Does it take more than 30 minutes to fall asleep or do you wake up during the night and have trouble returning to sleep, or do you wake up earlier than desired? Do you feel fatigued, moody or sleepy during the day? Do you give yourself adequate time in bed? If your answer is yes, then there is a high probability that you may be suffering from Insomnia, a chronic sleep disorder, in which an individual finds it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. Such patients usually awaken feeling unrefreshed, which takes a toll on their ability to function during the day. Hence they feel low on energy levels, experience low moods and slowly it starts to impact their health, work performance and quality of life. Irritability, depression or anxiety are common symptoms. At workplace such patients have difficulty paying attention, focusing on tasks or remembering, and are prone to increased errors or accidents and tension headaches. Uncommonly they may experience distress in the stomach and intestines.
Insomnia affects millions of people worldwide and is rising every year owing mainly to the high pressure lifestyles. It includes a wide range of sleeping disorders, from lack of quality of sleep to lack of quantity of sleep.
Insomnia may be the primary problem, or it may be secondary due to other causes, such as a disease or medication. The Common causes of insomnia include stress like concerns about work, school, health or family can keep the mind active at night, making it difficult to sleep. Stressful life events — such as the death or illness of a loved one, divorce, or a job loss — may lead to insomnia. Certain diseases like arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson's disease and Alzheimer's disease often result in insomnia. Insomnia may also be a symptom of underlying sleep disorder like restless legs syndrome or sleep apnea. Many drugs like antidepressants, heart and blood pressure medications, allergy medications, stimulants, and corticosteroids can interfere with sleep. Some pain medication combinations, decongestants and weight-loss products — contain caffeine and other stimulants. Tea, coffee, colas and other caffeine-containing drinks are well-known stimulants. Drinking coffee in the late afternoon and later, Nicotine in tobacco products, all can cause insomnia. Alcohol may cause sleepiness initially, but it prevents deeper stages of sleep and often wakes up the individual in the middle of the night.
People over 60 years of age, adult females, Travelers and Shift workers with frequent changes in shifts are much more likely to have insomnia. Hormonal shifts during the menstrual cycle, night sweats and hot flushes in menopause may play a role. Insomnia is also common during pregnancy. Sleep problems may affect children and teenagers as well. While some children and teens simply have trouble getting to sleep, others resist a regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.
Cognitive behavioral therapy forms the first line of therapy and helps in controlling or eliminating negative thoughts. Relaxation techniques, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help in controlling breathing, heart rate, muscle tension and mood.
Sleeping pills that are specifically approved to treat insomnia are called hypnotics. However, these medications should not be taken without medical advice or supervision. One should not rely on such pills for long durations as tolerance to these medicines is known to occur. A group of medicines called antihistamines, are sometimes used as a sedative. They may initially cause grogginess, but they reduce the quality of sleep, and have side effects, such as daytime sleepiness, dizziness, urinary retention, dry mouth and confusion.
Good sleep habits go a long way in ensuring a sound sleep. The term "Sleep Hygiene" refers to a series of such habits and rituals that can improve the ability to fall asleep and stay asleep.
Regular vigorous exercise for 20-30 minutes during the day promotes a good night's sleep but it should be at least five to six hours before bedtime. Naps during the day should be avoided but if one has to take a nap, it should be limited to no more than 30 minutes and no nap after 3 pm. The bedtime and wake time should be consistent from day to day, including on weekends and should ensure at least 7 hours of sleep. One should avoid heavy physical and mental work just before sleeping. Even an argument just before sleeping can be distressing and can potentially disturb sleep.
Certain substances and activities, including eating patterns, can contribute to insomnia. Caffeine containing drinks like tea, coffee, colas and alcohol and nicotine, should be avoided especially in the evening hours. While a light snack is fine but large meals and beverages should be avoided before bed. This prevents gastroesophageal reflux and frequent urination at night
The environment of the bedroom also should be sleep-friendly. TV, computers, video games, smartphones or other screens should not be kept in the bed room. The bed and bedroom should be used only for sleeping or sex. The room temperature should be comfortable but certainly cooler than the day. Dim lights, soft music, nice aromas reading a book can be tried.
If despite all this, an individual is not able to sleep in 20 minutes, then one should not try too hard. The individual should move out of the bed and perform some light non-stimulating activity like reading a book and come back to the bed only once the feeling of drowsiness has set in. one should remove all clocks and watches from the view. Anxiously watching the minutes tick by when one cant sleep is a surefire recipe for insomnia.
Yoga and meditation serve as adjunct modes of therapy and can help improve sleep quality with no significant risks associated.
Dr.Nangia was one of the five Physicians from across the globe and the only one from India to be felicitated by her Royal Highness Princess Royal of London on successfully completing the prestigious program of infectious diseases.
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