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Insomnia is defined as the inability to get enough or good quality sleep. The problem could be falling asleep, staying asleep, or both. Insomniacs do not feel refreshed when they wake up. Insomnia is a common symptom that affects millions of people and can be caused by a variety of conditions, diseases, or life events.

Overview

Sleep is necessary for both mental and physical recovery. It is a cycle with two distinct states: rapid eye movement (REM), during which most dreams occur, and non-REM (NREM). During NREM, four stages of sleep occur: stage I, when the person transitions from relaxed wakefulness; stage II, an early stage of light sleep; and stages III and IV, which are increasing degrees of deep sleep. The majority of stage IV sleep (also known as delta sleep) occurs during the first several hours of sleep. A period of REM sleep is usually followed by a period of NREM sleep.

Women and older people are more likely to suffer from insomnia. People who are divorced, widowed, or separated are more likely to have the problem than those who are married, and those with lower socioeconomic status are more likely to report it. Insomnia, also known as transient insomnia, is a common occurrence that usually lasts only a few days. Long-term or chronic insomnia lasts longer than three weeks and increases the risk of injury at home, at work, and while driving due to daytime sleepiness and decreased concentration. Chronic insomnia can also contribute to mood disorders such as depression.

Causes and Symptoms

A temporary situation in a person’s life, such as an argument with a loved one, a brief medical illness, or jet lag, is often the cause of transient insomnia. When the situation is resolved or the precipitating factor is removed, the condition usually resolves itself without the need for medical treatment.

Chronic insomnia usually has different causes, and there may be more than one. These include:

  • A medical condition or its treatment, including sleep apnea
  • Use of substances such as caffeine, alcohol, and nicotine
  • Psychiatric conditions such as mood or anxiety disorders
  • Stress, such as sadness caused by the loss of a loved one or a job
  • Disturbed sleep cycles caused by a change in work shift
  • Sleep-disordered breathing, such as snoring
  • Periodic jerky leg movements (nocturnal myoclonus), which happen just as the individual is falling asleep
  • Repeated nightmares or panic attacks during sleep

Another cause is excessive worry about whether or not a person will be able to sleep, which causes so much anxiety that the individual’s bedtime rituals and behavior actually cause insomnia. The more one worries about falling asleep, the more difficult it is. This is referred to as psychophysiological insomnia.

SYMPTOMS OF INSOMNIA

People who suffer from insomnia do not wake up refreshed after a good night’s sleep. They are exhausted. They may have difficulty falling asleep and frequently spend hours tossing and turning in bed. Alternatively, the individual may fall asleep without difficulty but awakens in the early hours of the morning, either unable to return to sleep or drifting into a restless, unsatisfying sleep. This is a common symptom in the elderly and those who are depressed. When a person’s sleep patterns are reversed, he or she has difficulty staying awake during the day and takes frequent naps. Nighttime sleep is erratic and frequently disrupted.

Diagnosis

A physician makes the diagnosis of insomnia based on the patient’s reported signs and symptoms. It can be beneficial for the patient to keep a daily record of sleep patterns, food intake, alcohol use, medications, exercise, and any other information recommended by the physician for two weeks. If the patient has a bed partner, information about whether the patient takes notes or is restless while sleeping can be obtained. This, along with a medical history and physical examination, can help confirm the doctor’s diagnosis.

Insomnia can be recognized and treated by a wide range of healthcare professionals. However, when a patient with chronic insomnia does not respond to treatment or the condition is not adequately explained by the patient’s physical, emotional, or mental circumstances, more extensive testing by a sleep disorder specialist may be warranted.

Treatment

Insomnia treatment entails addressing any physical and emotional issues that are contributing to the condition, as well as exploring lifestyle changes that will improve the situation.

CHANGES IN BEHAVIOR

Patients can make simple and effective changes to their daily routine to treat their insomnia. They should only sleep in their bedrooms and go to bed when they are tired. Other activities, such as reading, watching television, or snacking, should be done elsewhere. If they can’t sleep, they should go into another room and do something relaxing, such as reading. Television viewing should be avoided because it has an arousing effect. To establish a regular sleep-wake pattern, patients should set an alarm and get up at the same time every morning, regardless of how much they have slept. Daytime naps should be avoided, but if absolutely necessary, a 30-minute nap early in the afternoon may not interfere with nighttime sleep.

Another effective method is sleep-restriction therapy, which limits the amount of time spent in bed to the time spent sleeping. This method allows for a slight sleep debt to accumulate, which improves the individual’s ability to fall and stay asleep. If a patient sleeps five hours per night, his or her bedtime is limited to 5-5 1/2 hours. The amount of time spent in bed is gradually increased in small increments, with the individual rising at the same time each morning; at least 85 percent of the time spent in bed must be spent sleeping.

Medications

Sedatives, tranquilizers, and antianxiety medications are among the medications used to treat insomnia. All require a doctor’s prescription and have the potential to become habit-forming. They can lose effectiveness over time and cause drowsiness during the day. The medications should be taken two to four times per day for three to four weeks, though this will vary depending on the physician and patient. If the insomnia is caused by depression, an antidepressant medication may be beneficial. Over-the-counter medications, such as antihistamines, are ineffective at promoting sleep and can have a negative impact on sleep quality.

Other Measures

Relaxing before going to bed will assist a person in falling asleep more quickly. Learning to replace unpleasant thoughts with pleasant ones (imagery training) is a technique that can be very beneficial in reducing anxiety. Another effective measure is to listen to audiotapes that combine nature sounds with soft relaxing music. These, by themselves or in combination with other relaxation techniques, can safely induce sleep.

Changes to one’s diet and exercise routine can also be beneficial. Caffeine-containing beverages such as coffee, tea, and colas, chocolate (which contains a stimulant), and alcohol, which initially makes a person sleepy but can have the opposite effect a few hours later, are all foods to avoid. Maintaining a comfortable bedroom temperature, minimizing noise, and eliminating light are all beneficial. Exercise in the morning or afternoon on a regular basis can help to relax the body. This should be done 3-4 times per week and should produce a light sweat.

Alternative Treatments

Many alternative treatments are effective in treating both the symptoms of insomnia and the underlying causes of the condition. Incorporating relaxation techniques into bedtime rituals will help a person fall asleep faster and sleep better. Meditation, massage, breathing exercises, and a warm bath scented with rose, lavender, marjoram, or chamomile are among these techniques. It is also beneficial to eat a healthy diet rich in calcium, magnesium, and B vitamins. To promote relaxation, eat a high-protein snack like yogurt before bed, or drink a cup of herb tea made with chamomile, passionflower, or St John’s Wort. Acupuncture and biofeedback have also been shown to be beneficial.

Prevention

The promotion of a healthy lifestyle is central to the prevention of insomnia. Rest, recreation, and exercise, combined with stress management, regular physical examinations, and a healthy diet, can significantly reduce the risk.

 

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