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Insomnia

Insomnia is a sleep disorder that causes sleep deprivation due to difficulty in falling asleep or waking up too early and not able to fall back to sleep again. The deprived sleep causes mood changes, lack of energy levels, irritability and thereby decreases the quality of performance in day-to-day activities.

The average sleep duration in a normal adult usually ranges between 7-9 hours. However, the duration may vary depending on the physical and environmental changes.

Insomnia can be generally classified into two types, namely:

  • Acute sleep: It is also known short-term insomnia that may last for days to weeks
  • Chronic sleep: It is also known as long-term insomnia that usually lasts for months

Symptoms

Insomnia can be observed with the following symptoms that include:

  • Difficulty in falling asleep during night
  • Waking up too early in the morning
  • Waking up at midnight during sleep
  • Change in sleeping pattern
  • Feeling tired even after a good night’s sleep
  • Falling asleep during the day
  • Anxiety and depression
  • Increased irritability
  • Difficulty in focusing or paying attention

Causes

The primary cause of insomnia may be an imbalance in the neurotransmitter levels in the brain. However, secondary external characteristics may cause sleep deprivation such as:

  • Stress: Overstress and workload at home, school, office or financial stress stimulates the brain during night. This increases the thinking and working of the brain work at night, thereby depriving sleep.
  • Late night travel and work schedule: Late night travel or working in non-conventional shifts such as early morning or late night shifts, affects the internal clock, thereby disrupting the sleep pattern of the individual
  • Use of gadgets: Watching TV or using smart phones or laptops before bedtime usually stimulates the brain. This affects the sleep cycle of the individual and therefore deprives one’s sleep.
  • Eating habits: Having a heavy meal before dinner and not maintaining sufficient gap between bedtime and meal may cause heartburn, acid reflux and backflow of food, thereby causing uneasiness before sleep.
  • Caffeine use: Caffeine products such as tea, coffee and certain beverages are CNS stimulants. It acts by stimulating the brain. The use of these products before bedtime stimulates the brain and decreases the quality of sleep.
  • Medical conditions: Certain medical conditions such as cancer, cardiac disorders, chronic pain, over active thyroid function, Alzheimer’s and Parkinson’s disease cause poor sleep as these conditions are linked to insomnia.
  • Anxiety disorders: Anxiety, depression and post-traumatic stress disorder affect the sleep by disrupting the sleep pattern of the individual.
  • Age: An increase in age causes changes in the metabolism, physical activity and sleep pattern, thereby decreasing the quality of sleep in the individual.

Risk factors

Insomnia or sleeplessness is a common sleep disorder and may affect people of any age group; however, the incidence is higher in the following:

  • Gender: Women are at a greater risk of experiencing insomnia during menstruation and post-menopause due to hormonal changes, hot flushes and night sweats. Insomnia is also common in women during pregnancy and after childbirth.
  • Senior citizens: Individuals above 60 years of age tend to experience insomnia due to changes in their metabolism and physical activity. However, the duration of sleep gradually decreases with age.

Complications

Poor or deprived sleep not only affects the mental status of the individual but also affects the physical activity of the individual. Some of the common complications of insomnia include:

  • Decreased or poor performance at school or workplace
  • Greater risk of causing or experiencing accidents
  • Increased physical inactivity
  • Greater risk of developing anxiety disorders
  • Increased risk of developing chronic health complications such as diabetes and hypertension

Diagnosis

The nature and the type of insomnia can be diagnosed by the following procedures:

  • Physical examination: The individual is physically examined to determine the responsiveness towards instructions and commands as sleep deprivation decreases the brain activity and the responsiveness towards instructions and commands.
  • Sleep study: The test is performed in the sleep centre where the brain’s activity is recorded such as eye and body movements, heart rate, breathing and brain impulses. This test is helpful in determining the sleep disorders such as sleep apnea and restless leg syndrome.
  • Laboratory parameters: Certain laboratory parameters such as complete blood cell count (CBC) and thyroid function test are performed to determine any underlying cause of deprived sleep.
  • Questionnaire: The individual is asked to complete a questionnaire regarding the sleeping habits such as sleep-wake time, daytime drowsiness and the duration and intensity of sleep.

Treatment

The treatment for insomnia may include medication or sleep therapy. However, the choice of the treatment depends on the nature of insomnia.

Medication therapy: Sleeping pills are prescribed to treat sleeplessness or excess sleep. The dose and the duration of the treatment depend on the nature of sleep and the responsiveness of the individual to the medication therapy. Thus, regular monitoring of the individual is essential for better management of sleeping pills during insomnia.

Sleep therapy: Sleep therapy such as cognitive behavioural therapy for insomnia (CBT-I) is usually recommended as the first-line treatment to treat insomnia. This therapy eliminates and controls negative thoughts that are known to stimulate the brain before sleep. This therapy improves the quality of sleep and keeps away negative thoughts.

Sleep therapy includes relaxation techniques, stimulus control therapy, sleep restriction and light therapy that are effective in managing insomnia.

Management

Insomnia can be managed effectively by the below-mentioned practices, such as:

  • Do not use the bed for work or other activities apart from sleep and sex.
  • Have a moderate meal for dinner. Do not overeat or take heavy fatty meal as it affects the quality of sleep.
  • Avoid use of gadgets such as smart phones, laptops, computer or television at least half-an-hour before bedtime.
  • Practice yoga and meditation along with the conventional treatment as it improves the quality of sleep and also reduces stress.
  • Avoid taking plenty of fluids such as water or caffeinated beverages before sleep as it increases the visit to the toilet.
  • Do not consume medications such as antihypertensive and diuretic drugs before bedtime as it causes increased urination and frequent visits to the toilet.

Thus, insomnia can be managed effectively in the day-to-day life by implementing these lifestyle modifications and following certain practices apart from the conventional treatment procedure that helps in better sleep management.

 

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