What is insomnia?
Insomnia is a common sleep disorder characterised by the difficulty to fall asleep or stay asleep. It can make you wake up many times during the night or wake up too early in the morning. The result is poor sleep quality and lack of rest.
This disorder can significantly affect your quality of life, and the most immediate consequences are daytime sleepiness, reduced focus, and inability to keep an active life. In the long term, it can influence the development of other diseases.
How many hours of sleep is sufficient varies from individual to individual, but most adults require seven to eight hours.
Types of insomnia
- Short-term insomnia: many adults can suffer short-term insomnia at a certain point, lasting for a few days or weeks. It is often due to stress or a distressing situation that worries the person.
- Long-term insomnia: some people have long-term or chronic insomnia for more than a month. Insomnia may be the root problem or the outcome of another disorder or medication. This disorder impacts the person’s daily life and can have physical and psychological problems.
Causes
The causes of insomnia can be categorised depending on its origin.
Causes related to sleep hygiene or psychological factors:
- Physiological changes: ageing produces changes in the sleep pattern. Older people usually sleet fewer hours, and the sleep quality is lower, increasing the daytime sleepiness.
- Medication: some drugs can alter sleep. For instance, antidepressants, antihypertensives, bronchodilators, anticholinergics, decongestants, stimulants, or steroids.
Insomnia can be caused by another medical or psychological condition or environmental factors:
- Physical and psychological conditions: examples of diseases that can interfere with sleeping are cardiovascular disorders (heart failure, cardiac arrhythmia), pulmonary disorders (asthma, chronic obstructive pulmonary disease), endocrine disorders (thyroid disease), or neurological disorders (Parkinson, dementia, headaches). Also psychological problems such as , eating disorders (anorexia), depression or anxiety.
- Environmental factors: for example, too hot or too cold environments, or constant timetable changes due to shift work or jet-lag, can impact the circadian rhythm.
Symptoms
Insomnia symptoms are easy to identify, as the person notices issues to fall asleep, or he wakes up many times at night or too early in the morning. Therefore, the main symptoms are:
- Problems falling asleep at night
- Waking up several times during the night
- Waking up too early in the morning
- Daytime sleepiness, not feeling well-rested
- Tiredness
- Weakness
- Problems focusing on activities
- Problems processing information
- Irritability
- Depression and anxiety
- Worry thoughts
Prevention
Overall, good hygiene sleep helps to prevent insomnia and other issues related to lack of rest. The following are some tips to improve sleep:
- Use the bedroom only for sleeping. Avoid working, eating or doing any other activities in the bedroom. This helps the brain to associate bed with sleep.
- Adapt the bedroom temperature, so it is not too cold or hot.
- Create a relaxed and comfortable environment, modulating the light and avoiding noises.
- Switch off smartphones and keep them in another room while trying to sleep.
- Get the habit to go to bed at the same time every day.
- Do relaxation techniques, such as mindfulness or breathing techniques, work before sleeping.
- Avoid intense exercise before bedtime.
- Avoid heavy meals before sleeping.
- Limit the amount of liquid drank before sleep. This reduces the necessity to go to the bathroom in the middle of the night.
Diagnosis
The doctor will evaluate the person’s sleeping pattern if he uses medication, alcohol or drugs, the level of psychological distress, the clinical history, and physical activity levels. Some people need fewer hours of sleep than others; hence the insomnia diagnostic is personalised and based on individual needs.
Knowing the cause of the insomnia is needed to find the best treatment for the person. Therefore, physical exploration is needed to identify other possible conditions. Sometimes, insomnia is a symptom of depression or anxiety.
It is also relevant to understand the patient’s sleep hygiene, as well as the amount of alcohol or caffeine ingested at night, or if there is any family member with insomnia.
Treatment
Psychotherapy
Cognitive-behavioural therapy (CBT) is the most successful type of therapy for certain types of insomnia. The goal is to improve sleep hygiene, control the stimulus that causes insomnia and regulate timetables:
- Go to bed only when you feel sleepy.
- Don’t watch television, read or eat in the bed
- Limit external noises and smartphones as much as possible
- Go to sleep one hour after the last meal
- Avoid heavy meals at night
- Avoid alcohol consumption at night, as it reduces the total amount of sleep
- Reduce the caffeine and tobacco intake
- Relaxation therapies
- Establish a routine to set up the biological clock
- Address anxiety or stress
If you tend to worry a lot, these are some tools used in CBT therapy to stop worrying and rumination.
Medication
Medication can be used to treat insomnia symptoms or the physical and psychological conditions that cause it. Hypnotic drugs can help with insomnia symptoms, and other medications such as antidepressants, neuroleptics or anxiolytics, help with other conditions.
These drugs can cause addiction or make insomnia worse, so it is essential to follow the advice of a doctor.
Benzodiazepines are often used for insomnia. They can produce sedative or depressor effects on the central nervous system and muscle relaxation that can cause apneas. If used in the long term, these drugs can increase the risk of Alzheimer. Hence, it is established that people shouldn’t take them longer than 12 weeks.