Everything you need to know about INSOMNIA

Overview

The most common sleep condition, insomnia, affects 10-15% of the general population. Insomnia has a detrimental influence on a person's job, physical, and social performance, as well as general quality of life. Furthermore, the economic impact of insomnia is substantial, owing to lost productivity, work-related accidents, absenteeism, and health-care expenses. There is growing evidence relating stress to the onset of insomnia, and research from cognitive, endocrine, neurological, and behavioral domains provides convincing support for hyper-arousal in insomnia.

However, there is no agreement on the particular etiological causes of this illness. Although the biology of primary insomnia remains a mystery, several pharmacological and behavioral therapies have been developed and shown to be effective in controlled research. Despite the widespread availability of pharmaceutical medications and greater understanding of behavioral approaches, the vast majority of people suffering with insomnia do not appear to be receiving sufficient care.

Inadequate insomnia treatment has various serious and underappreciated implications, including the development of mental disorder and increased drug use.

What is Insomnia?

An insomniac is a person who has repeated difficulty with initiation, maintenance or quality of sleep that occurs despite an adequate time and opportunity for sleep and that results in some sort of daytime impairment. Around 95% of Americans have reported at least one episode of insomnia at some point in their lives. Acute insomnia can last from 1 night to a few weeks whereas insomnia becomes chronic when it happens at least 3 nights a week for over 3 months.

Types of Insomnia

Primary: When insomnia is not linked to any other health problems
Secondary: This type of insomnia occurs as a result of various health problems, such as asthma, arthritis, depression, cancer, pain and even some medications and substances (such as alcohol)

What causes Insomnia?

Primary insomnia can have a variety of causes which include:

Stress;
Environment , such as noises, light or temperature;
A change in your sleep pattern such as jet lag, a new shift at work.

Causes of secondary insomnia include:

Mental health problems, such as anxiety or depression;
Pain or discomfort at night;
Medications for colds, allergies, depression, high blood pressure;
Asthma;
Substance use (alcohol, tobacco, caffeine etc.);
Hyperthyroidism and other endocrine problems;
Related sleep problems such as sleep apnea, restless leg syndrome.

Insomnia signs and symptoms

Insomnia is often a symptom rather than a condition on itself. It is characterised as:

Trouble falling asleep or staying asleep through the night;
Waking up earlier than usual;
Irritability;
Sleeping for only short period of time;
Having a poor quality of sleep (many insomniacs wake up feeling unrested and end up feeling sleepy during the day);
Fatigue and sleepiness during the day;
Grumpiness;
Problems with memory and concentration;

Risk factors

Women and older people are more prone to develop insomnia, but young and middle-age African-Americans also have this high risk. Other risk factors include:

Long-term illnesses;
Mental health issues;
Working night shifts;
Genetics (insomnia sometimes runs in the family and genes often affect whether one is a deep or a light sleeper)
Frequent travels;
Uncomfortably low or high temperatures;
Having an irregular sleep schedule or common changes in routine;
Watching TV or using other electronic devices right before bedtime;
Recreational drug use like cocaine or ecstasy;
Frequent or long naps during the day;
Menopause, pregnancy, and premenstrual disorders.

Insomnia diagnosis

Sleep disorder tests are commonly used to diagnose insomnia, along with other tests that include a physical exam, a medical and sleep history to determine the cause of the insomnia.

During the exam, you should expect questions about any medical or psychological problem that could be contributing to your insomnia: weight gain, chronic snoring or questions about your stress levels.

Tests used to diagnose insomnia include:

A sleep diary which may be useful for the doctor to reach a diagnosis;
Polysomnogram is a test that measures activity during sleep;
Epworth sleepiness scale is a questionnaire that evaluates daytime sleepiness;
Actigraphy is a test that assesses sleep-wake patterns over a period of time and involve wearing an antigraph (small device placed on the wrist) that measures any movement during sleep;
Mental health exams are essential in finding the cause for insomnia as it may be a symptom of anxiety, depression, and other mental health conditions.

Insomnia before period

PMS (Premenstrual Syndrome) is a condition often defined by bothersome symptoms that occur in the days prior to the period and may even continue with menstruation. The severity of the symptoms vary but some women find that they are disruptive. It is not well known how and why PMS occurs but it is widely considered to be related to the changing hormone levels, which can impact sleep. Women who suffer from PMS are twice as likely to develop insomnia before and during their period. These problems can be even worse for people with PMDD (Premenstrual Dysphoric Disorder). PMDD is a more severe condition that includes significant changes to mood or emotional health and can greatly impact the quality of sleep. Many studies have shown that sleep quality worsens during the luteal phase (especially the latest days) when PMS and PMDD can occur. Progesterone which is naturally released in higher concentrations during the second part of the menstrual cycle increases the body’s temperature and can eventually cause fragmented or disrupted sleep. It also has an effect on the melatonin production, a hormone that is essential to the regulation of circadian rhythms. Some women also experience less paradoxical sleep (restorative part of sleep) during the late luteal phase. Paradoxical sleep is associated with heightened levels of brain activity, eye movement, and vivid dreams. Mood changes as a result of premenstrual disorders also have a great impact on sleep as the women may find themselves feeling more anxious or depressed. In addition to that as many as 14% of women experience heavy menstrual bleeding and they may have to get up to regularly change pads or tampons at night.

Insomnia during menopause

It is not uncommon for women to report sleep disturbances such as insomnia after menopause. Approximately 61% of postmenopausal women experience frequent episodes of insomnia. Menopause can affect the sleep cycle on three different levels:

Hormonal changes: progesterone and estrogen levels decrease during menopause and can trigger changes in the lifestyle, especially in sleeping habits. you may find it harder to fall asleep;

Hot flashes and night sweats which are very common in postmenopausal women and happen as a result of a surge of adrenaline. Adrenaline is known for triggering the fight-or-flight response, therefore your body may have a hard time recovering from this sudden burst of energy which makes it even more difficult to fall asleep.

Medications can cause a variety of symptoms (side-effects) including sleep disturbances.

Insomnia and pregnancy

Feeling tired is common in pregnancy, especially in the first 12 weeks of gestation. Hormonal changes can lead pregnant women to feel emotional, nauseated and even sleepy. Looking after physical health is advised: try to maintain a good sleep schedule, eat a healthy diet and get plenty of rest. As the bump gets bigger she could find it more difficult to lay down which may decrease the quality of her sleep. Also frequent urination is common during pregnancy which can wake the pregnant women at night therefore increasing the chances of poor quality of sleep.

Tiredness does not harm you or the baby but it can make it difficult for you to do everyday tasks. Bump-friendly sleeping position may help, which includes sleeping on your side. Research shows that after 28 weeks sleeping on your back increases the risk of stillbirth by double reason: decreasing blood and oxygen flow to the baby. Using pillows to support your bump or between your knees may help.

For more information see : Everything you need to know about pregnancy

Insomnia treatment

Treatment for insomnia depends on what causes it. It may be medical as well as nonmedical or it can join both of them. Some nonmedical solutions may be: developing better sleep habits or psychotherapy. But if insomnia is caused by a medical condition, it should be treated first. At the same time, if insomnia is a side effect of a medication, changing the medication or reducing the dose may also help. Before making any changes to any medications you should always talk to your health care provider.

Short-term insomnia is often caused by stress, usually improved if the stress factor is removed or if the body has adjusted to the new schedule. Over-the-counter sleep remedies may help for this type of insomnia.

Chronic insomnia may require use of sleep medications, such as:

Benzodiazepine sedatives;
Non-benzodiazepine sedatives.

These medicines may be addictive with prolonged use and can be dangerous if taken with alcohol or any other drugs that depress the central nervous system.

Side-effects of these medications also include morning sleepiness.

Doxepin (Silenor) is a medication used for people who have trouble staying asleep and may help by blocking histamine receptors. This drug may only be taken if you are unable to get at least a full seven to eight hours of sleep. Dosage is based on age, medical conditions, and response to therapy.

Belsomra (suvorexant) is an orexin receptor antagonist that works by regulating the sleep-wake cycle and helps with staying awake. Belsomra alters the action of orexin.

Ramelteon (Rozerem) is an insomnia medication that is less likely to cause morning sleepiness or addiction.

Antihistamines, although often used for allergies, can be found in many over-the-counter sleep drugs. These medications may cause drowsiness, daytime sleepiness, dry mouth, and a variety of other side-effects.

Antidepressants may help people with depression, although they are not approved to treat insomnia since they may also cause daytime sleepiness and other side effects.

Non-Medical Treatments for insomnia include:

Relaxation techniques. Many people who suffer from insomnia simply need help relaxing. Habitual insomniacs are often found in a vicious cycle of anxiety (staying awake makes them anxious so it is harder to fall asleep, some may even count the hours of sleep they have left which eventually increases anxiety) Breathing exercising are a good way of relieving stress. A good routine that can be done anywhere:

Exhale through your mouth completely;
Inhale through your nose while counting to four;
Hold your breath for seven seconds;
Exhale through your mouth while counting to eight;
Repeat three times.

Exercising can help achieve better sleep and improve daytime energy levels. A twenty to thirty minute routine three to four times a week tailored to your physical condition can be helpful. The workout sessions should be done in the morning or in the afternoon but never close to bedtime. Always check with your doctor to see what exercises fit you best.
Meditation and yoga may reduce tension, therefore, improving sleep. These are best done before bedtime. Such techniques can be learned from personal coaches, websites, books, etc.
Good sleep habits include keeping a regular sleep schedule: avoiding heavy meals, alcohol, tobacco, and caffeine right before bedtime, keeping the bedroom reserved for sex and sleep only, having an adequate environment (quiet and dark). Both children and adults may find it hard to fall asleep if they are overstimulated by activity or watching television right before bedtime. Fifteen minutes right before bedtime reserved for reading, listening to soft music or having a quiet conversation may all help in relieving stress, therefore improving the quality of sleep. If you find yourself waking up in the middle of the night, try to remain calm and be patient as sleep usually returns.

Alternative therapies for insomnia

Chamomile is a commonly used herb for the treatment of insomnia, however more research is needed. The FDA considers it to be safe, with no side-effects, but those with sensitivity to ragweed or chrysanthemums (or other members of the Compositae family) should not take it, since it can cause contact allergies;
Valerian root may help inducing and maintaining sleep. It is possible that it can interfere with some medications and it is not safe for children or during pregnancy;
Melatonin is a hormone produced by the pineal gland located in the brain and plays an essential role in regulating circadian rhythms. More studies are needed to understand the exact way this hormone works in the body. Some supplements can raise the melatonin level in the body up to 20 times normal. Side effects of melatonin are minimal;
Acupuncture is also an alternative therapy for insomnia, often used in traditional Chinese medicine.This procedure involves the insertion of tiny, thin needles (sometimes alongside electrical stimulus or heat) into the skin, at specific acupuncture points. Some recent studies have shown this therapy helped improve the quality of sleep in some insomniacs, but additional research is required before acupuncture is proved to relieve insomnia.

How to better manage PMS insomnia?

Besides common therapies, treatments, and medications you may find the following helpful:

Magnesium is a great remedy for PMS insomnia as it plays a crucial role in the production of hormones. Studies have shown that magnesium is effective for reducing anxiety as it interferes with GABA receptors;
Epsom bath salts (rich in magnesium) are a great alternative as a bedtime ritual. It may help decrease anxiety therefore making it easier to fall asleep;
Dimming the lights at least an hour before going to sleep helps with the production of melatonin;
Yin Yoga and stretching are great ways of relieving stress and tension especially when paired with deep breathing exercises. Deep belly breathing stimulates the parasympathetic nervous system, which induces relaxation;
Cannabidiol (CBD) is commonly used to help with anxiety and stress. It acts on the endocannabinoid system that regulates homeostasis. CBD is a potent anti-inflammatory that can be found in many forms: tinctures, flowers, and even skin products. CBD should not be confused with THC.

Insomnia treatments for perimenopausal and postmenopausal women

Although many of the alternative therapies may be useful for treating insomnia caused by menopause you should also consider:

Hormone replacement therapy which involves supplementing estrogen levels in both perimenopausal and menopausal women;
Low-dose birth control may be able to stabilise hormone levels which could treat insomnia;
Low-dose antidepressants;
Melatonin supplements.

Insomnia treatments in pregnancy

Keep in mind that you do not need to worry that not being able to sleep will harm your baby because it will not. Avoiding tea and caffeinated drinks in the evening is recommended, while also trying relaxation techniques before bedtime so you avoid staying wide awake at night. Some antenatal classes may also teach some techniques. Always ask your midwife or doctor for advice.

Occasionally, sleeplessness when associated with other symptoms can be a sign of depression. If you find yourself also feeling hopeless or losing interest in things you used to enjoy (which are symptoms of depression), speak to your doctor or midwife. Reading about habits that help prevent insomnia is also advised.

Complications of insomnia

Sleep is as essential as maintaining a healthy diet and regular physical activity. People with insomnia report having a lower quality of life compared to those who are not insomniacs. Complications of insomnia may include:

Poorer performance at school or on the job;
Higher risk for accident;
Slowed reaction time;
Increased risk and severity of chronic conditions such as high blood pressure and heart disease.

Although a few nights of bad sleep do no long-term harm, chronic insomnia can cause a variety of health problems that includes:

Breathing problems such as asthma;
Mental health conditions such as anxiety, depression, and even suicidal tendencies;
Heart problems like arrhythmia, coronary heart disease, heart failure, and even high blood pressure;
Pain. People who suffer from both chronic pain and insomnia may become more aware and distressed by their pain;
Pregnancy complications include having more painful labour, giving birth before the due date, needing a C-section, and having a baby with a low birth weight;
Metabolism disturbances can be caused by not getting enough sleep as it can cause a change in hormone levels. This can raise the risk of obesity, metabolic syndrome, and even diabetes.
Problems with the immune system which can make it harder for your body to fight off infections and makes it more prone to inflammations.

How can Insomnia be prevented?

Good sleeping habits can help prevent insomnia, such as:

Keeping a consistent sleep schedule (waking up and going to sleep at around the same times every day);
Staying active. Research shows that regular physical activity helps with preventing sleep disturbances;
Avoiding or limiting naps as these can energise you and make it harder for you to fall asleep at night;
Avoiding or limiting intake of alcohol, caffeine, nicotine, and any recreational drug, especially right before bedtime;
Avoiding heavy meals right before bedtime;
Making your bedroom comfortable by dimming the lights, using candles or aromatherapy;
Creating a bedtime ritual, such as reading, listening to music, or taking a warm bath.

What can you do now?

Before going to a checkup you may find some of these activities helpful in reducing or relieving your symptoms before you get help:

Try taking frequent naps whenever you feel tired. If you find yourself feeling sleepy and have the opportunity to sleep, take advantage of it.
Remember to stay hydrated, as water can help maintain energy levels up.
Listen to your body.

When should you get help?

You should talk to your doctor about insomnia if you find yourself at any of these situations:

Your partner notices you seem to stop breathing at night which is often associated with snoring. This could be a sign of an underlying condition that causes insomnia and you may need a referral to a sleep disorders specialist to monitor your sleep patterns as this could be a sign of sleep apnea;
You experience problems with sleep for more than a month without apparent cause, randomly fall asleep during the day or seem to never get enough sleep;
Your fatigue interferes with everyday activities and tasks;
Your sleep medication is no longer effective.

Conclusion

In the United States, insomnia is the most frequent sleep condition, affecting over one-third of the general population. Insomnia may have a negative impact on one's health, quality of life, academic performance, raise the risk of car accidents, decrease productivity at work, irritability, and cause daytime drowsiness. Insomnia is also regarded as a risk factor for medical conditions such as cardiovascular disease, chronic pain syndrome, depression, anxiety, diabetes, obesity, and asthma.