Microbeads, memory foam, ear plugs, blackout curtains, camomile tea, hot bath, warm milk, melatonin... most of us would get drowsy just reading this list.
But for insomniacs, these items are among the things they will try in their eternal quest for a good night's sleep.
Many people do have trouble falling asleep once in a while, but for at least 5 to 10 per cent of the population, sleeplessness is a serious issue that can lead to ever-increasing doses of sleeping pills, health complaints such as diabetes, heart disease, depression and even death.
According to the American Academy of Sleep Medicine, about 30 per cent of adults have symptoms of insomnia. It is more common among elderly people and women.
Dr Lim Li Ling, director of the Sleep Disorders Unit at the Singapore General Hospital, said insomniacs usually have trouble falling asleep and staying asleep. Or, they wake up too early in the morning, feeling unrefreshed.
'It leaves sufferers exhausted, irritable and unable to concentrate on simple tasks,' she said.There are many types of insomnia.
The three most common ones are: insomnia related to an underlying mood disorder such as depression or anxiety; psychophysiologic insomnia which relates to underlying medical problems and personality of the sufferer; and acute or adjustment insomnia, which refers to sleeplessness brought on by a sudden shock such as the death of a loved one.
The second group of people don't have a clear underlying cause, said DrRathi Mahendran, vice-chairman (clinical & training), Medical Board, Institute of Mental Health.
'These people tend to have an anxious, worrisome style and spend a lot of time worrying a lot about their sleep difficulties. They may sometimes hold unrealistic expectations about their sleep requirements,' Dr Mahendran said.
Insomnia is on the rise among all age groups simply as a result of modern life, said Dr Lim. She added that insomnia is very much a behavioural-psychological problem, dogged by overuse of sleeping pills
'You have so many distractions: television, the Internet, mobile phones. People find it hard to wind down and can get overstimulated,' she said.
There is also insomnia brought on by shift work, which can mess with the body's innate sleep mechanisms. It is estimated that shift workers get an hour's less sleep per night on average, than people who work day hours.
Dr Lim points out that work-related sleep deprivation is high particularly among nurses, frequent travellers and among her own medical colleagues, who may be on call 24 hours a day.
With the modern pace of life, many people view sleep as an indulgence or luxury, but it is vital for good health, as important as exercise and eating right.
'People don't realise just how bad it is for your body not to get enough sleep,' she said.
Sleep medicine is a relatively new field but research is already throwing up a wealth of information. Sleep is a daily renewal system that helps build concentration, consolidates memory and aids the repair of cells damaged during the day.
A chronic lack of sleep lowers your immunity and ups the risk of illness and accidents. People deprived of sleep for long periods can develop hallucinations and other mental problems.
While popular wisdom cites eight hours of sleep as the perfect amount, sleep is personal and a variable entity.
Dr Lim said the ideal sleep duration is anywhere between six and eight hours.
'The relationship between sleep and longevity is that of a U-shaped curve. People who get too little or too much sleep live shorter lives than those who fall somewhere in the middle,' she said.
The amount also changes with the life cycle. Babies sleep an average of 16 hours while adolescents need nine to 10 hours of sleep to function well.
Adults need between six and eight hours while older adults tend to need the same amount but experience more fragmented sleep due to frequent awakening. Dr Lim said that this is a natural result of degeneration of the brain's normal sleep-wake mechanism.
Ms Doris Sng (not her real name), 30, started suffering from sleep problems when she was 20 years old. She was working as a hostess in a club and she often got home from work at 6 or 7am. She would normally sleep till about noon or 1pm, but needed the sleeping pill, Dormicum, even for those few hours.
Dormicum is from a class of drugs call benzodiazapenes, which can be habit forming. The patient develops tolerance and starts needing higher and higher doses to get the same effect.
Ms Sng experienced an addiction so severe she would take up to eight pills a night, compared to the one pill she took initially. Yet, she suffered the after effects of drowsiness and depressed mood.
'I just felt so lost all the time,' she said.
She worked the night shift for six years before becoming a masseuse and had day hours. But she found that she could not sleep at night. The pills were not working and she was tired all the time so she decided to see a specialist.
It took a great effort to kick her addiction to Dormicum. MsSng was given a newer non-habit forming drug called Stilnox, for short term use, to be tapered off under the supervision of her doctor. She now takes half a tablet of Stilnox with a muscle relaxant to help her sleep. She also exercises every day and tries to keep caffeine and alcohol to a minimum.
Last month, she enrolled in a Cognitive Behavioural Therapy (CBT) programme which has proven to be one of the more effective therapies for insomnia.
'They taught me some relaxation exercises,' she said.
Dr Lim said that even though CBT is effective, it is not very popular with patients here. It involves changing your behaviour and most people still want the quick fix of a pill.'
Stage 1 is drowsiness lasting about five or 10 minutes. Stage 2 is light sleep, during which eye movements stop, heart rate slows and body temperature decreases. Stages 3 and 4 are called deep sleep and Rapid Eye Movement (REM) sleep or dream sleep. This is supposed to occur about 70 to 90 minutes into the sleep cycle and the eyes jerk in various directions under the eyelids. There are usually three to five REM episodes per night.
This story was first published in the Mind Your Body supplement on Apr 9, 2008.
