|
|
|
|
|
Insomnia is a persistent and distressing condition related to:
|
- The inability to fall asleep.
- The inability to stay asleep during the night or difficulty going back to sleep if one wakes in the night.
- Waking up too early in the morning.
- Waking up feeling unrefreshed.
|
|
Insomnia is usually accompanied by daytime tiredness, lack of energy, irritability, poor memory and concentration.
|
|
Insomnia is a common symptom, particularly so in our modern fast paced, highly connected world. It affects up to a third of the adult population. Acute insomnia is the commonest form of insomnia and can be caused by stress, major life events and environmental factors. However, some stressors may not resolve within a short duration and may continue to produce insomnia. Often, even after the original source of stress has resolved, the insomnia remains as it has now become a conditioned response. For some, the worry about poor sleep itself becomes the major stressor perpetuating the chronic insomnia.
|
|
Insomnia is chronic if a person has symptoms for a month or longer and can be either primary, where it is not directly associated with any other health condition or secondary, where it is a result of an underlying medical condition or the result of drugs or medications, including caffeine or alcohol. Patients who suffer from chronic insomnia should be evaluated by a sleep physician to ensure that the sleep problem is not due to an underlying medical or psychiatric condition which may require treatment.
|
|
The approach for the treatment of poor sleep generally falls into 2 categories: behavioural and pharmacological.
|
|
Commonly prescribed medications for the treatment of insomnia include benzodiazepines, such as Lorazepam and Diazepam, as well as newer drugs such as Zopiclone and Zolpidem. Although these medications are effective, they are associated with tolerance, addiction, residual hang over effects, rebound insomnia and may increase the likelihood of parasomnias, such as sleep walking, in patients who are susceptible.
|
|
Melatonin has been shown in some studies to be effective in treating insomnia particularly where there has been a disruption to the body’s biological clock or circadian rhythm.
|
|
Other commonly used medications for insomnia include the sedating antidepressants, such as amitriptyline or mirtazapine, and sedating antipsychotics, such as quetiapine or olanzapine. Some doctors prefer these medications over the traditional hypnotics because of the risk of dependence and tolerance, however, these classes of medications are not without their own side effects, which include heart rhythm disturbances, dry mouth, difficulty passing urine and confusion, especially in the elderly.
|
|
Cognitive behavioural therapy aimed at treating insomnia targets the maladaptive behaviours and beliefs that have developed or contributed to the development of insomnia. It is considered the gold standard in the treatment of insomnia and has been shown to be more effective long term than pharmacological treatments.
|
|
Cognitive behavioural therapy consists of several major components, usually implemented in combination.
|
|
Sleep hygiene is an essential component of cognitive behavioural therapy and emphasises on the environmental and physiological factors, behaviour and habits that promote good sleep. These include:
|
- Maintaining a regular sleep-wake schedule.
- Avoiding daytime naps.
- Regular exercise, however, exercise should not occur close to bedtime.
- Avoidance of stimulants such as caffeine and nicotine.
- Alcohol Avoidance. Whilst many believe that alcohol helps them relax and fall asleep, alcohol actually promotes sleep fragmentation, resulting in frequent awakenings during sleep.
- Ensuring that the bedroom is cool, quiet and dark and comfortable for sleeping.
|
|
Stimulus control is a reconditioning treatment which encourages discrimination between the daytime and sleeping environment. The removal of stimulants such as the TV, computers, games or social media from the bedroom and limiting the bed for sleeping and intimacy helps to re-establish the link between the bed and sleep. It is also useful to develop a bedtime routine, where there is an opportunity to “wind down” after the days’ hectic activities. This may include reading or listening to music prior to bedtime. It is important not to force oneself to sleep. This frequently backfires and creates more mental and physical stress which keeps us awake. Similarly, it is important not to “Clock watch”; watching the sleepness night go by only leads to more worry and frustration and worsening insomnia. If sleep does not occur within a reasonable period of time, it is advisable to get up and do something sedentary or boring until you feel sleepy, then return to bed and try again.
|
|
Sleep restriction therapy restricts the individuals time in bed, resulting in an element of sleep deprivation, thereby increasing the body’s own physiological drive to sleep. As sleep becomes more consolidated, the length of the time in bed is gradually increased in 15-30 minute increments.
|
|
Relaxation techniques are frequently used in combination with other cognitive behavioural therapies and include progressive muscle relaxation, guided imagery, breathing techniques and meditation. At a cognitive level, these techniques act by distraction and help to reduce physical and mental arousal.
|
|
Unlike medications, cognitive behavioural therapy addresses the underlying causes of insomnia rather than just relieving symptoms. But like trying to break a habit, it takes time and effort to make it work. In some cases, a combination of sleep medication and behavioural techniques may be required. It is best to speak to your sleep physician to find out which is the best approach for you.
|
Article will appear in the April 2015 issue of Ezyhealth.
|
|
|
