Causes, symptoms and treatment
Anxiety about lack of sleep worsens insomnia
Insomnia is thought to affect up to 35% of all adults
during the course of a year. Half of these sufferers
regard the problem as serious and most are women.
Definition
Insomnia can be defined as a condition of unsatisfactory
sleep either in terms of onset (problem falling asleep),
sleep maintenance (staying asleep) or early waking.
As a lack of sleep affects a person’s ability to
carry out day-to-day tasks it can be considered a 24 hour
disorder. Knowing the cause of the insomnia is not necessary for a diagnosis but it does help in finding the most suitable treatment and also helps to rule out any physical causes such as pain or other physical or
psychiatric illness.
Insomnia can often start with a stressful event such as starting or losing a job, birth of a new baby, bereavement etc. Bad habits around sleep routines alone or in addition to other stressors can also disrupt the sleep regulation mechanism in the brain leading to chronic (ongoing) insomnia. Older aged adults will also find that they require less sleep but this does not usually cause them any feelings of drowsiness during waking hours. Depression is often said to cause insomnia but in fact insomnia is also a risk factor for depression and may occur before depression. Certain medications, pain, cardiocascular and neurological disorders, substance abuse and anxiety can also cause disrupted sleep patterns.
Insomnia is a serious disorder with serious consequences. The person’s quality of life can be very badly disruptedas they struggle to cope with normal dailyresponsibilities. They are at increased risk of havingaccidents at work and on the roads, and even a shortperiod of sleep deprivation can increase the risk ofhypertension. Resulting absenteesim is a problem for theindividual and the economy.
During sleep the brain reorganises and refreshes itself
Insomnia can be described as a Psycho-physiological
Disorder. This means that the inter-play of biological
systems in the body and brain that are responsible for
maintaining good sleeping patterns and the way in which
we naturally respond to poor sleep create a cycle which
prepetuates the problem.
For example,being awake when we want to be asleep often
causes frustration and thoughts about all the things that
we need to be alert for the next day. We may clock-watch
to see how long we have been awake which irritates us and
therefore increases our arousal and wakefulness. The more
we try to sleep the further away we push sleep away.
Treatment and Help for Insomnia
Practise good “Sleep hygiene”. This is a term used by sleep specialists and means making sure your activities before sleep and your bedroom are conducive to sleep. For example;
If curtains do not block enough light use an eye mask
-Make sure your room is dark
-don’t go to bed until your are tired but get up the same
time every day- even weekends
- Use your bed for sex and sleep only, not browsing the
internet or work related activities.
- Make sure your room is completely dark
- turn any clocks away (especially illuminated ones) so
that you cannot clock watch
- leave a notepad and pen beside your bed so that if you
are worried about forgetting something in the morning you
can write it down and then let it go from your mind
- avoid stimulants from late afternoon
Severe insomnia is devastating to quality of life and
should be investigated first by your doctor to rule out
any other conditions which may be causing it. You may be
prescribed medication to help you catch up on lost sleep.
However these should not be used long-term. You may
need the help of a psychologist to help you to identify
behaviours which you may not be aware are disrupting your
sleep, to discuss life events which may be causing stress
and insomnia and to learn techniques to manage them such
as Cognitive Behavioural Therapy and relaxation
strategies.
Other sleep disorders which require medical attention
include;
- narcolepsy; falling asleep during the day without
warning or extreme muscle weaknesstriggered by emotion
such as laughing.
- circadian rhythm disorder; the individual may sleep
well and at regular intervals but at the wrong time of
day (as occurs in jet lag, shift work or other
lifestyle). behaviours).
- Parasomnias; unusual behaviours associated with sleep
which may be troubling or dangerous to the person such as
night terrors and sleep walking.
Night terrors (sleep terrors) involve sudden
waking from deep sleep usually in the first 1/3 of the
night, with signs of terror / trying to escape / fight
etc. The person does not respond to comforting and
usually does not wake from it but if does they have no
memory of the event. 30-40% of children have at least
one episode but luckily for most it does not happen
again. Approximately 5% of childrem will have repeated
episodes, which mainly happen between the ages of 2 and 7
years and then gradually decline. Adult cases are more
rare and almost always have continued since childhood.
There is a strong genetic component for night terrors.
Sleep walking affects some 15-20% of the population at
some time in their lifetime.It happens when the person
carries out activities which are familiar to them
automatically, as if on “auto-pilot”. They are
un-responsive to anyone aroumd them.It usually involves
just walking but can also involve getting dresses or
making tea etc. Sleep walking can be caused by certain
and substance abuse.
- Restless leg syndrome; periodic jerky limb (not
necessarily the leg) which disturb sleep.
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