Insomnia is a common sleep disorder that can make it hard to fall asleep ,hard to stay asleep or cause you to wakeup too early and not be able to get back to sleep. Insomnia can affect not only your energy level and mood ,but also your health , work , performance and quality of life. Mostly adults need 7-8 hrs. sleep in a night.
• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Ongoing worries about sleep
• Not feeling well rested after a night’s sleep
• Difficulty paying attention , focussing on tasks
• Increased errors or accidents
• Daytime tiredness or sleepiness
• Irritability , depression or anxiety
Two types of classification is there for insomnia. First on the basis of severity ,there are two types of insomnia –
• Acute insomnia –
It lasts from 1 night to a few weeks.
• Chronic insomnia –
when it happens atleast 3 nights a week for 3 months or more.
On the basis of reason , there are also two types of insomnia –
• Primary insomnia –
This means your sleep problems aren’t linked to any other health condition or problem.
• Secondary insomnia –
This means you have trouble in sleeping because of a health condition (like asthma , depression , arthritis ,cancer etc.), pain , medication or substance use like alcohol.
Causes of primary insomnia includes –
• Stress related to big life events like a job loss or change ,the death of a loved one , divorce .
• Things around you like noise ,light or temperature.
• Changes to your sleep schedule like jet lag ,a new shift at work.
Causes of secondary insomnia –
• Medications for cold , allergies ,high BP and asthma.
• Caffeine , tobacco or alcohol use.
• Mental health issues like depression , anxiety.
• Hyperthyroidism and other endocrine problems.
• Other sleep disorders like sleep apnea or restless legs syndrome.
Insomnia and ageing –
• Changes in sleep patterns – Sleep often becomes less restful as you age ,so noise or other changes in your environment are more likely to wake you up.
• Changes in activity – As because of less physically or socially active ,you may have interference with a good night’s sleep.
Risk Factors –
Nearly everyone has an occasional sleepless night but your risk of insomnia is greater if –
• You are a women – Hormonal shifts during menstrual cycle and menopause may play a role in disturbing sleep.
• You are over age of 60 yrs.
• You have a mental health disorder or physical health condition.
• You are under a lot of stress.
• You don’t have a regular sleeping schedule.
People with insomnia report a lower quality of life compared with people who are sleeping well.
Complications may include –
• Slowed reaction time while driving and a higher risk of accidents.
• Low performance at your work place.
• Increased risk and severity of long-term disease like BP ,heart disease.
• Mental health disorders such as depression or an anxiety disorder.
• Try to make a disciplined time table of going to sleep at night and get up in the morning.
• Avoid sleep naps during the day.
• Avoid caffeine, nicotine and alcohol late in the day.
• Get regular exercise.
• Follow a routine to relax before bed. Read a book , listen to music or take a bath.
• Make your bedroom comfortable ,dark ,quiet and not too warm or too cold.
Depending on your situation ,the diagnosis of insomnia and the search of its cause may include –
• Physical examination –
Your doctor may do a physical examination to look for signs of medical problems that may be related to insomnia.
• Sleep habits review –
In addition to asking you sleep related questions,your doctor may have given you to complete a questionnaire to determine your sleep wake pattern and your level of daytime sleepiness.
• Sleep study –
In case cause of your insomnia is not clear or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome ,you may need to spend a night at a sleep center. Test are done to monitor and record a variety of body activities while you sleep including brain waves, breathing, heartbeat,eye movement and body movements.
Cognitive behavioral therapy ( CBT-1) –
It can control or eliminate negative thoughts and actions that keep you awake and is generally recommended as the first line of treatment for people with insomnia. Typically it is equally or more effective then sleep medications.
The behavioral part of CBT-1 helps you develop good sleep habits and avoid behaviours that keeps you distant from sleeping well. Strategies includes e.g. –
• Stimulus control therapy –
This method helps to remove factors that condition your mind to resist sleep.
• Relaxation Techniques –
Progressive muscle relaxation , biofeedback and breathing exercises are ways to reduce anxiety at bedtime.
• Sleep Restriction –
This therapy decreases the time you spend in bed and avoids daytime naps , causing partial sleep deprivation, which makes you tired the next night.
• Remaining passively awake –
It is also called paradoxical intention , this therapy for learner insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
Prescription Medications –
Doctors generally don’t recommend relying on prescription sleeping pills for more than a few weeks.
Benzodiazepine sedatives such as triazolam ,estezolam , lorazepam,temazepam ,flurazepam and non – Benzodiazepine sedatives such as zolipiden,eszopiclone and zaleplon are drugs that can help induce sleep, however ,these medications may be addictive with extended use.
Ayurvedic Perspective –
Insomnia is termed as Anidra in Ayurveda. It is described as a condition that is caused by degradation of vata dosha. As per Ayurveda ,when we have excess vata and our minds are full of too many thoughts, it is impossible to relax. When cough functions normally it gives us healthy sleep. Ayurveda describes three qualities of mind as Satva ,Raja & Tama. While Raja gives us interrupted sleep ,Tama is essential for healthy sleep. Problems like anxiety,rage ,envy,stress etc. increases the raja property of our psyche ,which in turn leads to insomnia.
Line of treatment –
Panchkarma Therapies –
• Shirodhara –
• Shiroabhyanga –
• Netratarpan –
• Anjana –
• Padabhyanga –
Effective Herbs –
• Brahmi – It is known as brain tonic, helps to improve concentration and alertness and induces sleep.
• Shankhpushpi – It soothe the nervous system and relieve mental fatigue.
• Vacha – It has calming properties which help the brain too relax ,cure tension and treat insomnia.
• Sarpagandha – It contains more than 50 alkaloids that help in reducing high BP ,this ,in turn ,induces sleep.
• Ashwagandha – It promotes sound sleep. It treats anxiety ,stress and exhaustion.
• Jatamansi – It relaxes brain and induces sleep.
Besides lifestyle changes ,herbs Pranayam & specific yoga postures also help in inducing sleep.
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