Insomnia is the most common SD and may be particularlydisabling in the elderly. Individuals with insomnia have impaired next day functioning and increased risk of depression which significantly affects their quality of life.4 Short-term insomnia had been observed in 15–20% of the general population in developed countries, while chronic insomnia, which lasts over 1 month occurs in 9–15% of the population.1
Causes of insomnia
Some of the common causes of insomnia include the following:
- Psychological problems like fear, stress, emotional tension, work problems, unsatisfactory sexual life.
- Psychiatric problems such as clinical depression, anxiety and posttraumatic stress disorder.
- Psychoactive drugs or stimulants including caffeine, cocaine, ephedrine, amphetamines and methylphenidate.
- Cardiac—Ischemia and congestive heart failure.
- Endocrine—Hyperthyroidism and menopause.
- Neurology—Stroke, Alzheimer’s disease.
- Gastrointestinal—Gastroesophageal reflux disease.
- Stressful or life-threatening events.
- Disturbances of the circadian rhythm— shift work and jet lag.
- Environmental noise or other disturbances—bed partner with loud snoring.
Symptoms of insomnia
Symptoms of insomnia may include
- Difficulty in falling asleep
- Trouble in staying asleep, and
- Not feeling restored by sleep
Most often daytime symptoms will bring people to seek medical attention. These day time problems caused by insomnia include
- Poor concentration
- Poor memory
- Irritability and
- Impaired social interaction
Treatment of insomnia
Cognitive behavioral therapy:
The mainstay of treatment for insomnia is cognitive behavioral therapy (CBT) along with judicious use of hypnotic agents. Cognitive behavioral therapy should be considered as first-line intervention for chronic insomnia. Recent study had shown that cognitive behavioral therapy had a long-term effect of improved sleep-related psychological activity and daytime functioning compared to other medications in chronic insomnia.1
Pharmacological treatments for insomnia involve judicious and intermittent usage of benzodiazepine or nonbenzodiazepine hypnotics.
The most commonly used class of hypnotics is benzodiazepines such as
- Nitrazepam and
These medications can develop tolerance and dependence, especially after consistent usage over prolonged period.
Nonbenzodiazepines cause both psychological and physical dependences, and the same memory and cognitive disturbances as benzodiazepines, in addition to morning sedation.
Other sedatives used in treatment of insomnia include antidepressants and antihistamines.
Nevertheless, long-term use of sedative hypnoticsis contraindicated due to adverse effects that can outweigh benefits, including habituation, dependency, andimpairment of daytime psychomotor and cognitive performance,daytime drowsiness and rebound insomnia.
General therapeutic recommendations for insomnia include the following:
- Practice relaxation techniques before sleep time.
- Avoid large meals, excessive fluid intake and strenuous exercise before bedtime.
- Avoid sleep-disturbing substances such as alcohol, nicotine and caffeine before bedtime.
- Avoid reading and watching television while on the bed.
- Establish a bedtime routine.
Guidelines for better nights sleep
To have a good and comfortable sleep follow the following points.
- Have regular bedtimes and wake-up times.
- Develop a bed time rituals ti relax before going to bed.
- Go to bed only when you are sleepy, sleep as much as possible to feel refreshed.
- Use the bedroom only for sleep.
Written by: Healthplus24 team
Date last updated: September 30, 2012