What is insomnia?
Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep, and that results in some form of daytime impairment.Types of insomnia
Acute insomnia
Acute insomnia is the most common type of insomnia. It is short term and lasts for a few days up to a month. It is also commonly called adjustment insomnia because it is usually caused by a change in environment or stressful events. Some common causes of acute insomnia are as follows:
- New environment and unfamiliarity
- Excessive noise or light
- Extremes of temperature
- Uncomfortable bed or mattress
- New job or school
- Relocation to a new place
- Jet lag
- Work deadlines or examinations
- Death of a relative or close friend
- Difficulties in a relationship
- Physical discomfort such as pain
- Certain medications
- Acute illness and allergies
The insomnia causes may differ according to the type of Insomnia
Insomnia is usually a transient or short-term condition. In some cases, insomnia can become chronic or long term. Insomnia is said to be chronic if the patient experiences difficulties in sleeping at least three days a week for at least a month. Chronic insomnia may be primary or secondary. Primary chronic insomnia is also called idiopathic insomnia because there is no specific cause. Secondary chronic insomnia is also called comorbid insomnia. Comorbid insomnia is more common than primary insomnia and occurs due to other underlying medical conditions (comorbidities).
Common causes of chronic insomnia include the following:
- Chronic medical conditions such as acid reflux disease, thyroid disease, diabetes, sleep apnea, neurological conditions such as Parkinson’s disease and chronic pain
- Psychological conditions such as depression, anxiety, schizophrenia, and bipolar disorder
- Medications such as anti-hypertensives (blood pressure [BP] medication), respiratory medications, anti-histamines, hormonal medication, anti-epileptic drugs (seizure medication), anti-depressants and chemotherapy
- The central nervous system (CNS) or brain stimulants such as nicotine and excessive caffeine
- Lifestyle factors such as frequent travel causing jet lag, constantly rotating shift work, irregular naps and sleep timings
- Nasal block and sinus allergies
- Age (Insomnia becomes more common with age)
- Onset insomnia
- Onset insomnia is difficulty initiating sleep. This type of insomnia may be short term or chronic. The common causes are as follows:
- CNS stimulants such as nicotine and excessive caffeine
- Change in environment and unfamiliarity
- Stress and anxiety
- Chronic pain
Maintenance insomnia is when the patient has difficulty staying asleep or waking up too early and difficulty going back to sleep. Maintenance insomnia may be caused by chronic medical conditions or psychological conditions such as depression, anxiety, or stress. Some medical conditions that may cause maintenance insomnia are as follows:
- Asthma and other respiratory conditions
- Nose block and sinus allergies
- Restless leg syndrome
- Acid reflux disease
- Chronic pain
Behavioural insomnia of childhood (BIC) can usually be managed with appropriate behavioural therapy. BIC has three subtypes:
- BIC sleep-onset: It can usually be resolved with a few behavioural changes such as creating a healthy sleep routine or learning self-soothing or relaxation techniques. It occurs due to negative associations with sleep, such as needing to go to sleep by being rocked or nursed or watching TV while going to bed.
- BIC limit-setting: This occurs due to the child’s refusal to go to bed.
- BIC combined type: This is a combination of both BIC subtypes.
How is insomnia treated?
The treatment usually includes a combination of more than one treatment modality and uses a multi-disciplinary approach. Treatment options include the following:
Cognitive-behavioural therapy
- Sleep hygiene education: This addresses behaviour that is incompatible with sleep such as caffeine or alcohol use, environmental noise, inappropriate room temperature, and watching TV in bed.
- Cognitive therapy and relaxation therapy: This involves inculcating correct sleep beliefs, reducing stress and anxiety, relaxation exercises, and meditation. Acupressure and massage therapies can help in relaxation and reducing chronic pain.
- Stimulus-control therapy: This works by associating the bed with only sleepiness and when it is time to sleep.
- Sleep-restriction therapy: This is based on the fact that excessive time in bed can lead to insomnia. Hence, it is advised for adults to limit sleep time to around five to seven hours.
Sedative-hypnotic drugs, sedating antidepressants, antihistamines, and other drugs may be prescribed by a physician.
Devices:
FDA-approved prescription devices can be used in patients with insomnia.
Diet and exercise:
Patients are advised the following:
- To avoid caffeinated beverages in the late afternoon or evening
- To avoid alcohol in the evening
- To avoid large meals right before bedtime
- To exercise in the late afternoon or early evening (six hours before bedtime) can promote sleep
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