It’€™s 3am and you are wide awake. Small sounds amplify into threatening burglars, tiny problems seem insurmountable’€¦ and the harder you try, the more sleep completely eludes you.

Insomnia ‘€“ or difficulty in falling asleep, maintaining sleep or waking too early ‘€“ afflicts most adults at some stage of their lives.

While many aspects of sleep are still a mystery to us, there is no doubt that all living creatures need sleep in order to survive. Mammals’€™ sleep has two phases: rapid eye movement (REM) sleep, during which time we dream; and non-REM or deep sleep, during which our blood pressure and heart rates are lower than normal.

An experiment conducted by Dr Allan Rechtschaffen of the University of Chicago’€™s Sleep Research Laboratory found that rats deprived of sleep died within two to three weeks. Deprived of REM sleep, the rats took seven weeks to die.

A lack of sleep can seriously disrupt people’€™s lives, making them less productive at work and more accident-prone. Driver fatigue accounts for a high percentage of car accidents, as sleep deprivation affects co-ordination, reaction time and judgement.

Usually insomnia is linked to changes in a person’€™s life such as a traumatic incident, medication or physical pain.

Given the violent nature of our society, both past and present, post traumatic stress is widespread in South Africa.

“Sleep disorders are one of the most common side-effects of post-traumatic stress,” says psychologist Mary Robertson, manager of the Trauma Clinic at the Centre for the Study of Violence and Reconciliation.

“People may experience restlessness, struggle to fall asleep and have nightmares in which they or their loved ones are in danger,” says Robertson, who counsels victims of a range of traumatic incidents ranging from car hijackings and armed robberies to car accidents, rape and human rights abuses.

“Sleep deprivation lowers a person’€™s emotional resources, often leaving them feeling low and emotionally depleted. It affects concentration and problem-solving. It can make a person more irritable,” adds Robertson.

While a person who has experienced a traumatic event can expect sleep disruptions for about four to six weeks, insomnia that persists for longer than that usually indicates an underlying medical or psychological cause.

Depression is a very common cause of chronic insomnia. A US study found that 80% of people with depression experienced sleep problems and that chronic insomnia was most common amongst women over the age of 65.

Caffeine, alcohol consumption before sleep, shift work, stress, sickness and pain (especially afflictions such as arthritis) are also common culprits causing insomnia.

The most common medical problem causing sleep disruptions is called apnea, which usually manifests itself in chronic snoring.

Sleep apnea is a medical condition in which a person does not get enough oxygen when sleeping. This is caused either by an obstruction in the throat during sleep (obstructive sleep apnea) or a delay in the signal from the brain to the breath (central sleep apnea).

The narrowing of the airways which causes obstructive sleep apnea is often the result of obesity or alcohol consumption before sleeping.

With both forms of apnea, the sleeper needs to wake up many times in the night to resume breathing. While sleepers often don’€™t remember waking in the night, by morning they feel tired and this affects their ability to function during the day.

Yvonne Glaser of the Sleepwake Sleep Laboratory in Johannesburg says that a large proportion of the patients referred to the laboratory by their doctors have sleep apnea.

“We offer a range of things including night time observation of patients to diagnose their problem,” says Glaser.

While the sleep laboratory is a private concern, it does have a telephone helpline which offers free advice to those with medically related sleep problems.

Another medical problem associated with sleep disorders is restless leg syndrome. While this may sound like an elaborate excuse offered by your partner after he or she has kicked you in the night, it is a genuine medical complaint.

People suffering from RLS jerk their legs every 20 to 40 seconds during sleep. This disrupts their sleep and causes them to wake up feeling exhausted.

Another sleep-related problem is narcolepsy, or the irresistible need to sleep. People suffering from narcolepsy can have “sleep attacks” at any time during the day.

Scientists believe narcolepsy is a disorder in the brain in the frontal cerebral cortex, where the regulation of sleep (along with speech, short term memory and flexible thinking) takes place. It causes REM sleep to intrude on wakefulness, and can be treated by life-long medication.

Medication can also be prescribed to treat insomnia, although some doctors are reluctant to prescribe sleeping pills when there could be an underlying psychological cause. Often anti-depressants are more effective than sedatives.

Aside from medication, sleep experts recommend maintaining regular hours, avoiding naps during the day or spending too much time in bed, avoiding alcohol, nicotine and caffeine.

A hot bath before bed to increase body temperature and a light snack are also seen to be beneficial, as is regular exercise ‘€“ but not too close to bed time.

People who become obsessively worried about an inability to sleep are advised to only go to bed when they are sleepy and to move to a different room if they are unable to sleep within 20 minutes of going to bed.

The Sleepwake Sleep Laboratory helpline for medically related sleep disorders is (011) 784 6367 or 073 181 1701. The Trauma Clinic (for counselling relating to post traumatic stress) can be contacted on (011) 403 5102.