Insomnia: Can’t Sleep? Causes and Treatments
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.
Types of insomnia
1 :: Primary: Not directly associated with any health condition.
2 :: Secondary: 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: lasts for less than a week time, it is generally associated with other disorders, change in sleep environment or timing.
2 :: Acute: lasts for less than a month time, generally stress related.
3 :: Chronic: 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 sleep deprivation?
1 :: Medical conditions
- GI Reflux
- Chronic pain
- Nasal allergies
- High blood pressure
- Restless leg syndrome
- Endocrine disorders- hyperthyroidism
- Hormonal changes (postmenopausal women)
- Neurodegenerative disorders-Parkinson’s disease
2 :: Psychoactive drugs/Stimulants
- Alcohol abuse
- Certain Herbs
- Certain medications-anti-anxiety, pain killers (opiods)
3 :: Alteration of Circadian Rhythm
- Jet lag
- Shift work
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.
- Melatonin: Low Melatonin levels are also linked with sleep deprivation.
- Progesterone: Low Progesterone level is correlated with sleep deprivation and depression, (Biological Psychology 2012)
- 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)
- 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.
- Day time sleepiness
- Lower immune response
- Tiredness, fatigue, exhaustion
- Problems with concentration, memory
- 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 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 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. 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.
- Music therapy
- EEG biofeedback
- Self help therapy
- Metacognition therapy
- Focus on sleep hygiene
- Sleep restriction therapy
- Paradoxical intervention
- Stimulus control therapy
- Behavioral intervention like cognitive behavioral therapy (CBT)
- Relaxation therapies (Jacobson and Mitchell relaxation techniques)
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
- Restrict time spent awake in bed
- Maintain regular sleeping pattern
- Perform regular day time exercise
- Practice relaxation techniques before going to sleep
- Maintain adequate lighting, noise and room temperature
- Avoid caffeine, nicotine, alcohol heavy meals, vigorous exercise a few hours before going to sleep
4 :: Dietary management.
- Eat at regular interval and at fixed time, whenever possible
- Include Magnesium rich foods like green leafy vegetables, pumpkin seeds
- Include Tryptophan rich foods like chicken, cheese, tuna, tofu, eggs, nuts and seeds
- 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
5 :: Yoga for Insomnia. If you struggle with insomnia, yoga and related modalities can help you sleep better. This article is a simplified understanding of how yoga asana, pranayama, breathing techniques and simple meditation can help to overcome insomnia.
Unlike the sleep inducing medicines which work on the symptoms of insomnia, yoga works on both the causes as well as the symptoms of insomnia. Read on… Yoga for Insomnia.
6 :: Relaxed Breathing for insomnia. The easiest yoga proficiency is simple relaxed breathing routine i.e. breathe in and out through nostril, which activates parasympathetic nervous system – creating muscular, mental and emotional relaxation. Relaxed breathing can be 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, shaucha pranayama can also be performed as they are reported to be very effective in the treatment of stress related disorders including insomnia. Read on… Relaxed Breathing: A guide to a good night sleep.
7 :: 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.