What is insomnia?
Insomnia is defined as a disorder that makes it difficult to initiate or maintain sleep, or both, despite adequate time and opportunity for a good sleep. Poor quality of sleep because of insomnia leads to a person waking up the next day tired and impairs daytime functioning. Insomnia does not only impair energy levels but also affects mood, health and the overall quality of life.
There are two types of insomnia:
- Primary insomnia, in which a patient has sleep problems that are not directly associated with any health condition.
- Secondary insomnia, which refers to sleep problems resulting from other health problems like depression, arthritis, cancer, heartburn, pain, substance use like alcohol, etc.
What are the causes of the disorder?
Common causes of insomnia include:
- Psychiatric issues – These may include:
- Stress – Health or family concerns, worry about work or school, or stressful or traumatic life events can keep the mind active at night, making it difficult to sleep, and lead to insomnia.
- Anxiety – Routine anxieties and post-traumatic stress disorders, or even worry about not being able to sleep make it difficult to sleep.
- Depression – Depression and other mental health disorders can cause trouble falling to sleep.
- Medical conditions – Health problems like arthritis, cancer, lung disease, heart failure, gastro-oesophageal reflux disease (GERD), hyperthyroidism, Alzheimer’s disease and Parkinson’s disease, along with chronic pain, breathing difficulties or need to urinate frequently can cause insomnia. Other sleep-related disorders like sleep apnoea and restless legs syndrome that become more common with age can also cause insomnia.
- Poor sleep habits – An uncomfortable sleep environment, stimulating activities before bed, or an irregular sleep schedule can result in insomnia.
- Medication – Some prescription drugs like allergy medication, heart and blood pressure medication, antidepressants, corticosteroids and stimulants, along with some over-the-counter (OTC) drugs like decongestants, weight loss medication and pain relievers can interfere with sleep.
- Stimulants – Some well-known stimulants are coffee, cola and tea, which contain caffeine that make it difficult to sleep. Though alcohol is a sedative and may initiate sleep, it prevents deeper stages of sleep by causing a person to awaken in the middle of the night.
- Irregular eating habits – Eating too much and too late in the evening can make a person feel uncomfortable while lying down. Many people experience heartburn or reflux of acid and food into the oesophagus that makes it difficult to fall asleep.
What one needs to know about symptoms or signs?
A person with insomnia usually takes more than 30 minutes or more to fall asleep and may get only six or fewer hours of sleep over a period of three nights or more a week.
Symptoms of insomnia include:
- Difficulty falling asleep at night
- Waking too early or in the middle of the night
- Feeling tired after a night’s sleep
- Daytime sleepiness or tiredness
- Irritability, anxiety, depression
- Inability to focus on work; increased errors
- Worry over sleep
Which specialist should be consulted in case of signs and symptoms?
Those facing sleep problems must talk to their general practitioner who may refer him/her to specialised doctors who can evaluate and treat insomnia. Pulmonologists or doctors who treat lungs can evaluate sleep apnoea or other sleep disorders. Neurologists with a speciality in sleep disorders may also treat various sleep ailments.
What are the screening tests and investigations done to confirm or rule out the disorder?
The doctor will begin evaluation by asking the patient a series of questions to ascertain his/her sleep-wake pattern and the level of daytime sleepiness. A physical exam will look for signs of other problems that could be causing insomnia.
Sometime, a blood test is recommended to check for any underlying thyroid issue that could be causing sleep disturbances.
More specific tests include monitoring and recording various body activities while a patient sleeps. This includes observing breathing, heartbeat, and brain waves, along with eye and body movements.
What treatment modalities are available for management of the disorder?
Correcting sleep habits and addressing any underlying causes of insomnia like medical conditions or medications can help restore sleep abnormalities. Treatment of insomnia can be divided into two approaches: non-medical or behavioural therapy and medical therapy.
A. Behavioural therapy
- Cognitive behavioural therapy – This therapy focuses on controlling or eliminating worries and negative thoughts that could disrupt sleep.
- Relaxation techniques – Breathing exercises, biofeedback and progressive muscle relaxation help reduce anxiety at bedtime.
- Sleep restriction – This treatment focuses on reducing the time spent in bed, leading to partial sleep deprivation that makes a person feel more tired the following night.
- Stimulus control – Limiting the time spent awake in bed and associating bedroom with only sleeping activities allows a person to fall asleep more easily.
- Light therapy – This therapy uses light to push back the internal body clock to adjust sleeping too early and awakening too early sleep rhythms.
- Passive wakefulness (paradoxical intention) – Learned insomnia is treated by reducing the worry and anxiety associated with sleeping. It allows a person to stay awake rather than focusing on falling asleep.
- Practising good sleeping habits – Maintaining a regular sleep schedule is important in correcting insomnia.
B. Medical therapy
- Prescription medication can help a patient get sleep at regular time. However, doctors do not rely on prescription sleeping pills for more than a few weeks, though there are some medications that can be used for longer periods.
- Non-prescription medications contain antihistamines that make a person feel drowsy. However, over-the-counter sleeping pills reduce the overall quality of sleep and may induce side effects like dizziness, daytime sleepiness, dry mouth and urinary retention.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Overall, insomnia can be treated as most cases result from transient stressful situations that get reversed once the situation is resolved. Medical and behavioural therapies prove useful in treating chronic cases, and lifestyle and home remedies are also helpful in treating the condition.
How can the disorder be prevented from happening or recurring?
Good sleeping habits lead to a restful sleep and allow for daytime alertness. Small changes in lifestyle and daily routine during the day and at bedtime can cure and prevent insomnia.
“An Overview of Insomnia,” WebMD.com, http://www.webmd.com/sleep-disorders/guide/insomnia-symptoms-and-causes
“Insomnia,” MayoClinic.com, Mayo Clinic Staff, http://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293
“Insomnia,” MedicineNet.com, http://www.medicinenet.com/insomnia/article.htm
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