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Insomnia- A Global Problem Of Insufficient Sleep

Insomnia- A Global Problem Of Insufficient Sleep
Medically reviewed by Dr. Hina Razzaq

What is insomnia?

Insomnia is a sleep disorder that affects millions of people across the globe. Unfortunately, everyday life stress has turned the condition into an actual nightmare. 

Insomnia is characterised by an inability to fall asleep, waking up frequently after initially falling asleep or both.

Symptoms of insomnia

Some common symptoms of insomnia include:

  • Difficulty falling asleep initially and waking up frequently in the middle of the night.
  • Difficulty falling back asleep.
  • Feeling exhausted during the daytime.
  • Irritability
  • Depressed mood.
  • Difficulty in concentrating.
  • Memory issues.

Types of insomnia

Many studies carried out worldwide have shown the prevalence of insomnia in 10%–30% of the population.

Insomnia is classified into two main types:

Acute insomnia:

This type of insomnia occurs when an individual experiences short-term sleeping difficulties, usually for a few weeks.

Chronic insomnia:

This type of insomnia is long-term. It occurs when individual experiences sleeping difficulties for three or more days each week, regularly occurring for three months or longer.

Depending on the cause, insomnia may also be classified into:

Primary insomnia:

The cause of insomnia is unknown, and this does not arise from any existing health conditions.

Secondary insomnia:

Secondary insomnia is a result of a health condition such as chronic pain or disease, mental health conditions, certain medications or substance use.

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What causes insomnia?

Globally, around one-third of people experience sleep disturbances. However, only if these sleeping difficulties meet specific criteria they will come under sleep disorder insomnia.

The American Psychiatric Association (APA) has changed its classification. In APA’s Diagnostic and Statistical Manual (DSM-IV) primary insomnia was listed as a diagnosable disorder, but this was later revised in 2013, terming it as the insomnia disorder in the DSM-5.

Numerous factors can contribute to the development of sleep disturbances, including:

  • Stress or traumatic event 

Worrying about work, school, family and financial situation can lead to stress and make it harder to sleep at night. In addition, trauma such as illness or death of a loved one or divorce can contribute to disrupted sleep. 

  • Poor lifestyle/sleeping habits

An irregular bedtime schedule, uncomfortable sleep environment, napping during the day, watching TV, using a laptop, or using smartphones before bedtime can all disrupt the sleep cycle. 

  • Medical conditions

Medical conditions such as cancer, heartburn, asthma, or cardiovascular disease and conditions like arthritis that lead to chronic pain can result in insomnia. In addition, neurological disorders such as Alzheimer’s disease or Parkinson’s disease may also contribute to insomnia. 

  • Mental health conditions such as post-traumatic disorder, depression or anxiety 

Insomnia commonly occurs with mental health disorders. For example, awakening too early or multiple times during the night can be a sign of depression or anxiety. 

  • Consuming a heavy meal late at night

Overeating right before bedtime can cause an uncomfortable feeling while lying down. Many people experience heartburn GERD due to backflow of acid, which results in an uncomfortable feeling in the chest. 

  • Irregular work schedule or travelling

Travelling across multiple time zones can lead to jet lag. Furthermore, changing shifts frequently at work or working very early or late can disrupt your body’s circadian rhythms and lead to sleep disturbances.

  • Certain medications and substance use

Certain prescription medications such as antidepressants and medicines for asthma or hypertension can give rise to insomnia. In addition, some over-the-counter drugs, including pain medications, allergy and cold medications, and weight-loss products or those containing stimulants, can disrupt sleep.

Sleep apnea can affect sleep as a person stops breathing periodically throughout the night, causing one to get up during the night repeatedly. In addition, restless legs syndrome can make it difficult to fall asleep as it causes unpleasant sensations in your legs and an uncontrollable desire to move them. 

Diagnosis of insomnia

There isn’t any specific test that is used to diagnose insomnia. Instead, your physician will take a detailed history and ask you questions about your sleep problems, medical history and medications. He may perform a physical exam and order some blood workup to rule out any medical conditions that may result in sleep disturbances. Moreover, your physician may request you to keep a sleep diary to identify the patterns that may lead to sleep disturbances. In some cases where other sleep disorders such as sleep apnea are the suspected cause, sleep studies are carried out.

Risk factors for insomnia

Some main factors that contribute to the development of insomnia include:

  • Stress, life events, or stressful routine can result in temporary sleep disturbances. However, long-lasting or continuous pressure may result in chronic insomnia. 
  • Being a woman: Hormonal changes associated with the menstrual cycle and premenstrual symptoms contribute to sleeplessness. Additionally, symptoms such as hot flashes and night sweats during menopause can disrupt sleep. Pregnancy can also result in insomnia.
  • Being over 60 As you age, changes in sleep patterns and health conditions can contribute to insomnia. According to research conducted in 2019, the prevalence of insomnia in older adults is up to 75 percent.
  • Having a mental health disorder or physical health condition. Mental health conditions and physical can both result in insomnia.  According to some studies, 40% of people with insomnia usually have an underlying mental health disorder.
  • Having an irregular schedule. Irregular shifts at work or travelling can affect the sleep-wake cycle. 
  • Drinking a lot of caffeine, alcohol and tobacco use: Consuming caffeine, alcohol and tobacco use can result in insomnia. 
  • A genetic predisposition to insomnia has been identified. Specific genes may increase your risk of developing sleep disorders. 

How to cure insomnia?

There are several treatment options for insomnia. Therapy, natural remedies, supplements and medication primarily help deal with sleep disorders. However, treatment options vary and often depend on the type and cause of sleep disorders.

CBT 

Cognitive behavioural therapy is considered an efficient approach for chronic insomnia. CBT-I helps you deal with the underlying issues causing sleep disturbances. It is a structured intervention for sleep disorders that helps identify the thoughts and behaviours that contribute to sleep problems and replaces them with habits that promote sleep. CBT can be used in combination with several techniques other techniques such as:

  1. Relaxation training: Under the supervision and guidance of your therapist, you can learn many techniques to deal with sleep disorders. For example, a therapist can offer advice about several relaxation techniques and help identify triggering factors that can, in turn, effectively help in the treatment of insomnia. 
  2. Sleep hygiene training: This involves correcting bad habits that result in poor sleep.
  3. Stimulus control: This includes going to bed only when sleepy and having a proper sleeping schedule throughout the week. 
  4. Sleep restriction: This comprises of first significantly limiting and then gradually increasing your time in bed  

Medications

Your physician may prescribe certain medications to treat insomnia. However, sleeping aids are usually for short-term use and should be taken under the supervision of a doctor. The following medications are commonly prescribed:

  • triazolam 
  • eszopiclone 
  • zolpidem 

Supplements:

Over-the-counter supplements such as melatonin often prove beneficial for some individuals in managing sleep disturbances. During the sleep cycle, melatonin is a hormone naturally produced by the body. Therefore, consuming melatonin a couple of hours before bedtime reduces the time it takes for a person to fall asleep. Furthermore, melatonin is safe to consume for the short term.

Natural Remedies/Alternative Therapies

Natural remedies and alternative therapies have remarkable results in managing sleep disorders. Some options worth exploring include:

  • Natural sleep aids such as herbal teas, warm milk, and valerian root supplements may help keep insomnia at bay. 
  • Meditation. This technique can help relieve stress, anxiety, and pain, which may cause disrupted sleep. 
  • Acupuncture. This is a well-known traditional Chinese medicine technique that helps ease symptoms. This technique mainly involves the insertion of thin needles at pressure points on specific areas of the body.  
  • Aromatherapy: Several studies have indicated that aromatherapy can help promote peaceful sleep. Effective essential oils believed to be effective include:

Prevention of insomnia

Some measures that may help combat the problem include:

  • Avoiding caffeinated beverages near your bedtime
  • Avoiding heavy meals or spicy foods close to your bedtime
  • Put your cellphones, laptops or other screens away at least 30 minutes before bedtime.
  • Maintaining the same schedule for sleeping and waking consistently throughout the week
  • Avoid naps during day time
  • Avoidance of intense activity or exercise near bedtime
  • Turning your bedroom into a dark, quiet place as bedtime draws near
  • Listening to some soothing music or a guided meditation.

Complications of insomnia

If insomnia persists, it can adversely affect your physical and mental health, leading to complications such as: 

  • Poor performance at work or school, poor relationships
  • Higher risk of accidents due to fatigue 
  • Mental health disorders, such as anxiety, depression or substance abuse
  • Increased risk of long-term diseases such as cardiovascular diseases. 
  • Weight gain and obesity
  • Memory issues

Some other types of insomnia:

  • Paradoxical insomnia

Paradoxical insomnia is also called sleep state misperception. It occurs when a person feels their sleep is disturbed, but no evidence confirms the presence of any sleep disorder. Individuals with this are excessively concerned about their sleep and misperceive the actual sleep time because of irrational beliefs.

  • Sleep-maintenance insomnia

 Difficulty remaining asleep throughout the night is termed sleep-maintenance insomnia. Such type affects people with either chronic or short-term insomnia and is reported among middle-aged and older adults.

  • Sleep-onset insomnia

Experiencing trouble falling asleep when first lying down for the night is referred to as sleep-onset insomnia. Both chronic and short-term insomnia can be a component of this type.

  • Behavioural insomnia of childhood: 

The inability of the child to fall asleep without a particular item or routine is called behavioural insomnia of childhood. For instance, a child unable to sleep without a favourite toy may be having this variant of insomnia.

  • Fatal insomnia

This term is a misnomer. Even though it contains the word insomnia, fatal insomnia is not a sleep disorder but rather a neurological condition that can lead to severe sleep difficulties. Also known as fatal familial insomnia (FFI), it is actually a very rare genetic disorder that causes progressive brain damage. 

  • Idiopathic insomnia

This type begins in childhood but is usually lifelong. The exact causes are unknown or unidentifiable. Studies suggest that this condition is present in 1.0% of young adults 

  • Coronasomnia

The recent pandemic has given rise to a new form of insomnia known as ‘Coronasomnia.’ It is characterised by sleep difficulties caused by stress, anxiety, and depression induced or intensified by the pandemic. Although insomnia is closely linked to anxiety and stress, coronainsomnia refers to sleep disorders whose primary cause is COVID-19.

The main identifiable causes of coronainsomnia include the loss of a daily routine, increased exposure to media, financial and emotional distress, the impending feeling of unpredictability and social isolation. All these directly affected the psychological well being and created long-lasting sleep problems. 

Cortisol is a stress hormone that operates inversely to melatonin, the sleep hormone. Cortisol levels typically rise in the early morning and fall in the evening. During the evening, melatonin production increases as the body prepare to go into sleeping mode. However, when the cortisol levels remain elevated due to stress or other causes, melatonin production is affected, resulting in disrupted sleep.

When To Consult A Doctor

Insomnia can create havoc in your life. It’s a sleep disorder that can affect a person’s mental, emotional health, and physical well-being. If you are suffering from sleepless nights, don’t hesitate to reach out to a doctor for help. You can get in touch with a doctor at Your Doctors Online to identify the causes and help determine the best possible treatment option for you. So you don’t have to put up with restless, sleepless nights anymore, connect with one of our online doctors and ease all your worries! Symptoms of insomnia may overlap with other sleep disorders symptoms, so it is of utmost importance to work closely with a doctor rather than trying to self-diagnose any sleeping problem that you may be experiencing.  

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dr asim cheema

Dr. Asim Cheema

Internal Medicine

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