Insomnia : An Overview

What is insomnia?

Have you ever suffered from a difficulty in falling asleep or frequent night time awakenings? For most people, the answer is yes.

Insomnia (or sleep disturbance) is a common symptom with a prevalence rate of 30-40% in the general population. But a single episode of sleep disturbance is not a serious problem. The rate of significant insomnia disorder is only 5-10%.

So, what is insomnia and when should it be called clinically significant?

Here we will examine the causes and best treatment options.

How to cure insomnia -

What is insomnia?

Persistent problems falling asleep, maintaining sleep or poor quality of sleep for at least 3 days a week for one month is considered clinically significant insomnia. It is most commonly a symptom rather than a disease itself. It may be due to any specific underlying diseases or without any identifiable causes.

What are the types of insomnia?

If insomnia is temporary, it is termed as acute insomnia.

When it’s persistent and mostly due a specific cause it is known as chronic insomnia.

It may also be classified as primary or secondary depending on the causes.

  1. Primary insomnia: no identifiable cause
  2. Secondary insomnia: due to an underlying disease.
What are the causes of insomnia?

Your insomnia may be a result of wide range of factors. Here are some probable causes:

Causes of Primary insomnia:

  • Psychophysiological insomnia: difficulty initiating and maintaining sleep with associated somatized tension anxiety; over-concern with the inability to sleep, and learned sleep prevention
  • Paradoxical insomnia: also called ‘sleep state misperception’: patient complains of little or no sleep without objective evidence of sleep disturbance
  • Adjustment sleep disorder: sleep disturbance temporally related to stress, conflict or environmental change causing emotional arousal. The disorder usually resolves once the stress is no longer present
  • Inadequate sleep hygiene: clinically significant disruption of the normal sleep/wake schedule due to a wide range of daily living activities (eg level of coffee consumption or frequent late nights)
  • Idiopathic insomnia: Rare, lifelong inability to sleep adequately

Secondary or comorbid causes of insomnia

  • Sleep disorders classified elsewhere: sleep-related breathing disorders; circadian rhythm disorders; sleep-related movement disorders
  • Insomnia due to medical condition: pain (arthritis, peptic ulcer, headache), respiratory disorders (COPD, cystic fibrosis, asthma), diabetes, Parkinson’s disease, endocrine disorders (Addison’s disease, Cushing’s syndrome)
  • Insomnia due to mental disorder
  • Drugs and alcohol

Several drugs may cause insomnia. As an example, antidepressants (MAOIs, SSRIs, venlafaxine or reboxetine); anti-Parkinsonian medication; bronchodilators (aminophylline, theophylline or pseudoephedrine); cardiovascular medication (β-blockers, clonidine, high-dose digoxin, verapamil); chemotherapy agents; corticosteroids/anabolic steroids; NSAIDs (high-dose); stimulants (dexamfetamine methylphenidate, amphetamines, cocaine, caffeine, nicotine); levothyroxine withdrawal/dependency (hypnotics, opiates, alcohol, or cannabis)

What are the symptoms of insomnia?

You will suffer from various problems if your sleep is affected…

  1. Difficulty in falling asleep
  2. Trouble with maintenance of sleep
  3. Excessive daytime sleepiness
  4. Irritability
  5. Inability to concentrate
  6. Inadequate sleep quality or duration
  7. The problem persists in spite of having the opportunity to sleep
How does it affect people?

Insomnia is a risk factor for developing depressive, anxiety and substance abuse disorders. Insomnia is associated with motor vehicle accidents, work absenteeism, and reduced quality of life.

How to cure insomnia?

There are effective treatments available for insomnia. In the case of secondary insomnia you need to receive treatment for the underlying disease first. For primary insomnia, both pharmacological and non-pharmacological treatments are available.  The best treatment for insomnia is non-pharmacological. If still the problem persists, your doctor will advise you some drugs.

How can I get rid of insomnia without drug therapy?

There are several pointers you can follow to improve your quality of sleep. Try to follow the advice below.

  1. Cognitive behavioral therapy (CBT)

The aim of CBT is to break the cycle of insomnia. Poor sleep quality leads to stress and makes you anxious about not being able to sleep. This, in turn, causes further tension and anxiety which makes your sleeping habits poorer and can lead to the development of dependency on sleeping pills… Then a worsening of insomnia and so the vicious cycle goes on. Contact a psychiatrist for proper advice regarding CBT.

  1. Maintain sleep hygiene

        Establish good sleep habits:

  • Control environmental factors (noise, light, temperature)
  • Avoidance of caffeine-containing drinks after about 4pm
  • Not smoking for at least an hour before bed
  • Regular exercise (not late at night)
  • Avoid drugs causing insomnia

      Stimulus control:

  • Go to bed only when sleepy; avoid other activities (with the exception of sex) whilst in bed. If sleep does not occur, do not remain in bed for more than 10–20 minutes, get up and go to another room (without turning on all the lights), returning to bed only when sleepy
  • Establish a regular time to get up with no more than 1 hour variation (even at weekends and during holidays)
  • Sleep restriction if your sleep is fragmented… A sleep restriction strategy may help you to reduce total time spent in bed and improve the quality of sleep by consolidation. Try to maintain a sleep-wake diary
What are some medications available for insomnia?

There are different groups of drugs available for insomnia.

This, though, is the last option only if non-drug treatment does not work for you. Contact your doctor and he will assess your conditions to exclude any secondary causes. If any underlying disease is present, it must be treated first.

The drugs available are benzodiazepines like clonazepam, diazepam, bromazepam as well as non-benzodiazepines like zolpidem, zopiclone or zopeplon. The drug most suitable for you will be selected by your doctor.

To conclude, insomnia may be a tiresome experience but it’s not incurable. If not properly treated, it may affect your daily life severely. Don’t panic as it will just worsen the problem.

Contact your doctor as soon as possible to choose the best treatment for your insomnia and lead a happy life.

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