Insomnia


Introduction

Insomnia is a condition in which one has difficulty falling asleep and maintaining sleep throughout the night. Insomniacs do not get sufficient sleep and, therefore, do not feel refreshed during the day. They have difficulty carrying out daily activities because they are not well-rested. The body requires sufficient sleep for physical restoration. When one does not get enough sleep for prolonged periods, their productivity is significantly reduced. Insomnia is characterized by lack of energy, reduced concentration, poor memory, irritability, fatigue, and daytime sleepiness. An individual is considered to have insomnia when the symptoms of the condition last for over three months. Insomnia is mainly caused by sleep disturbances due to poor sleep hygiene, such as sleeping in noisy environments, working in bed, and taking stimulants before bed. It can also be caused by underlying health problems including depression, anxiety, obesity, and other sleep disorders. The condition is treatable through medication, supplements or lifestyle changes.

Symptoms

Insomnia is characterized by difficulties in falling asleep and maintaining sleep throughout the night. A person with the disorder does not get adequate night time sleep and this leads to:

1. Impaired cognitive performance

Insomnia significantly affects cognitive function because sleep is needed in restoring mental processes. A person who gets sufficient sleep wakes up feeling refreshed and stays alert throughout the day. Their mental function is usually at full capacity throughout the day. On the other hand, individuals who have insomnia have impaired mental function and show characteristics such as:

  • Decreased alertness
  • Lack of vigilance
  • Slow response speed
  • Poor memory
  • Difficulty in concentrating

The lack of sleep destabilizes neurobehavioral functions when a person is awake, and their daily activities are significantly affected.

2. Sleep deprivation

Insomnia causes difficulty in falling asleep and, therefore, a person does not get sufficient sleep. They are sleep deprived and show characteristics such as exhaustion, daytime sleepiness, and impaired mental function. The condition affects a person’s daily activities as they can easily fall asleep when carrying out various tasks. Their energy levels are also low because they feel unrefreshed and find it difficult to engage in normal activities.

3. Excessive daytime sleepiness

Excessive daytime sleepiness is a major symptom used in the diagnosis of insomnia. The lack of sleep caused by insomnia leads to a person feeling drowsy during the day. The individual stays awake throughout the night and, therefore, is unrefreshed in the morning. They require frequent naps during the day to offset their sleepiness feeling. Due to exhaustion and drowsiness during the day, insomniacs can fall asleep when carrying out tasks that require a high level of alertness, such as driving, leading to accidents.

4. Fatigue

Insomnia causes insufficient sleep at night and, therefore, a person does not get enough rest. Normally, up to eight hours of uninterrupted sleep are required to feel refreshed and stay alert throughout the day. When an individual does not get enough sleep, they feel exhausted and have difficulty carrying normal tasks. The body is also not restored due to the lack of night time sleep, and the individual is, therefore, excessively tired.

Causes

Insomnia is caused by disturbances and disruptions that make it difficult to fall asleep and maintain sleep throughout the night. These disruptions can be due to:

1. Poor sleep hygiene

Sleep hygiene refers to the habits that a person carries out to prepare for sleep and the state of the environment in which one sleeps. Poor sleep hygiene involves the different factors that lead to sleep interruptions, including:

  • Taking stimulants, such as caffeine, before bed
  • Consuming alcohol
  • Sleeping in a noisy environment
  • Having too much light in the bedroom
  • Irregular sleep schedules
  • Napping during the day

These factors make it difficult for a person to fall asleep at night. When one tries getting some sleep, they are constantly interrupted, and they have to wake up several times during the night. Individuals who have poor sleep hygiene do not get sufficient sleep and end up being sleep deprived.

2. Underlying health conditions

Some health conditions make it difficult for a person to fall asleep, thus causing insomnia. They include:

a.  Depression

Depression is a mental condition in which one remains in a constant state of despair. The condition makes it difficult for a person to fall asleep and maintain uninterrupted sleep throughout the night. It increases the sleep onset time, therefore, a person sleeps for only a few hours. The person also wakes up constantly at night and awakens early in the morning. The sleep efficiency and quality are reduced significantly and one ends up feeling unrefreshed during the day.

b. Anxiety disorder

The anxiety disorder is a condition in which a person remains in a constant state of fear and worry. They have excessive feelings of fear that affect sleep. It is commonly associated with insomnia. The person experiences restlessness when asleep, thus their sleep quality is reduced. The person also stays awake for long at night stressing or thinking too much and does not get sufficient sleep.

c.  Obesity

Obesity is a condition in which an individual has excess body fat that affects their daily function. It is associated with many sleep disorders because it significantly reduces sleep efficiency. An obese person is frequently fatigued and requires naps during the day. They end up having difficulties falling asleep at night. Obesity also causes breathing difficulties due to excess fat around the neck area and the diaphragm. The fat compresses the air passages obstructing the flow of air. The breathing difficulties constantly interrupt one’s sleep throughout the night.

3. Other sleep disorders

Insomnia is commonly symptomatic of other sleep disorders, such as:

a. Obstructive sleep apnea (OSA)

Obstructive sleep apnea is a common sleep disorder that affects breathing. The airways are obstructed when asleep by tissues and abnormalities around the air passages. The individual has frequent breathing disruptions that can last for up to ten seconds. The person stops breathing several times during the night, and this disrupts their sleep. They awaken frequently and their sleep quality is significantly reduced.

b. Restless legs syndrome (RLS)

The restless legs syndrome is a disorder that causes unusual sensations in the legs, such as itching, burning, aching, and pulling. This condition is caused by nerve damage and its symptoms appear in the evening and night hours when sitting or lying down. The person experiences an intense urge to move their legs to get rid of these sensations. This condition makes it difficult to maintain sleep because the symptoms worsen when lying down.

c.  Irregular sleep-wake rhythm

The irregular sleep-wake rhythm is a rare sleep disorder in which a person has unusual sleep-wake patterns. It is caused by alterations in the circadian rhythm, which controls sleep and wake times. A person normally sleeps in the nighttime, when there is darkness, and stays awake during the day, when there is sunlight. When a person has this condition, however, the body’s sleep-wake rhythm and the light-darkness cycles are not aligned. They sleep at irregular times and do not get enough hours of sleep at night.

4. Low melatonin levels

Melatonin is a hormone that regulates sleep by controlling the natural sleep-wake cycle. The hormone causes the body to prepare for sleep when it is dark and its absence causes one to stay alert during the day or when there is light. Low melatonin levels lead to difficulties in falling asleep and maintaining sleep throughout the night.

Diagnosis

The diagnosis of insomnia is mainly based on the information provided by the individual concerning the condition. The doctor also uses other methods during the diagnosis, including:

1. Reviewing medical history

A person’s medical history can be used to identify any underlying health conditions that may be affecting sleep and causing insomnia. This condition commonly occurs as a symptom of other health problems, especially sleep disorders. Doctors, therefore, assess the patient’s past and present health conditions to determine the health problems that may be causing difficulties in maintaining sleep.

2. Overnight sleep study

An overnight sleep study is an analysis of the body’s activity when asleep. A device is attached to the patient’s body to measure and record different elements related to sleep, including brain waves, muscle activity, breathing rate, and heartbeat. The study is usually carried out in a sleep center where the patient is watched throughout the night. The doctor obtains useful information on the sleep habits of the patient that help in the diagnosis.

3. Sleep diary

The doctor can ask a patient to keep a sleep diary for up to two weeks to provide more information for use in diagnosis. The diary contains a record of the individual’s sleep and wake times, naps taken during the day, and wake times at night. The patient records this information to help the doctor to ascertain their sleep habits.

4. The multiple sleep latency test (MSLT)

The MSLT is a group of tests that are carried out to measure a person’s sleep latency, which is the time taken to fall asleep. Individuals who have insomnia have difficulty falling asleep and, therefore, have a long sleep latency. These tests are used to determine the length of sleep that a person gets at night, with people who have insomnia showing very few sleep hours.

5. Epworth Sleepiness Scale (ESS)

A patient who reports excessive daytime sleepiness as a symptom is tested using the ESS. The ESS is a questionnaire that is given to a patient for use in diagnosis. It contains questions about the individual’s likelihood to fall asleep during different times of the day. The scale ranges from 0 to 24. A person who experiences excessive daytime sleepiness gets high scores, often over 16, in the scale.

Treatment

Insomnia is mainly treated by addressing the underlying health condition that may be causing it. It can also be treated through:

1. Medication for aiding sleep

Medications can be used to help a person stay asleep throughout the night. These medications are known as hypnotics and they work by reducing the activity of the brain when asleep, thus improving sleep quality. The common types of hypnotics used in treatment include:

a.  Benzodiazepines

Benzodiazepines are medications that suppress the activity of the central nervous system. They reduce the activity of the brain and enable a person to have uninterrupted sleep throughout the night. Common benzodiazepines used in the treatment are:

  • Xanax
  • Valium
  • Ativan
  • Librium
  • Klonopin

b. Antidepressants

Antidepressants are medications used in treating depression. They have a sedative effect and are, therefore, used in low amounts to treat insomnia. When taken, they reduce the activity of the central nervous system and enable a person to fall asleep. Serotonin reuptake inhibitors (SSRIs), which are common antidepressants, are frequently used to improve sleep quality. They reduce sleep onset and help a person maintain sleep.

c.  Melatonin receptor agonists and supplements

Melatonin receptor agonists activate melatonin receptors and increase the production of melatonin. Melatonin is an important hormone that regulates sleep and wake times. People who have low melatonin levels have difficulties in falling or maintaining sleep. When these medications are taken, the person can fall asleep at night and get sufficient sleep. The commonly prescribed melatonin receptor agonists include:

  • Agomelatine
  • Ramelteon
  • Tasimelteon

Melatonin supplements, available over the counter, can also be taken by individuals who have insomnia. They increase the amount of melatonin in the body, thus enabling a person to sleep throughout the night.

2. Lifestyle changes

Some changes in one’s lifestyle can help improve sleep by eliminating habits that affect sleep quality and efficiency. These changes are based on proper sleep hygiene, and they help a person to get sufficient sleep. A doctor can recommend changes such as:

  • Sleeping in a dark and quiet environment
  • Having a regular sleep schedule
  • Avoiding naps during the day
  • Having fixed work schedules that do not extend into sleep time
  • Avoiding alcohol
  • Avoiding stimulants, such as nicotine and caffeine, before bed
  • Consuming a healthy diet
  • Exercising regularly during the day

Conclusion

Insomnia is a serious sleep disorder in which a person has difficulty falling asleep at night. Sleep is needed by the body for restoration and to help one stay alert throughout the day.  A person who has difficulty sleeping lacks restorative sleep and does not feel refreshed. They show symptoms such as fatigue, sleep deprivation, excessive daytime sleepiness, and impaired mental function. Insomnia is caused by different factors, including poor sleep hygiene, underlying health conditions, low melatonin levels, and other sleep disorders. It is diagnosed based on the information provided by the individual concerning their sleep habits, as well as analysis of their medical history. Tools such as a sleep diary, polysomnography, MSLT, and ESS can be used to aid in making a proper diagnosis. The condition is mainly treated by addressing the underlying health condition. It can also be treated using hypnotics, natural supplements and lifestyle changes.

 

 

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