Insomnia – Symptoms, Causes, Prevention and Diagnosis


Insomnia

Introduction:

Insomnia is a sleep disorder where we have trouble falling or staying asleep. It is also called as sleeplessness. Insomnia can be short term(acute) lasting a few days or weeks and long term (chronic) lasting more than a month. Insomnia is usually followed by loss of energy, sleepiness in the day, irritability and depressed mood. There are two types of insomnia:



Primary Insomnia

When no health condition or problem are related to the sleep problems, it is called as primary insomnia. Stress, busy schedule can be some reasons to keep you awake.


Secondary Insomnia

When health condition like cancer, asthma, heart pain, depression, arthritis, pain, medication, alcohol, etc. are related to the sleep problems is called secondary insomnia.


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Symptoms


Symptoms of insomnia


Insomnia is a sleep disorder due to which it affects the mind and body.



The different symptoms of insomnia


Daytime tiredness or sleepiness.

When you do not get proper sleep in the night, you often feel tired and drowsy next morning.


Irritability or grumpiness.

No proper sleep leads to drowsiness and tiredness which leads to irritation and grumpiness for small issues.


Depression or anxiety

Irritability, tiredness, drowsiness leads to unwanted thoughts or discussions leading to depression or anxiety.


Low concentration, difficulty in focusing, remembering or low memory.

Sleep deprivation directly affects the brain. Tiredness and drowsiness leads to low concentration leading to low memory.


Waking up during the night or too early.

Insomnia is a condition in which we do not get proper sleep or a complete sleep and hence we keep waking up in the night or too early in the morning.


Not feeling well - rested even after sleeping.

Insomnia or sleep deprivation keeps you awake and hence you feel as if you have not rested well even after sleeping.


Headache and dizziness.

Insomnia is a cause for headache and dizziness which is again due to sleep deprivation.


Exhaustion and fatigue.

Tiredness or sleepiness leads to exhaustion and fatigue.


Trouble in digestive system

Sleep disorder or insomnia causes trouble in the digestive system. You experience uneasiness or heaviness due to the same.



Causes of Insomnia



Insomnia can be caused due to health problems or other issues also. The main causes of insomnia are:


Stress

Due to different issues in life like job loss, death of loved one, moving from one place to another, etc. Concerns about work, health, finances keeps mind active at night which makes it difficult to sleep.


Change in sleep schedule.

It may be due to change in work shift, jet lag, etc. Our body goes through a natural cycle of physical, mental and behavior changes in the 24 hour cycle which is called circadian rhythm. This acts as an internal clock and disruption of circadian rhythm leads to insomnia.


Noise, light, etc.

Noise and light an also disturb the sleep. External disruptions in the neighborhoods which disrupts the sleep also leads to insomnia.


Mental health issues

Mental health issues like anxiety, depression, post traumatic stress disorder etc. are causes of secondary insomnia.


Medications

Medications for health issue like allergies, cold, asthma, depression, blood pressure, etc. also lead to secondary insomnia. Pain killers, allergy and cold medications, weight loss products contain caffeine and stimulants which keeps us awake leading to insomnia.


Consumption of alcohol, tobacco, caffeine, etc.

Consumption of alcohol, tobacco, caffeine leads to insomnia. Caffeinated drinks keeps us awake as they have stimulants in them. Nicotine also is a stimulant found in tobacco products which also results in disruption of sleep leading to insomnia. Alcohol makes us fall asleep but it does not let us go into the later stages of sleep or a deep sleep which again leads to insomnia.


Thyroid, sleep apnea and restless leg syndrome

Thyroid, sleep apnea and restless leg syndrome also lead to secondary insomnia. Sleep apnea leads to periodic stopping of breathing which disrupts the sleep. Restless leg syndrome has unpleasant sensations in the legs which makes us to keep legs moving leading to disruption of sleep and this leads to insomnia.


Heavy dinner

Having heavy dinner leads to fullness of stomach making us feel physically uncomfortable, experience heartburn due to acidity, backflow of food and acid through the esophagus which disrupts sleep leading to insomnia.


Poor sleep habits

Poor sleep habits like irregular bedtime schedule, untimely naps, uncomfortable sleep environment, eating or watching TV, use of mobiles at bedtime, etc. interferes with the sleep cycle leading to insomnia.



Prevention of Insomnia




When we know the cause of insomnia, it becomes easy to prevent it. Some of the prevention tips of insomnia are;


  • Avoid stress. Create a relaxing bedtime ritual by taking a warm bath before sleep, reading good books or listening to soft music also relieves stress and helps in good sleep.

  • Set a timetable. Keep a consistent time for sleeping and waking up including the weekends.

  • Stay active. Keep yourselves active all day along with regular exercises.

  • Avoid naps. Avoid in between naps or limit the number of naps in the day to get a better sleep in the night.

  • Avoid or limit caffeine and alcoholic products to get a proper sleep pattern.

  • Avoid large meals before sleeping in the night so that you will not have any physical discomfort and acidity problem while you sleep.

  • Check if the medicines that you take contribute to insomnia. Consult your doctor and ask for alternative medicines.

  • Make your bedroom comfortable to sleep so that there is no light or noise which would disrupt the sleep.


Diagnosis of Insomnia




If you are unsure you have insomnia, visit the doctor. Doctor will first conduct a simple check up and if required more tests will be done to know the root cause of the problem. the different tests done to diagnose insomnia are:


Review:

The doctor does a review or asks few questions to understand your sleep pattern or any medical history due to which you are facing problem in sleeping. In order to be ready for this, before you take an appointment with the doctor you can just make a note of the sleep pattern, the diet and medications you are taking if any so that it would be easier for the doctor to analyze the problem.


Blood Tests

Blood tests will be done to ensure if you are suffering from thyroid or any other medical health conditions which disrupt sleep.


Sleep Test

Even after the blood test if the cause of insomnia is unclear, you may have to spend a night in a sleep center and the doctor will do different test to monitor and record various body activities while you sleep. These tests are done to record the brain waves, breathing pattern, heartbeats, eye and body movements which help to know if you are suffering from sleep apnea, circadian rhythm disorder or narcolepsy.


Actigraphy monitoring

Actigraphy monitoring can be done to confirm the cause of the sleep disorder by using a device called an actigraph which is similar to a wrist watch. This watch monitors the movement and is used to assess sleep - wake cycles, circadian rhythm, etc. This information is then used to create a graph. This device can be worn for a week or for a few months. Actigraph can record data for 24 hours per day for about two weeks.



Complications


As diet and exercise are important for our health, so is sleep. necessary for our health. Insomnia can affect our mental and physical health. Some of the complications of insomnia are:


  • Performance steps down to a lower level in job or at school.

  • Higher risk of accidents as due to insomnia there is a slower rate of reaction time.

  • Mental health disorder such as anxiety, depression, etc.

  • High blood pressure and heart disease are at a higher risk.

  • Brain disorders like Parkinson's Alzheimer, epilepsy, stroke and traumatic brain diseases are found in people with chronic insomnia.

  • Problem with metabolism. Not enough sleep can change the levels of hormones that control hunger and digestive system which results in obesity, diabetes, etc.

  • Problems with the immune system. No sleep affects the immunity of the body and hence makes it difficult for the body to fight diseases.

  • Pregnant women can face complications like preterm birth, more labor pain, low baby birth weight, etc. due to insomnia.

  • People who have pains can get aware of the chronic pain due to insomnia and can get distressed due to the pain.


Treatment:


Lifestyle change is a simple way to treat short term insomnia. Chronic insomnia can be treated by a type of counselling called as Cognitive behavioral therapy. Medicines can also be given to treat insomnia or help have a regular sleep schedule. A doctor's advice is a must to help get your insomnia treated in an efficient manner.


Healthy sleep habits


  • Make your bedroom sleep friendly.

  • Avoid caffeine, tobacco and alcohol.

  • Make a timetable and follow strictly on when to sleep and when to wake up.

  • Avoid daytime naps.

  • Avoid heavy dinner and more fluid before bed.

  • Do a lot of physical activity.

  • Manage stress. Practice meditation and yoga to manage the stress.

  • Avoid medicines which keep you awake. Ask your doctor for an alternative medicine. Some medicines keep you awake at night.


Cognitive Behavioral Therapy for Insomnia (CBT - I)


It is a 6 to 8 week long treatment plan to help you to sleep better and remain in sleep for a longer time. This is a treatment plan for chronic insomnia. CBT - I can be done by a doctor or a nurse or a therapist either in the clinic or online. It is divided into following parts:


  • Cognitive therapy deals with the stress management of the brain and helps you to think positively and feel less nervous.

  • Relaxation or meditation therapy is used to relax and help sleep faster.

  • Good sleep habits can be developed by giving sleep education.

  • Stimulus Control therapy helps to sleep better by scheduling a pattern in which bed is used only to sleep, i.e., the stimuli is generated as such that as soon as you climb the bed you fall asleep and other distractions are avoided.


Medicines


Medicines are used to treat insomnia. Some of them are:


  • Benzodiazepine

  • Melatonin receptor agonists

  • Orexin receptor antagonists.


These medicines cannot be taken for a longer time as you might get addicted to them and also may have side effects.



Conclusion


Insomnia can be treated at an earlier stage if diagnosed properly. Simple lifestyle changes, sleeping habits, work schedule, scheduled visits to the doctor, following the prevention measures and most importantly having a positive thought of getting well soon helps you fight insomnia. Nothing is hard to achieve if tried with a sincere effort.




William C Dement says, " Sleep deprivation is the most common brain impairment."

Faisal Khokar says, " Sleep deprivation causes emotional weakness."

Fight insomnia to keep your mental and physical health condition better. A final quote by Tom Rath, " Sleep is an investment in the energy you need to be effective tomorrow." Sleep well, fight insomnia, stay healthy and achieve your dreams.



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