Insomnia is a sleep disorder characterized by trouble in falling asleep, staying asleep or suffering from poor quality sleep.
According to the National Sleep Foundation, Insomnia can pose a risk for weight gain, low libido, forgetfulness, high blood pressure, obesity, depression, daytime sleepiness and impaired psychomotor performance among a long list of related health issues.
1 :: Primary insomnia: not directly associated with any health condition
2 :: Secondary insomnia: sleeping disorder caused by health conditions like depression, arthritis, cancer, chronic pain etc.
On the basis of duration of Sleep difficulty, Insomnia is of 3 types
1 :: Transient insomnia: lasts for less than a week time, it is generally associated with other disorders, change in sleep environment or timing
2 :: Acute insomnia: lasts for less than a month time, generally stress related
3 :: Chronic insomnia: lasts for longer than a month time, caused by other disorders. Chronic insomnia can be associated with hallucinations, mental fatigue and muscle wearing.
What causes Insomnia?
1 :: Medical conditions
- Nasal allergies
- GI Reflux
- Endocrine disorders- hyperthyroidism
- Neurodegenerative disorders-Parkinson’s disease
- Chronic pain
- Restless leg syndrome
- Hormonal changes (postmenopausal women)
- High blood pressure
2 :: Psychoactive drugs/Stimulants
- Certain medications-anti-anxiety, pain killers (opiods)
- Certain Herbs
- Alcohol abuse
3 :: Alteration of Circadian Rhythm
- Shift work
- Jet lag
4 :: Poor sleep hygiene
- Extreme temperatures
5 :: Rare genetic disease – Fatal familial insomnia
6 :: Exercise induced Insomnia – Common in athletes with prolonged sleep onset latency
7 :: Imbalanced Hormones associated Insomnia – Sleep studies using polysomnography revealed that insomnia is associated with altered levels of following hormones
- Cortisol: Cortisol is a stress and awakening hormone, whose levels are generally elevated in persons with primary insomnia (Psychopharmacology 2003). An altered hypothalamic-pituitary-adrenal axis caused by chronic stress and depression can increase levels of cortisol
- Estrogen: Lower Estrogen levels as reported in postmenopausal women can cause hot flashes, altered stress reactions and disturbed sleep patterns (Journal of sleep research, 2003)
- Progesterone: Low Progesterone level is correlated with insomnia and depression, (Biological psychology 2012)
- Melatonin: Low Melatonin levels are also linked with insomnia
- Day time sleepiness
- Tiredness, fatigue, exhaustion
- Problems with concentration, memory
- Lower immune response
- May pose a risk for dementia, diabetes, sleep apnea
Insomnia Diagnosis is made by general evaluation consisting of physical examination and evaluation of medical & sleep history. Physician may also ask you to keep a sleep diary for a week or two. In which you have to mention sleep/wake duration and frequency. Physician may ask for various tests including polysomnography, advanced CT scan on MRI brain for patients with chronic insomnia.
It is important to identify the contributing factors of insomnia before commencement of its treatment. Insomnia can be managed by pharmacological/medicinal and nonpharmacological strategies
1 :: Medicinal intervention It is generally used to decrease the symptoms of insomnia or to treat short duration insomnia, while their role in chronic insomnia is unclear as it can cause dependence, drug tolerance or severe rebound withdrawal signs on discontinuation. Medicines commonly prescribed are:
- Sleeping pills
2 :: Non-pharmacological strategies for Insomnia These are the long-term strategies and the first line of treatment of managing insomnia, depending on patient’s condition and severity of insomnia one or more of the following treatment strategies can be used
- Focus on sleep hygiene
- Behavioral intervention like cognitive behavioral therapy (CBT)
- Sleep restriction therapy
- Relaxation therapies (Jacobson and Mitchell relaxation techniques)
- Paradoxical intervention
- Music therapy
- EEG biofeedback
- Self help therapy
- Stimulus control therapy
- Metacognition therapy
3 :: Sleep Hygiene Following sleep hygiene can often check acute insomnia. It includes all the habits required to promote good sleep, which includes
- Minimize day time napping
- Maintain regular sleeping pattern
- Avoid caffeine, nicotine, alcohol heavy meals, vigorous exercise a few hours before going to sleep
- Maintain adequate lighting, noise and room temperature
- Restrict time spent awake in bed
- Practice relaxation techniques before going to sleep
- Perform regular day time exercise
4 :: Dietary management
- Include unrefined carbs (low glycemic index) with protein and fiber rich diet to regulate blood glucose release, as both high and low blood sugar levels can increase incidence of insomnia
- Eat at regular interval and at fixed time, whenever possible
- Include Tryptophan rich foods like chicken, cheese, tuna, tofu, eggs, nuts and seeds
- Include Magnesium rich foods like green leafy vegetables, pumpkin seeds
5 :: Sine Wave Breathing for insomnia The easiest yoga proficiency is proper Sine Wave breathing routine i.e. breathe in and out through nostril, which activates parasympathetic nervous system – creating muscular, mental and emotional relaxation. Sine wave Breathing is done before going to bed. Another technique called brahmari Pranayama, which has been proved to be effective in treating insomnia by creating vibrations in the brain; it can create a soothing (alpha waves) effect.
Other Pranayama like deep breathing, anuloma-viloma, bhastrika, kapalabhati, shauchapranayama can also be performed as they are reported to be very effective in the treatment of stress related disorders including insomnia
6 :: Meditation for Insomnia A study at The Stanford Medical Center found that a 6-week program of Mindfulness Meditation and Cognitive Behavioral Therapy can improve sleep.
Researchers from the University of Massachusetts Medical School have developed an effective sleep therapy that includes Meditation as an important component.
Meditation is an effective way to control your physical, mental and emotional state. With meditation production of serotonin hormone increases which influences mood and behavior in a positive manner. One of the methods of meditation is Sahaj Samadhi, which uses fundamental sounds or mantras for meditation. It is done for 20 minutes twice a day. It soothes the nervous system and provides rest and good sleep
Another type of meditation is Yoga Nidra, which is a sleep like state experienced during prolonged meditation. It is a state of complete relaxation. It helps to reduce anxiety, stress, depression and other psychomotor disorders.
It is worth to take physician’s consent before consuming dietary supplements, herbal supplements or other over-the-counter products for aiding sleep, as their safety, effectiveness and interaction with other drugs has not been established yet and they can be dangerous to take on your own.