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Medicare / Health Articles / Articles
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Insomnia
Sleep is an important normal physiological process required in our lives for our health and well being. Getting the right quantity and quality of sleep has an important impact on our daily lives for it is a restorative process that allows our body to recharge so that we feel refreshed and ready to face daily new challenges.
Sleep requirements vary over the human life cycle as the sleep pattern changes with age. Generally as one age, the total sleep time decreases and the average adult sleep time is around 7 to 9 hours.
| Infants/Babies* | 0-2 months : 10.5 -18.5 hours
2-12 months : 14.0 -15.0 hours |
| Toddlers/Children* | 12-18 months : 13.0 -15.0 hours
18 months – 3 years : 12.0 -14.0 hours
3 -5 years : 11.0 -13.0 hours
5- 12 years : 9.0 - 11.0 hours |
| Adolescents | 8.5 – 9.5 hours |
| Adults/Older Persons | On average: 7 – 9 hours
|
* Total time includes naps
What is Insomnia?
Insomnia is an experience of inadequate or poor quality sleep characterised by one or more of the following:
- difficulty sleeping
- difficulty maintaining sleeping
- waking up too early in the morning
- non-refreshing sleep
Insomnia also involves several daytime consequences. One may experienced tiredness, lack of energy and mood changes such as irritability. These consequences may markedly affect one’s quality of life and impairment of daily activity performances.
Types of Insomnia And Its Causes
Acute insomnia refers to periods of sleep difficulty that lasts between one night to a few weeks while chronic insomnia refers to sleep difficulty occuring at least three nights per week for one month.
Insomnia is a symptom and not a disorder by itself. It is normally a sequalea of an underlying condition. Acute insomnia is transient and is often caused by emotional or physical discomfort for instance, significant life stress ( eg work stress, grief), acute illness and environmental disturbances such as noise, light and temperature. Sleeping at a time that is inconsistent with the daily biological rhythm such as in persons with jet lag and shift workers may also cause acute insomnia.
Chronic insomnia on the other hand may be caused by many different factors acting singly or in combination and is often occurring in conjunction with other health problems. These health problems include:
- psychiatric and neurological disorders such as dementia, parkinson’s disease
- general medical conditions such as perimenopause/ menopause, Gastric Esophageal Reflux Disease, cancer, arthritis etc
- specific sleep disorders such as obstructive sleep apneo,restless leg syndrome and periodic limb movement
- chronic medications such as antihypertensives, antidepressants, stimulants etc
Treatment
Treatment of insomnia involves medications and behavioural therapy.
In acute insomnia, the need of treatment is dependent on severity of daytime consequences, the duration of the episode and the predictability. It may also be necessary to prevent development of untreated cases into chronic learned insomnia.
In the management of acute insomnia, good sleep habit can be instituted to help promote sleep. For general sleep hygiene measures :
- Wake up at the same time of day
- Discontinue caffeine 4 to 6 hours before bedtime and minimize total daily use. Caffeine is a stimulant and may disrupt sleep
- Avoid nicotine especially near bedtime and upon night awakenings; it is also a stimulant
- Avoid use of alcohol in the late evening to facilitate sleep onset; alcohol can cause awakenings later in the night
- Avoid heavy meals too close to bedtime, as this may interfere with sleep. A light snack may be sleep-inducing
- Regular exercise in the late afternoon may deepen sleep; vigorous exercise within 3 to 4 hours of bedtime may interfere with sleep
- Minimize noise, light and excessive temperature during the sleep period
- Move the alarm clock away from the bed if it is a source of distraction
A short course of sleeping-promoting medicine known as the benzodiazepines may be prescribed by the physician to promote sleep in patients. Generally, these medicines are given at the lowest effective dose for a period of 2 weeks and preferably intermittently. Chronic usage is not recommended as it may lead to problems such as dependence and tolerance. Little safety and efficacy data is available to guide their usage beyond two to three months. Other side effects of benzodiazepines include poor movement coordination, falls (especially in elderly), drowsiness, rebound insomnia, amnesia, irritability and morning hangover effects which happen mostly in the long-acting benzodiazepines. Newer non-benzodiazepines sleeping pills such as zopiclone are safe effective alternatives with lesser incidents of side effects of the benzodiazepines. However, its commonly experienced side effect by is bitter aftertaste in the mouth.
In treatment of chronic insomnia, sleep promoting medications may help relief insomnia symptomatically. Behavioural interventions like relaxation therapy, sleep restriction therapy, stimulus control therapy and cognitive therapy have been employed to relief chronic insomnia too. However, the main objective in the management of chronic insomnia should be targeted at treating any underlying medical condition causing the insomnia. For instance, a patient with depression induced insomnia may be prescribed an anti-depressant at night.
Other Forms of Therapy
Several forms of over-the-counter preparations are available commercially as sleep aids. Sedating antihistamines like diphenhydramine have been used to improve sleep on a short term basis. However, their long term efficacy has not been demonstrated. Possible side effects include dry mouth, blur vision, constipation and urinary retention.
Similarly, very little scientific proofs exist to justify the efficacy and safety in long term usage of herbal preparations containing Valerian, Hops and Passionflower. Furthermore, most of them do not have consensual standardization and therapeutic potency leading to varying active contents in different brands.
Melatonin, a natural hormone secreted naturally from the pineal gland, has been known to have effect on the circadian rhythm in humans. Though several studies showed that melatonin appears to relieve jet lag, clinical studies in patients with insomnia have provided inconsistent results and melatonin’s role in treating sleep-related disorder remains to be defined.
Our slumber can be plagued by over 80 known sleep problems and disorder. Hence it is important to consult your doctor if problems of insomnia persist too long.
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