Insomnia

Description of Insomnia

Definition
 
Insomnia is having problems with falling asleep or staying asleep. It is a common complaint occurring in almost one-tenth of the adults. Children also suffer from insomnia.
 
Causes and Risk Factors
 
Insomnia may be short-term or chronic. Short term insomnia is having problems with sleep due to:
1. Stress due to a painful event in life such as death of a loved one or divorce
2. Worry before an exam
3. Anxiety before an interview
4. Pain or uneasiness due to a temporary illness
5. Travel that causes jet lag
6. Unfamiliar surroundings
7. Uncomfortable bed
8. Disturbance, such as due to noise

Chronic insomnia is having trouble falling asleep for at least 3 days in a week for 3 consecutive months. It may occur due to:
1. Stress
2. Parkinson disease
3. Alzheimer disease
4. Depression
5. Bipolar disorder
6. Drug abuse
7. Alcohol intake
8. Heavy smoking
9. Obstructive sleep apnea

Poor sleep habits may also affect sleep:
1. Not following a regular schedule for sleeping
2. Working in evening or night shifts
3. Using mobile phone or laptop in the bed
4. Watching television in bed

Some factors that increase the risk of insomnia include:
1. Female sex
2. Age
3. Medical condition
4. Mental disorder
Insomnia may occur in young children who are used to falling asleep only in a particular way such as when being rocked, held, or fed. When these conditions are absent, the child may have problems falling asleep.
 
Signs and Symptoms
 
Symptoms of insomnia include:
1. Difficulty falling asleep
2. Difficulty staying asleep
3. Getting up too early
4. Problems in day to day functioning due to insufficient sleep
5. Problems with attention and memory
6. Tiredness and sleepiness during day time
7. Problems with work, family, and social life
 
Investigations
 
The diagnosis of insomnia includes taking an extensive history of the patient that includes questions on:
1. Duration of sleep during night time
2. Daytime napping if any
3. Frequency of having difficulty sleeping
4. Medical condition, if any
5. Any stressful event in the recent past

The doctor may conduct a few tests, such as:
1. Blood test for thyroid disorders, anemia (low hemoglobin), uremia (high uric acid levels)
2. Imaging tests such as CT and MRI
3. Sleep record over a period of 2 weeks to know the time at which a patient falls asleep, the duration of sleep in the daytime as well as night time. The patient may be asked to record these in a diary.
4. Wrist actigraphy to detect movements during sleep. A device called actigraphy is worn on the wrist during sleeping. It records body movements and can help distinguish wakefulness from sleep.
5. Sleep quality tests to measure the quality of sleep, such as insomnia severity index or Pittsburgh sleep quality index.
6. Polysomnography to find out sleep disorders by recording a set of parameters during sleep. The parameters studied during sleep include brain waves, heart rate, breathing, oxygen levels, and eye and leg movements. This test is also called sleep study.
 
Treatment
 
Treatment of insomnia includes making changes in sleep habits, taking medicines, doing relaxation exercises, and treating the underlying condition that causes insomnia.
The doctor may prescribe some sleep medicines such as:
1. Diphenhydramine
2. Melatonin
3. Zolpidem
4. Ramelteon

Follow these sleep habits to help treat insomnia:
1. Keep a regular time for sleep. Sleep and wake up at the same time every day.
2. Avoid sleeping during the day.
3. Avoid bright light in the room while sleeping.
4. Avoid distractions such as mobile phone or a book.
5. Put some relaxing music.
6. Do not worry or think about stressful events while in bed.
7. Avoid heavy meals close to bedtime.
8. Reduce coffee or tea intake, especially in the evening time.
9. Reduce alcohol intake and smoking.
10. Do not exercise heavily close to bedtime.
11. Do not think about office work or plan things when trying to sleep.
12. Take a warm shower before sleeping.
13. Do not keep checking the time when trying to sleep.
14. Do not drink too much water before sleeping.
15. Using gadgets such as laptop, ipad, or mobile phones in bed are a big hindrance to sleeping well. So avoid their use in bed.
16. Do not keep lying in the bed if you are not able to sleep even after trying for at least 30 minutes. Leave the bedroom and try to engage yourself in an activity that takes your mind off sleeping. Do an activity that you do not enjoy much as it will help you feel sleepy. Return to the bedroom when sleepy and repeat if not able to sleep.

Home treatments that may help with sleep include eating food that contains the amino acid tryptophan. Tryptophan reduces anxiety, helps in calming down and induces sleep. Drinking a glass of warm milk before bedtime works well with having a good night’s sleep. You can add a little honey to it.

Other foods that contain tryptophan include:
1. Nuts
2. Sunflower seeds
3. Cheese
4. Turkey
5. Chicken
However, remember not to eat too much just before trying to sleep. Scheduling your dinner time to evenings may help you sleep better.
Doing regular light exercise can help you get a good sleep. Try yoga, meditation or breathing exercises to relax.
 
Complications and When Should You See a Doctor
 
Deficient sleep may cause the following complications:
1. Problems with memory
2. Problems in concentration
3. Impaired social life
4. Reduced work performance
5. Sleepiness in the day time

Side effects of sleep medicines may include:
1. Headache
2. Problems with memory
3. Dry mouth
4. Constipation
5. Elevated prolactin levels
See a doctor if you are not able to get a good quality sleep even after following a proper sleep hygiene.
 
Prognosis and Prevention
 
Prognosis is good and prevention is easy with good sleeping habits.
 
References
 
Mansukhani MP, Kolla BP, St. Louis EK, Morgenthaler TI. The nervous system. In: Bope ET Kellerman RD, eds. Conn's Current Therapy 2017. Philadelphia PA: Elsevier; 2017:chap 9.
Posner D. Insomnia. In: Ferri FF, ed. Ferri's Clinical Advisor 2018. Philadelphia PA: Elsevier; 2018: 710-712.e1.
 

Frequently Asked Questions about Insomnia

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