Losing sleep now and then is not unusual. In fact, just about everyone experiences sleepless nights at some point of time. Yet, by any conservative estimate, today insomnia is the most common symptom conveyed to a General Physician or a Psychiatri
Losing sleep now and then is not unusual. In fact, just about everyone experiences sleepless nights at some point of time. Yet, by any conservative estimate, today insomnia is the most common symptom conveyed to a General Physician or a Psychiatrist. Experts feel that Insomnia is increasingly surfacing as the New Age health concern, even though it is not a disease or disorder by itself. In fact, it is a symptom of an underlying behavioural problem. According to studies, these behavioural problems are largely owing to the fast paced lifestyles of individuals in urban metros.
Insomnia further leads to various psychosomatic problems like depression, anxiety, additions, severe nervousness, nail-biting, fidgeting, lack of concentration, lack of motivation, lack of self-confidence, lack of self-esteem, obsessional behaviour, over-eating, phobia's, panic attacks and stress.
Understand Insomnia and curb and control your way of life because some things are just not worth losing sleep over.
Types of Insomnia
Insomnia, usually temporary, is often categorized by how long the phase lasts:
- Transient insomnia lasts for a few days and for no more than three weeks
- Chronic insomnia occurs when the following characteristics are present:
- When a person has difficulty falling asleep, maintaining sleep, or re-sleeping after being woken up for at least three nights a week for one month or longer
- In addition, the patient is disturbed because of this and believes that normal daily functioning is impaired because of sleep loss
Causes of Transient Insomnia
Response to change or stress
A reaction to change or stress is one of the most common causes of short-term insomnia. The precipitating factor could be a major or traumatic event. Temporary insomnia could also develop after a relatively minor event, like extremes in weather, an exam, travelling, trouble at work.
In such cases, normal sleep almost always returns when the condition resolves, the individual recovers from the event, or the person becomes acclimated to the new situation. Treatment is usually not required.
Causes of Chronic Insomnia
Following Transient Insomnia
An episode of transient insomnia disrupts the person's circadian rhythm. The patient begins to associate the bed not the rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges. Over time, this event repeats, and bedtime becomes a source of anxiety. Once in bed, the patient think about his sleeplessness and all attempts to sleep fail. A cycle is established
Medical Conditions and Treatments
Among the many medical problems that can cause insomnia are allergies, arthritis, cancer, heart disease, gastroesophageal reflux disease (GERD), hypertension, asthma, rheumatologic conditions, Alzheimer's disease, Parkinson's disease, hyper-thyroidism, and attention deficit hyperactivity disorder. Several medications including anti-depressants and cardiac drugs may cause insomnia as a side-effect.
A large percentage of chronic insomnia cases prove to have a mental basis. Patients with Anxiety, Depression and Psychiatric disorders show evidence of disrupted sleep on EEG (electroencephalogram - a test to measure brain activity).
Alcohol as a Cause of Insomnia
An estimated 10% to 15% of chronic insomnia cases result from alcohol, cocaine, and sedative addiction.
An imbalance in specific hormones important in sleep has been associated with aging and may be partly responsible for the higher incidence of insomnia in older people.
Sleep problems seem to run in families, with approximately 35% of people with insomnia having a positive family history, with the mother being the most commonly affected family member.
Effects of Insomnia
Sleep deprivation, and the daytime sleepiness that follows, is increasingly recognized as a cause of mood disruption and contributor to industrial errors and motor vehicle crashes. Though Indian statistics are lacking, insomnia costs the US approximately $13.9 billion each year in direct medical costs and unknown billions from decreased productivity and consequences of accidents.
Negative Effects on Thinking and Performance
Studies suggest that insomnia worsens many waking behaviours including the following:
- Reduced concentration
- Impaired performance
- Learning difficulties
- Cause of Alcohol and Substance Abuse
- Although alcohol and substance abuse can cause insomnia, insomnia may cause addiction in attempts to fall asleep
Effects on the Heart and Mortality Rates
Some studies have associated a higher risk of heart disease with shift work. More research is needed to confirm this finding.
Headaches that occur during the night or early in the morning may be caused by sleep disorders.
Behavioural or psychological techniques can actually cure chronic insomnia and studies report their effectiveness in nearly all patients with primary chronic insomnia. (Medications cannot cure this condition and prolonged use frequently results in dependency.)
Prevention of sleeplessness is very much dependent upon the patient's ability to relax and learn the art of sleeping well. Behavioural changes are effective and work better than drugs in all age groups, including elderly patients. Studies have reported that between 70% and 80% of those who are treated with non-drug methods experience improved sleep.
Experts recommend the following methods in order of effectiveness for patients with chronic insomnia:
Go to bed only when ready to sleep. If unable to sleep within fifteen to twenty minutes, get up and go into another room. Return to bed only when sleepy.
Relaxation Therapy: There are specific and effective techniques that can reduce or eliminate anxiety and body tension. The muscles can relax, and restful sleep can occur.
Paradoxical Intention: Paradoxical intention is a psychological approach that is based on doing the opposite of what one wants or fears and take it to extreme.
Patients are given feedback to recognize certain states of tension or sleep stages so that they can avoid them voluntarily.
Sleep Restriction Therapy
Sleep restriction therapy may be effective, although evidence is inconclusive.
Cognitive-Behavioural Therapy: Cognitive behavioural therapy (CBT) is a form of therapy that emphasizes observing and changing negative thoughts (such as, "I'll never fall asleep!")
Exercise may be one of the best ways to achieve healthy sleep. It gives you a feeling of wellbeing and contentment and helps you fall asleep.
Bright light can discourage drowsiness, and darkness can cause sleepiness, day or night. The use of a special light box may be helpful.
Many people are reluctant to consult with a psychologist or psychiatrist, yet insomnia is commonly caused by emotional disorders that can be successfully treated.
Drug treatments for Insomnia
Sleep medication should generally be used only to prevent insomnia in people with transient or short-term insomnia when non-medical treatments have failed and should be started and maintained only under medical supervision. Medication should be withdrawn gradually and the patient should be aware of the possibility of rebound insomnia when stopping medication.
Melatonin: Although melatonin is now commonly taken for insomnia, its actual effects are still unclear. Some studies have found that although many people fall asleep faster with melatonin, it has no effect on total sleep time or daytime feeling of sleepiness or fatigue.
High doses of melatonin have been associated with the following adverse events:
- Mental impairment
- Severe headaches
It may increase the risk for seizures in children with existing neurological disorders.
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