INSOMNIA

INSOMNIA; UNDERLYING FACTORS AND STRATEGIC SOLUTIONS

As much as people may dislike sleep genuinely or not, it still doesn’t disprove the fact that sleep is essential to every human being as it revitalizes us. A lack of sleep due to any reason can result to Insomnia which is also known as sleeplessness. Insomnia is a situation of sleep disorder where people have trouble sleeping. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood.  Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.  Insomnia can occur independently or as a result of another problem. Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol. Other risk factors include working night shifts and sleep apnea. Diagnosis is based on sleep habits and an examination to look for underlying causes. A sleep study may be done to look for underlying sleep disorders. Screening may be done with two questions: "do you experience difficulty sleeping?" and "do you have difficulty falling or staying asleep? People who are more likely to suffer from insomnia include: travelers - particularly through multiple time zones, shift workers with frequent changes in shifts (day vs. night), the elderly, drug users, adolescent or young adult students, pregnant women, menopausal women, those with mental health disorders, etc.

TYPES

Insomnia can be classified as chronic insomnia, transient insomnia, and acute insomnia.

A. Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.

B. Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.

C. Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.

CAUSES

Psychological factors and physical factors are some of the causes of insomnia. Sometimes an underlying medical condition causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. The causes are however due to:

1. Disruptions in circadian rhythm - jet lag, job shift changes, high altitudes, environmental noise, extreme heat or cold.

2. Psychological issues - bipolar disorder, depression, anxiety disorders, or psychotic disorders.

3. Medical conditions - chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases, hyperthyroidism, arthritis, brain lesions, tumors, stroke.

4. Hormones - estrogen, hormone shifts during menstruation.

Several small studies in adults and children have suggested that an exposure to light from televisions and smart phones prior to going to sleep can affect natural melatonin levels and lead to increased time to sleep. According to a study conducted by Rensselaer Polytechnic Institute found that backlit tablet computers can affect sleep patterns. These studies suggest that technology in the bedroom can worsen insomnia, leading to more complications.

MEDICATIONS

According to the American Association of Retired Persons (AARP), the following medications can cause insomnia in some patients: corticosteroids, statins, alpha blockers, beta blockers, SSRI antidepressants, ACE inhibitors, ARBs (angiotensin II-receptor blockers), cholinesterase inhibitors, second generation (non-sedating) H1 agonists, glucosamine/chondroitin, etc.

SIGNS AND SYMPTOMS

Signs and symptoms that are associated with insomnia include: Difficulty falling asleep at night, waking during the night, waking earlier than desired, daytime fatigue or sleepiness, Irritability, depression, or anxiety, being uncoordinated, an increase in errors or accidents, tension headaches (feels like a tight band around head), Sleep deprivation, etc.

TREATMENT OPTIONS

Some types of insomnia resolve when the underlying cause is treated or wears off. In general, insomnia treatment focuses on determining the cause. Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioural) treatments may be used as therapies.

Non-pharmacological approaches and home remedies for insomnia include:

a. Improving "sleep hygiene" - not sleeping too much or too little, exercising daily, not forcing sleep, maintaining a regular sleep schedule, avoiding caffeine at night, avoiding smoking, avoiding going to bed hungry, and ensuring a comfortable sleeping environment.

b. Using relaxation techniques - such as meditation and muscle relaxation.

c. Cognitive therapy - one-on-one counselling or group therapy.

d. Stimulus control therapy - only go to bed when sleepy. Avoid watching TV, reading, eating, or worrying in bed. Set an alarm for the same time every morning (even weekends) and avoid long daytime naps.

e. Sleep restriction - decrease the time spent in bed and partially deprive the body of sleep, this increases tiredness ready for the next night.

Other medical treatments for insomnia include: prescription sleeping pills, antidepressants, over-the-counter sleep aids, antihistamines, melatonin, ramelteon, etc. Visiting the hospital to seek your doctor’s recommendation (if you are experiencing Insomnia) is also important.

SOURCE: MEDICALNEWSTODAY