Insomnia ashansiam February 9, 2022

What is Insomnia?

  • Insomnia is when a person either has difficulty in falling asleep or staying asleep. And in some people, it presents as waking up way too early and being unable to go back to sleep. Everyone has trouble sleeping sometimes but when it lasts for a long time it becomes a problem. Acute insomnia is when it lasts for days to weeks. Chronic insomnia is when it lasts more than a month.
  • People with insomnia tend to feel sleepy during day time. This affects their daily functioning and productivity. They can get irritable. They may have problems with attention and memory too!
How much sleep do you really need?
  • The sleep time differs with age. As a person grows older the time spent sleeping declines. A newborn sleeps around 16-18 hours per day. Adults need about 7-8 ½ hours of sleep. Some people tend to sleep less than this. If you wake up feeling fresh and not feel sleepy during day time, it means that you are getting adequate sleep at night.
  • What time should you go to bed? Find out using our bed time calculator
What are the complications associated with insomnia?
  • As a result of excessive daytime sleepiness, those with insomnia tend to perform poorly at their jobs. Falling sleep at the wheel can lead to road traffic accidents. Some people get depressed.
  • Insomnia is also associated with increased risk of heart attacks and high blood pressure.
  • Inadequate sleep can shorten the life expectancy.
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What can cause insomnia?
  • Stress,
    • Stress at work, financial worries, health related worries, divorce or death of a loved one can lead to insomnia. Any thought/ worry that keeps the mind active at night will give rise to insomnia.
  • Poor sleep hygiene – Poor sleep hygiene practices lead to insomnia. Refer to our section on sleep hygiene.
  • Long distance travelling/ jet lag – when a person travels from one time zone to another, it can this disrupts the internal body clock and give rise to insomnia. This is generally short lasting.
  • Shift work/ night shifts – those who work night shifts have a disruption of their sleep wake cycles.
  • Screen time – spending time looking at phone screens/digital tablets can disrupt sleep and lead to insomnia.
  • Medications – some medications can interfere with sleep. Ex; diuretics, some antidepressants, caffeine containing preparations.
  •  Stimulants,
    • These interfere with sleep. There are three common culprits.
    • Coffee /caffeine – drinking coffee late in the evening prevents sleep. Other commonly consumed food items that contain caffeine include certain popular fizzy drinks and chocolate.
    • Nicotine – smoking has a stimulant effect, preventing sleep.
    • Alcohol – promotes sleep but prevents deep sleep and can lead to waking up in the middle of the night.
  • Other disease conditions,
    • Obstructive Sleep apnea – the intermittent awakenings disrupts sleep.
    • Gastro-esophageal reflux disease (GORD) – heartburn.
    • Poorly controlled asthma – wheezing tends to keep up the patients at night.
    • Chronic obstructive pulmonary disease (COPD) – shortness of breath/wheezing prevents sleep.
    • Chronic pain – pain prevents falling asleep or it can wakes the patient up.
    • Restless legs syndrome – these patients get an unpleasant sensation in their legs, and an irresistible desire to move their legs therefore preventing sleep.
    • Alzheimer’s disease.
    • Parkinson Disease.
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When should you suspect Insomnia?
  • You could be having insomnia if you have,
    • Trouble falling asleep at night.
    • Waking up in the night.
    • Waking up early and unable to fall asleep.
  • Symptoms of inadequate sleep such as,
    • Day time drowsiness – you may fall asleep while driving or while talking to a friend.
    • Irritability/ mood changes.
    • Difficulty concentrating.
    • Forgetfulness.

What should you do if you think you have insomnia?

  • Take a 60 second test online to check if you are at risk of having Insomnia.
  • If you think you have any of the symptoms and signs mentioned above or you completed the above 60 second test and the result came up as moderate or high for insomnia, please visit your nearest doctor.

How is insomnia treated?

  • The most important aspect of treatment is to identify and treat any underlying cause or precipitant.
  • Sleep better! – maintain good sleep hygiene.
    • Please see our chapter on Sleep Hygiene to improve your sleep.
Maintain a sleep diary!
  • Download a sleep diary.
  • A sleep diary should be maintained for 14 days.
  • This will give you and your doctor a good understanding of your sleep habits.
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Cognitive behavioral therapy
  • This is a form of psychological therapy. The psychologist and the patient work together to make a plan/ treatment strategy. This involves several sessions.
  • Sleep education – the patient is informed about sleep and insomnia.
  • Sleep restriction therapy – this involves reducing the time spent in bed. This is carried out in multiple sessions.
  • Sleep compression – this is another less intensive sleep reduction therapy, where there is a gradual reduction in time spent in bed.
  • Stimulus control therapy – helps the patient to re learn the association between the sleep environment and rapid onset of sleep. This involves a set on instructions to stop the patient from struggling to fall asleep and to increase the chance of quickly falling asleep. Eg – go to bed only when sleepy, if you are unable to sleep get out of bed and stay somewhere until sleepy again, avoid daytime naps, wake up at the same time in the morning regardless of the time spent sleeping, and use the bedroom only for sleep (and sex), do not eat, work watch television/videos etc in bed.
  • Cognitive therapy – this involves identifying thoughts that lead to negative emotions. Eg thoughts that can increase arousal and delay sleep.
  • Relaxation – Relaxation helps sleep. Two common techniques are progressive muscle relaxation and diaphragmatic breathing. In progressive muscle relaxation, the patient focuses on specific group of muscles, then tenses and relaxes the muscles. In diaphragmatic breathing, the patient sits in a chair, with both feet on the floor. He or she places on hand on the chest and one on the tummy with the little finger about 1 inch above the belly button. Then breath very slowly through the nose, using only the diaphragm, with minimal use of the chest muscles. Only the hand on the belly should move. Count “in” when breathing in (eg 1 in, 2 in) and “out” when breathing out. Do 10 breaths counting forward from 1-10 and 10 breaths counting backwards from 10-1.
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Medication in insomnia
  • There are many types of sleeping tablets. However they are not usually recommended to take. The problems in taking sleeping tablets are, daytime sleepiness, tolerance (with time the usual dose will lose effect), addiction (some people become dependent on sleeping tablets).
Other treatments methods
  • Other medicines that may be used to help sleep include melatonin and some antihistamines.
  • Herbal remedies are used by some people to help with sleep.
  • However, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended.
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