction

The treatment of sleep disorders may be quite complex and often require multiple professionals and options.

In treating your sleep disorders, your doctor may choose one or a combination of the following options:

• Lifestyle and sleep hygiene modifications

• Behavior Therapy

• Medical management

 

Lifestyle and sleep hygiene modifications

These consist of:

• exercising regularly

• avoiding alcohol

• adjustment to sleep hygiene

• avoiding or limiting naps

• avoiding large meals and stimulant beverages before bed

• avoiding smoking

• treating pain adequately

 

Behaviour Therapy

This is a treatment approach that is designed to help change some of the day-to-day behaviors that may be contributing to your sleep disorder. It is probably the best long term option for the management of chronic sleep problems.

Behaviour therapy requires seeing a psychologist or psychiatrist or a behavioural sleep psychologist, as available.

The process of behaviour therapy may be expensive as it takes quite a while to see significant and sustained results.

There are very few specialists in many African countries today that are trained and licensed to practice in the field of clinical behaviour therapy.

 

Medical management (Pharmacological)

The use of sleeping medications in the treatment of sleep disorders should be limited to the short-term (i.e., few days to one or two weeks).

This is because sleep medications have moderate to severe side effects, and do cause dependency and tolerance.

When considered necessary, your doctor may prescribe specific medication(s) to you depending on the type of sleep disorder that you are diagnosed with.

For example, if you are diagnosed with:

• Insomnia, your doctor may prescribe any of the non-benzodiazepine hypnotics like Zolpidem, Zaleplon or Eszopiclone or a melatonin receptor agonist like Ramelteon to you.

These drugs are best used for a duration of one to few weeks in the management of acute or transient insomnia.

The goal of treatment is to normalize disrupted sleep pattern in the short term while switching to behaviour therapy for the long term management of chronic insomnia.

• Depression as cause of your sleep disorder, your doctor may prescribe an antidepressant, a drug that affects the availability of special chemicals in your brain, i,e., neurotransmitters. Neurotransmitters are released by your brain cells and are used by these cells to communicate with one another.

Examples of antidepressants in common usage in Africa include:

• Fluoxetine, or Sertraline.  These drugs are examples of a selective serotonin reuptake inhibitor (SSRI), or

• Amitriptyline, is a tricyclic antidepressant (TCA non-SSRI) drug, or

• Venlafaxine, Duloxetine, Mirtazapine or Bupropion.  –These are examples of a nonTCA, non-SSRI or SNRI drugs.

• Non-24 hours sleep wake disorder, your doctor may prescribe a melatonin receptor agonists like Tasimelteon for you.

• Restless leg syndrome disorder (RLSD), your doctor may prescribe a dopamine agonist like Ropinirole, Pramipexole, Rotigotine.

Many unregulated dietary supplements and herbal preparations are available for purchase in most African pharmacies, supermarkets and chemists. Your allopathic doctor my not readily recommend or prescribe their use because of lack of evidence on their safety and efficacy.

 

Medical management (Non-Pharmacological)

Your doctor may also recommend non-pharmaceutical therapies for you like:

• Continuous Positive Airway Pressure (CPAP) - for Obstructive Sleep Apnea

• Relaxation training – for Insomnia,The training is aimed at reducing somatic stress or intrusive thoughts at bedtime.

• Stimulus control therapy - for chronic insomnia.

This is aimed at training the insomnia patient to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep-wake schedule. It is a form of behaviour therapy.

The training will include;

• Go to bed only when sleepy.

• Get out of bed when unable to sleep.

• Use the bed/bedroom for sleep and or sex only (no reading from digital devices, or watching TV etc.).

• Arise at the same time every morning

• No napping, etc.. 

 

The following limitations of non-pharmacological management have been identified from research studies with respect to insomnia:

• Improvement in sleep onset or total sleep time are not immediately achieved.

• Patient cooperation is required for management success.

• Skilled therapist is required.

• Therapy is time intensive and expensive

 

Takeaway

There are like 80 to over 100 different conditions that make up sleep disorders. These are grouped into two; i.e. Dyssomnia or Parasomnia.

The three commonest sleep disorders globally are in the dyssomnia group and include Insomnia, Sleep apnea and Restless leg syndrome.

Due to the pressures and circumstances of daily living, you like many others worldwide may have occasional trouble falling asleep, staying asleep, and having refreshing and satisfying sleep. This does not necessarily mean that you suffer from sleep disorder.

If you think that you may have a sleep disorder, speak early with your doctor or other healthcare provider in order to be professionally evaluated, diagnosed and treated appropriately for return to better sleep quality and sustenance of quality health.

Do not self-medicate yourself for a perceived sleep disorder.

Also do not use dietary supplements and herbs without talking with your doctor or pharmacist.

 

  

                         

 

 

Resources

 

 

Related:

 

Normal Sleep: What African should know

 

 

 

Slideshow: Who is at risk of major sleep disturbances?

 

 

 

 

Sleep medications: Types, Uses and Side effects

 

 

 

Snoring

 

 

 

 

Published: February 7, 2023

© 2023. Datelinehealth Africa Inc.

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