“The best cure for insomnia is to get a lot of sleep”

Insomnia is the difficulty or inability to fall asleep at night, that results in unrefreshing or non-restorative sleep. Sleep deprivation significantly affects the wellbeing of an individual, mental and physical health, and impacts quality of life.

In the modern era, a large section of the population struggles to sleep at night, no matter how tired they may be. Many people wake up in the middle of the night and lie awake for hours anxiously watching the clock.

Why are People Sleep Deprived?

Insomnia can be caused by physical and psychological factors. There is sometimes an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Some common causes of insomnia are:-

• Disruptions in Circadian rhythm – Jet lag, jobs that involve shift changes, travel to high altitudes, environmental noise, extreme heat or cold.
• Psychological issues – Bipolar disorder, depression, anxiety disorders, or psychotic disorders.
• 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, tumours, stroke.
• Hormones – Estrogen, hormone changes or imbalances during menstruation.
• Other factors – sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, pregnancy.

Some Medications that can disturb sleep and precipitate insomnia include:-

• 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

How Do You Spot Insomnia?

Disturbed sleep and insomnia re easy to recognise by observing signs and symptoms. Though insomnia itself may be a symptom of an underlying medical condition, some many signs and symptoms are associated with insomnia such as:-

• Difficulty in falling asleep at night
• • • • Waking up in the middle of the night
      • Waking up earlier than normal
      • Feeling tired after a night’s sleep
      • Daytime fatigue or sleepiness
      • Irritability, depression, or anxiety
      • Poor concentration and focus on tasks
      • Being uncoordinated, an increase in errors or accidents.
      • Frequent tension headaches (feels like a tight band around the head).
      • Difficulty in socializing
      • Gastrointestinal symptoms
      • Worrying about sleeping

Types of Insomnia

Though insomnia appears to be primarily the lack of good sleep, it includes a range of sleeping disorders under its umbrella. While some disorders affect the quality of sleep, some affect the quantity of it. Based on this, insomnia can be categorised into three types:

• Transient insomnia – Insomnia when the symptoms last for up to three nights.
• Acute insomnia – This type is also called short-term insomnia. Its symptoms can last for well over several weeks.
• Chronic insomnia – As the name goes, this type of insomnia lasts for months, or even years sometimes.

How can Insomnia be Diagnosed?

To find the best possible cure for insomnia, patients are usually referred to a sleep specialist, who begins his/her consultation by asking a thorough medical history, sleep patterns, and history of psychiatric disorders, drug and/or alcohol abuse.

This is followed by a physical examination, that may be conducted to detect any underlying conditions that the patient may have.

To diagnose for insomnia, the individual must have a disturbed sleep that should have lasted over 1 month and should have impacted the patient’s lifestyle and wellbeing negatively by causing stress, mood swings, disturbed mood, poor performance at work, short temper, and lack of patience. The doctor may advise the patient to start keeping a sleep diary that can help both understand the patient’s sleep patterns.

Some other tests that are conducted include:

Polysomnograph- This is an overnight test that is used to record the sleep patterns in individuals suffering from insomnia.

Actigraphy- This is a diagnostic test that uses a device to be worn on the wrist, called an actigraph, that measures movement and sleep-wake patterns.

Are There any Risk Factors of Insomnia?

Insomnia isn’t a disorder of the old and troubled only. It can affect people of any age; and is more common in adult females than adult males. It can affect the individual’s performance at work and school, resulting in obesity, cause mental health ailments like anxiety, depression, and irritability, cause concentration and memory problems, and also reduce immune system function.

Treating Insomnia 

The treatment for insomnia is multifactorial. However, some common ways to manage the disorder include:

• Sleeping pills
• Antidepressants
• Sleep aids available online or in the medical shops
• Antihistamines
• Melatonin-based drugs or supplements
• Ramelteon

A word of caution while using sleep medicines is their dependency on the body and possible side effects. Apart from the medical management of insomnia, there are a host of home remedies that can be followed daily. Some of these include:

• Better sleep Discipline: Not sleeping too much or too little, sleeping on time
• Regular workouts
• Avoiding forced sleep
• Maintain a regular sleep schedule
• Avoiding caffeine at night
• Steer clear of smoking and alcohol before bedtime
• Never sleep hungry
• Maintain a peaceful, relaxing environment in your bedroom that can help you fall asleep
• Using relaxation techniques like meditation, breathing exercises and muscle relaxation.
• Stimulus control therapy – Go to bed only when sleepy. Avoid watching TV, use your mobile phone, reading or eating in bed. Set an alarm for the same time every morning (even weekends) and avoid long daytime naps.
• Sleep restriction: Decreasing the time spent in bed and partially depriving the body of sleep can increase tiredness, ready for the next night.

Practising yoga, exercise and walks if practised daily or atleast 2-3 times in a week can help:

• Reduce stress and negativity
• Enable you to have a sound sleep
• Reduce cortisol levels
• Improve many medical conditions
• Provide allergy and asthma relief
• Lower blood pressure
• Lower heart rate
• Reduce anxiety and muscle tension
• Increase strength and flexibility
• Slow down the ageing process

Insomnia can severely impact one’s life in multiple ways if not treated promptly. In the medical world, it is quite an overlooked disorder and symptom and it is time we check our patients for insomnia!