The pattern of insomnia often is related to the etiology.
1. Onset insomnia – difficulty falling asleep at the beginning of the night, often associated with anxiety disorders.
2. Middle-of-the-Night insomnia – insomnia characterized by difficulty returning to sleep after awakening in the middle of the night or waking too early in the morning
3. Middle insomnia – waking during the middle of the night, difficulty maintaining sleep. Often associated with pain disorders or medical illness.
4. Terminal (or late) insomnia – early morning waking. Often a characteristic of clinical depression.
Causes:
There are several causes for insomnia. Generally, causes for this condition can be separated into three categories: insomnia due to lack of disorder, insomnia due primarily to physical medical condition, and insomnia due primarily to psychiatric disorder.
Insomnia due to sleep disorders:
1. psychophysiological insomnia, Difficulty Initiating and Maintaining Sleep (DIMS).: It is cause by somatized tension, or stress that is expressed in bodily dysfunction, and learned associations that prevent sleep. Consequently, sleep, the one environment that soothes and rebuilds the body, is undermined by stress and anxiety.
2. Sleep-State Misperception: People with sleep-state misperception sleep adequately, but feel they do not.
3. Obstructive Sleep Apnea (OSA): In OSA, the airway collapses during sleep due to lack of muscle tone. A person with OSA may awaken from an apnea in the early morning and be unable to resume sleep.
4. Central Sleep Apnea (CSA): It is commonly associated with a cerebral vascular condition, congestive heart failure, and old age. Unlike OSA, there is no obstruction of airflow. During sleep, a person with CSA does not receive the stimulus to breathe; the respiratory musculature fails, breathing stops and the person wakes up to resume breathing.
5. Sleep Hygiene and Environmental Sleep Disorder: Inadequate sleep hygiene consists of all the habits that are not conducive to sleep longevity, like late-night exercise, late-night stressful activities, late-night consumption of alcohol or caffeine, sleep with loud noise, and sleeping on a poor mattress.
6. Altitude Insomnia: Ascension to high altitudes, those greater than 4000 meters can cause acute insomnia.
7. Adjustment sleep disorder: It usually describes insomnia related to acute, temporary stress, preoccupation, or trauma.
8. Limit-Setting Sleep Disorder: this sleep disorder is experienced by children. It is caused by a parent’s inability to enforce a consistent bedtime for the child.
9. Sleep-onset Association Disorder: This condition is most common in children. A child may need a set of cues to fallen asleep and if the cues are not present, the child has difficulty falling asleep and resuming sleep once awakened.
10. Food Allergy Insomnia: It usually begins in infancy and resolves between the ages of 2 to 4.
11. Medication-Dependent Sleep Disorder: Insomnia may arise when a person who takes chronic medicines.
12. Stimulant-Dependent Sleep Disorder: there are variety of drugs with stimulant properties that can cause insomnia.
13. Alcohol-Dependent Sleep Disorder: people who depend on alcohol to help them sleep may experience insomnia when they do not use it.
14. Toxin-Induced Sleep Disorder: Toxins, like heavy metals and toxic chemicals in the blood, can cause insomnia.
15. Time-zone change (Jet Lag) Syndrome: Rapid transmeridian travel desynchronizes circadian rhythm and leads to jet lag, which may cause insomnia or excessive sleepiness.
16. Shift Work Sleep Disorder, Shift Work Change (SWC): People who work alternating shifts may develop insomnia because of a continually fluctuation sleep-wake schedule.
17. Irregular Sleep-Wake Pattern: It may affect the elderly, people with central nervous system disorders, and people who are bedridden or institutionalized, all of whom tend to have less concrete sleep-wake patterns because there is no demand to go to work, go to school, and so on.
18. Delayed Sleep-Phase Syndrome (DSPS): In this the circadian rhythm is not synchronized with conventional sleep-wake periods.
19. Advanced Sleep-Phase Syndrome: People with this may find it impossible to stay up and they usually wake up very early.
20. Non-24-Hour Sleep-Wake Syndrome: It is a rare disorder in which a person’s circadian rhythm progressively signals sleep later each night.
21. Nocturnal Leg Cramps: Painful cramps in the legs and feet during sleep are common in the elderly. The pain wakes the person up and can cause sleep maintenance insomnia.
Insomnia due to Psychiatric Disorder:
Psychiatric disorder increase the risk of insomnia. Insomnia, including abnormal sleep cycles or excessive sleepiness, is often a prominent symptom of schizophrenia, and it is a common complaint for people suffering from generalized anxiety disorder and depression.
Insomnia due to medical disorder:
Insomnia due primarily to physical medical condition, are
1. Alcoholism: alcohol may induce sleep for up to four hours, but after that it can lead to frequent awakenings and sleep fragmentation.
2. Degenerative Neurological Disorders: Insomnia is often associated with degenerative neurological disorders such as Alzheimer’s disease, Pick’s disease, and hydrocephalus.
3. Parkinson’s Disease: Insomnia is a common complication of Parkinson’s disease and of the medications used to treat it.
4. Fatal Familial Insomnia (FFI): It is a progressive disorder that begins with difficulty initiating sleep and leads to total lack of sleep within a few months.
5. Headaches: Any type of headache that occurs during sleep may wake a person up.
6. Chronic Obstructive Pulmonary Disease (COPD): Many aspects of COPD can disturb one’s sleep. Low blood oxygen levels, coughing to clear secretions from the lungs, bronchospasm, and the side effects of the medications used to treat the condition can create a night of broken sleep.
7. Asthma: Asthma-related bronchospasm and subsequently airway obstruction is often worse during night. This may lead to shortness of breath that causes a person to wake up.
8. Gastroesophageal Reflux Disease (GERD) and heartburn: Nocturnal acid reflux and its characteristic chronic burning sensation in the lower esophagus can arose one from sleep. If the symptoms are pronounced before going to sleep, they may cause sleep-onset difficulties.
9. Fibromyalgia: Fibromyalgia causes chronic pain in muscles and joint tissue, which can significantly disrupt or prevent sleep.
Insomnia diminishes the quality of life, reduces cognitive function, and affects overall health.
Symptoms:
Each person experiences insomnia differently. People with insomnia may:
1. Have trouble falling asleep.
2. Wake up and have trouble falling back to sleep.
3. Wake up too early in the morning.
4. Feel tired when they wake up, like they did not get enough sleep.
5. Feel grouchy, sleepy, or anxious, and be unable to get things done during the day time.
Treatment:
The main focus of treatment for insomnia is directed towards finding the cause. Once a cause is identified, it is important to manage and control the underlying problem, as this alone may eliminate the insomnia. Treating the symptoms of insomnia without addressing the main cause is rarely successful. Generally, treatment of insomnia entails both natural and medical aspects. The natural and alternative insomnia treatments such as acupuncture, massage, and homeopathy are some of the most effective natural sleep remedies. These modalities all aim to restore the body and mind to their natural balance, providing effective cures for insomnia.
Natural remedies for Insomnia:
Here are some natural remedies for insomnia:
1. Sleep hygiene: Several simple steps can be taken to improve a patient’s sleep quality and quantity. These steps include:
Sleep as much as you need to feel rested but do not oversleep,
Exercise regularly at least 20 minutes daily, ideally 4-5 hours before bedtime,
Avoid forcing yourself to sleep,
Keep a regular sleep and awakening schedule,
Do not drink caffeinated beverages later than afternoon.
Avoid alcoholic drinks prior to going to bed,
Do not smoke, especially in the evening,
Do not go to bed hungry,
Adjust the environment in the room like lights, temperature, noise, etc.
Do not go to bed with your worries; try to resolve them before going to bed.
2. Relaxation: In many instances, stress is the cause of insomnia, and stress is a state of mind. So to calm the mind and body practice meditation, yoga, massage, muscle relaxation or dimming the lights and playing soothing music prior to going to bed.
3. Stimulus control: Following a few simple steps may help patients with chronic insomnia:
Go to bed when you feel sleepy,
Do not watch TV, read, eat, or worry in bed.
If you do not fall asleep 30 minutes after going to bed, get up and go to another room and resume your relaxation techniques,
Set your alarm clock to get up at a certain time each morning, even on weekends. Do not oversleep.
Avoid taking long naps in the daytime.
4. Sleep restriction: It is achieved by averaging the time in bed that the patient spends only sleeping. Rigid bedtime and rise time are set, and patient is force to get up even if they feel sleepy this may help the patient sleep better the next night because of the sleep deprivation for the previous night. Sleep restriction have been useful in some cases.
5. Other simple measures that can be helpful to treat insomnia include:
Avoid large meals and excessive fluids before bedtime,
Control your environment,
Avoid doing work in bedroom.
Herbs useful for insomnia:
The following herbs can be use for treating insomnia:
1. Chamomile (Anthemis nobilis): Chamomile tea is used for insomnia and restlessness combined with irritability, particularly in children.
2. Hops (Humulus lupulus): Hops pillows are sometimes used for mild insomnia.
3. Lavender (Lavandula officinalis): A few drops of lavender oil added to a bath before bedtime are recommended for persons with sleep disorder.
4. Passion flower (Passiflora incarnata): Passion flower is used for minor sleep problems in both children and adults.
5. Valerian (Valeriana officinalis): It is recommended for those type of people who have a hard time falling asleep, because it shortens sleep latency.
6. Wild lecttuce (Lactuca virosa): Wild lettuce is a mild sedative and nervine used for restlessness and insomnia.
7. California poppy (Eschscholzia californica): It has improve both sleep latency and quality.
8. Kava kava (Piper methysticum): It imparts a calm feeling, relaxes the body, and sometimes enhances communication and dreaming. This herb is often used for sleeplessness and fatigue.
9. St. John’s Wort (Hypericum perforatum): It can help relieve chronic insomnia and mild depression when related to certain brain chemistry imbalances.
10. Melatonin: It is a human hormone that is increasingly popular as a supplement to promote sound sleep, especially in people who travel between time zone or who work odd hours.
by:Bharat Saud
