Article: Insomnia

Insomnia is characterized by an inability to sleep and/or to remain asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a sleep disorder [1] [2]. It is oftenly caused by fear, stress, anxiety, medications, herbs or caffeine. An overactive mind or physical pain may also be a cause. Finding the underlying cause of insomnia is usually necessary to cure it.

Types of insomnia

Three different types of insomnia exist. Insomnia may be classified as transient, acute (short-term), and chronic. Insomnia lasting from one night to a few weeks is referred to as transient. This is generally the case for most people, as one often suffers from jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified to be intermittent. Acute insomnia is the inability to consistently sleep well for a period of three weeks to six months. However, after this time, the person does not experience insomniatic episodes. Insomnia is considered to be chronic, the most serious, if it persists almost nightly for at least a month, and sometimes longer.

Common causes of insomnia

A person can have primary or secondary insomnia. Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be generalized anxiety disorder.

Some of the most common causes of insomnia are:

  • Sleep apnea is a condition that occurs when a sleeping person's breathing is interrupted, thus interrupting the normal sleep cycle. With the obstructive form of the condition, some part of the sleeper's respiratory tract loses muscle tone and partially collapses. People with obstructive sleep apnea often do not remember any of this, but they complain of excessive sleepiness during the day. Central sleep apnea interrupts the normal breathing stimulus of the central nervous system, and the individual must actually wake up to resume breathing. This form of apnea is often related to a cerebral vascular condition, congestive heart failure, and premature aging.
  • Circadian rhythm sleep disorders cause insomnia at some times of the day and excessive sleepiness at other times of the day. Common circadian rhythm sleep disorders include jet lag and delayed sleep phase syndrome. Jet lag is seen in people who travel through multiple time zones, as the time relative to the rising and falling of the sun no longer coincides with the body's internal concept of it. The insomnia experienced by shift workers is also a circadian rhythm sleep disorder.
  • Parasomnia includes a number of disorders of arousal or disruptive sleep events including nightmares, sleepwalking, violent behavior while sleeping, and REM behavior disorder, in which a person moves his/her physical body in response to events within his/her dreams. These conditions can often be treated successfully through medical intervention or through the use of a sleep specialist.
  • Gastroesophageal Reflux Disease causes repeated awakenings during the night due to unpleasant sensations resulting from stomach acid flowing upward into the throat while asleep.
  • Mania or Hypomania in bipolar disorder can cause difficulty falling asleep. A person going through a manic or hypomanic episode may feel a reduced need for sleep. Sleep deprivation can worsen a manic episode, or cause hypomania to develop into mania.

A common misperception is that the amount of sleep one requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive. [3]

Insomnia is a common side-effect of some medications, and it can also be caused by stress, emotional upheaval, physical or mental illness, dietary allergy and poor sleep hygiene. Insomnia is a major symptom of mania in people with bipolar disorder, and it can also be a sign of hyper-thyroidism, depression, or other ailments with stimulating effects.

In addition, a rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called Fatal Familial Insomnia.

Treatment for insomnia

In many cases, insomnia is caused by another disease or psychological problem. In this case, medical or psychological help may be useful.

Many insomniacs rely on sleeping tablets and other sedatives to try to get some rest. The most commonly used class of hypnotics prescribed for insomnia are the benzodiazepines. This includes drugs such as temazepam, diazepam, lorazepam, nitrazepam and midazolam. These medications can be addictive, especially after taking them over long periods of time.

Non-benzodiazepine prescription drugs, including the Ambien and Lunesta, are quickly replacing benzodiazepines as a first-line treatment for insomnia, as these drugs show little to no possibility of addiction or dependence.

Some antidepressants such as mirtazapine, trazodone and doxepin have a sedative effect, and are prescribed off label to treat insomnia.

Low doses of Atypical antipsychotics such as quetiapine(Seroquel) are also prescribed for their sedative effect.

Some insomniacs use herbs such as valerian, chamomile, lavender, hops, and passion-flower.

Some claim to have overcome insomnia through the use of marijuana. Though there are no reliable sources to prove its effectiveness.

Some traditional remedies for insomnia have included drinking warm milk before bedtime, taking a warm bath in the evening; exercising vigorously for half an hour in the afternoon, eating a large lunch and then having only a light evening meal at least three hours before bed, avoiding mentally stimulating activities in the evening hours, and making sure to get up early in the morning and to retire to bed at a reasonable hour.

Traditional Chinese medicine has included treatment for insomnia throughout its history. A typical approach may utilize acupuncture, dietary and lifestyle analysis, herbology and other techniques, with the goal to resolve the problem at a subtle level. Although these methods have not been scientifically proven, some insomniacs report these remedies are sufficient to break the insomnia cycle without the need for sedatives and sleeping tablets[citation needed]. Warm milk contains high levels of tryptophan, a natural sedative. Using aromatherapy, including lavender oil and other relaxing essential oils, may also help induce a state of restfulness. Melatonin has proved effective for some insomniacs, mostly in regulating the sleep/waking cycle.

The more relaxed a person is, the greater the likelihood of getting a good night's sleep. Relaxation techniques such as meditation have been proven to help sleep. They take stress from the mind and body which leads to a deeper more restful sleep.[citation needed]

Alleviating insomnia

Helpful advice:

  • Sufferers of insomnia should avoid all caffeine. Caffeine is often a factor in insomnia, including insomnia in night-shift workers. Caffeine occurs in coffee, tea, yerba mate (Ilex paraguaiensis), guarana, Kola nut (this includes all cola drinks); also occurs in "energy" sodas like Red Bull and similar, chocolate bars and other candy. Drink herbal teas or plain water instead of caffeine-containing liquids. Although cocoa does not contain any caffeine, it contains another stimulant, theobromine. Some medicines contain caffeine, as it is used to accelerate or enhance the effectiveness of the other active ingredients. Sufferers should consult their doctor before taking any prescribed medication.
  • The bedroom environment should be conducive to sleep. Some people are very sensitive to light while others are sensitive to noise. The bedroom should be dark and quiet at night.
  • Try to avoid thinking of worries, fears and perhaps phobias. Such concerns are likely to prevent the mind from resting and may be exaggerated. It is a good idea to write down any particular worries that are bothering you, keeping a diary or noting down your emotions and thoughts can be very cathartic and any particular worries can be revisited and dealt with at a more appropriate time.
  • Write down plans for the next day, so you can go to sleep without fear of forgetting anything important.
  • Calm, relaxing music can help as it gives you something neutral to focus on and some are reported to relax you by tuning your brain in to certain rhythms, allowing you to fall into a deeper sleep.
  • Avoid use of the computer and television immediately before sleeping, as they stimulate the visual cortex.
  • Practice good sleep hygiene. Do not use the bed for too many activities besides sleep. Using the bed for reading, writing, watching TV and other such non-sleep-related activities will lower your association of the bed with sleeping. Similarly, try to keep to a regular schedule of what time to go to bed and what time to wake up. Try not to sleep during the daytime.
  • Sleep apnea can be a cause of insomnia. While a visit to the doctor will help in the diagnosis or ruling out of sleep apnea, a definitive answer will have to come from a study at a sleep lab.
  • Sometimes lack of sleep is indicative of an emotional problem that's not being dealt with. If a person is not happy with their lifestyle, or they are putting off problems that should be dealt with, it can often result in sleeping trouble. Just as the human body has nutritional requirements, all people have social and environmental requirements. Sometimes more social activities can help.
  • Patients with depression may suffer from insomnia. A doctor can treat this, sometimes by changing or adding prescriptions.
  • In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or metta. This practice of generating a feeling of love and goodwill can have a soothing and calming effect on the mind and body[1]. This seems to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the Mettā Sutta, Siddhartha Gautama, "The Buddha" tells the gathered monks that easeful sleep is one benefit of this form of meditation.
  • Exercise taken earlier in the day may help by reducing stress and promoting tiredness.
  • Sexual activity before sleep can help some.
  • Obscure allergies, such as dairy allergies, can sometimes cause sleeping disorders. Other symptoms may be very mild, such as slightly stuffed sinuses. A nutritionist can make helpful dietary and supplement recommendations.
  • If an alarm has been set, avoid looking at the clock during the night and cover the display if necessary. This prevents mental calculations of how much sleep has been lost so far and how little sleep can be obtained before the alarm will sound. Accepting that the amount of sleep obtained can only be determined upon waking, not while waiting to get to sleep, may also be beneficial.

Multifaceted approaches

Most people who have cured their insomnia have done so by reviewing and experimenting with many different cures. Often, a combination of dietary and lifestyle changes is the most helpful approach. As with many similar health problems, a determined, across-the-board holistic approach to sleeping problems is advised as the most effective solution.


Statistics for insomnia

According to the U.S. Department of Health and Human Services, approximately 60 million Americans each year suffer from insomnia. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men [4].

Footnotes

  1. ↑  Lutz, A., Greischar, L.L., Rawlings, N.B., Ricard, M., and Davidson, R.(2004). Long-term meditators self-induce high-amplitude gamma synchrony during mental practice. Proc. Natl. Acad. Sci. USA 101,16369–16373. [5]

See also

  • Fatal familial insomnia
  • Sleep deprivation
  • Actigraphy

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