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Insomnia

Introduction

According to the American Academy of sleep medicine’s ICSD – 3 manual, insomnia is defined as “persistent difficulty with sleep initiation duration, consolidation or quality”. This common sleep disorder may be short term (acute) or can last a long time (chronic), and can affect not only your energy level and mood but also your health, work performance and quality of life.

Statistics

Various sleep surveys and studies conducted by sleepfoundation.org have estimated that 10%-30% of adults live with chronic insomnia while some other studies may show 50% - 60%.

Studies also show that insomnia affects 30% - 48% of older people, this may be attributed to chronic medical conditions, social isolation and higher use of prescription medications as well as factors such as unhealthy sleep habits and stress.

Other studies show that insomnia may occur in 23.8% of teenagers and more than 50% of pregnant women may experience sleep issues that overlap with that of insomnia symptoms.

Symptoms

Insomnia symptoms may include

· Difficulty falling asleep at night

· Waking up during the night

· Waking up too early

· Not feeling well rested after a night’s sleep

· Daytime tiredness or sleepiness

· Irritability, depression or anxiety

· Difficulty paying attention, focusing on tasks or remembering

· Increased errors or accidents

· Ongoing worries about sleep

Types

There are two types of insomnia

1. Primary insomnia - this means your sleeping problems aren’t linked to any other health conditions or problems

2. Secondary insomnia – this means you have trouble sleeping because of a health condition (like asthma, depression, arthritis, cancer or heartburn), pain medication or substance (like alcohol).

While insomnia may manifest in different ways, most diagnoses fall into one of two categories:

1. Sleep – onset insomnia, this refers to difficulty falling asleep. This type of insomnia may occur with people who have a hard time relaxing in bed as well as people whose circadian rhythm is not in sync due to factors like jet lag or irregular work schedules.

2. Sleep maintenance insomnia refers to difficulty staying asleep after initially nodding off. This type is common in elderly sleepers as well as people who consume alcohol, caffeine or tobacco before bed. Certain disorders like sleep apnea and periodic limb movement disorder can also cause sleep maintenance insomnia.

Causes

1. Primary causes of insomnia include

· Stress concerns about work, school, health, finances, job loss, change or death of a loved one may keep your mind active at night, making it difficult to sleep. Stressful life events or trauma may also lead to insomnia.

· Surroundings – things and settings around you such as noise, light or temperature may also contribute to insomnia

· Inconsistent sleep schedule (jet lag, new shift at work)

· Poor sleep habits (irregular bedtime schedule, naos, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching Tv, computers, video games, smartphones or other screens before going to bed may interfere and disrupt your sleep cycle.

· Genes (insomnia may run in families)

· Eating before bed (too much food may induce heartburns, backflow of acid and food from the stomach into the esophagus)

2. Secondary causes

· Mental health issues like depression and anxiety or adhd

· Medications for colds, allergies depression, high blood pressure and asthma

· Caffeine, tobacco or alcohol use or use of illicit drugs

· Pain or discomfort at night

· Pregnancy, PMS or menopause

· Other sleep disorders like sleep apnea or restless legs syndrome

· Alzheimer’s disease or dementia

Risk factors

1. For women

Insomnia is more common in women than in men. This is possibly due to the hormonal shifts during the menstrual cycle and in menopause. During menopause, night sweats and hot flashes often disrupt sleep.

2. For people over the age of 60

Due to changes in sleep patterns and health, insomnia is likely to occur. Moreover, older people may be less likely to sleep soundly because of bodily changes related to aging and medical conditions or taking medications that disturb sleep.

Treatment and prevention

Acute insomnia does not need treatment

However, for chronic insomnia, treatments include:

1. Cognitive behavioral therapy for insomnia: Therapy (CBT-I), this is a brief structured intervention for insomnia that helps identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

2. Medications, though may not be a first choice for treating chronic insomnia unlike behavior and lifestyle changes, in some cases taking sleeping pills for a short time can help you sleep.

Note: does melatonin help you sleep?

Your body produces a hormone called melatonin that promotes sleep. While some people take melatonin supplements as a sleep aid, there is no sufficient proof that these supplements work. Please talk to your healthcare provider before taking one.

Preventions methods (lifestyle changes and improvements to your bedtime routine and bedroom setup can often help you sleep better)

· Avoid large meals, caffeine and alcohol before bed

· Be physically active during the day and outside if possible

· Cut back on caffeine, including coffee, sodas and chocolate throughout the day and especially the night

· Go to bed and get up the same time each day including weekends (establish a good routine)

· Quit smoking

· Turn your bedroom into a dark, quiet and cool sanctuary

· Unwind with soothing music, a good book or meditation

· Put away smartphones, TVs, laptops and other screens at least 30mins before bedtime

sources


Researcher: Hayley

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