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INSOMNIA, CAUSES AND TREATMENT
Lata was not able to sleep at night. She took around two hours lying in the bed before sleeping. Even if she slept at her bedtime she would wake up by 2:00 a.m in the morning. Lata also could not manage to fall asleep if her scheduled time for sleep crossed and she almost stayed awake all through the night. This resulted in lot of daytime fatigue and her functioning got impaired.
WHAT IS INSOMNIA?
Like many others Lata is suffering from Insomnia. Insomnia is a condition in which there is the problem in initiation, and maintenance of sleep. Also, the duration of sleep may be reduced or the quality of sleep is hampered such that one has a disturbed sleep. Other consequences include the disturbances of mood, fatigue, problems in interpersonal relationships, occupational difficulties and reduced quality of life.
TYPES OF INSOMNIA
Transient insomnia occurs for less than a week, short term insomnia lasts for about one to four weeks and Chronic insomnia lasts for about a month.
Chronic insomnia occurs in about 10 -15% of the population. It occurs more frequently in women, people with old age and patients with chronic mental and psychological disorders.
CAUSES OF INSOMNIA:
Insomnia is primary or secondary. Primary insomnia is the one which might have been from childhood and may be due to heightened arousal during sleep. Sometimes the insomnia is paradoxical because there is a misperception of the state of sleep, such that the findings suggest that the person is sleeping but the person feels that he/she was not
Secondary insomnia occurs when there are psychosocial stressors causing adjustment problems, with inadequate sleep hygiene, or due to psychiatric disorders (depression, anxiety etc.) or due to medical problems or due to drug or substance abuse.
The technique to treat insomnia without medication includes a group of Cognitive Behavioral Techniques. These are described below:
- STIMULUS CONTROL THERAPY:
- It assumes that insomnia is a maladaptive response to factors such as bedtime and bedroom environment. It includes the following points:
- Go to bed only when you are sleepy
- Use the bedroom only for sleep and sex.
- Go to another room when unable to sleep for 15-20 minutes.
- Then read or engage yourself in quiet activities and return to bed only when you are sleepy. Repeat the process if required.
- Have the regular wake time regardless of the duration of sleep.
- Avoid daytime napping.
- SLEEP RESTRICTION THERAPY:
It assumes people can improve their sleep by temporary sleep deprivation through voluntarily reducing their time in bed.
Reduce time in bed to estimated total sleep (minimum by 5 hours).
Increase time in bed by 15 minutes every week, when estimated sleep efficiency (the ratio of time in bed) is at least 90%.
- RELAXATION THERAPIES:
- It is based on the hypothesis that insomnia is associated with hyper arousal.
- It involves progressive muscular relaxation and biofeedback.
- It also involves mental imagery, meditation and hypnosis.
- COGNITIVE THERAPIES:
It deals with the cognitive component of the therapy such that it involves educating the client about the sleep needs, the correction of unrealistic expectations and a discussion of anxiety and catastrophic thinking e.g. exaggerating oneself the poor consequences of sleep.
- Education to change the attitudes and belief about sleep
- Education to remove the catastrophic thinking
- Education to eliminate unrealistic expectations
- Changing the thinking style such that the person tries to get rid of mental worries.
- SLEEP HYGIENE:
It addressees the extrinsic factors like the noise in the room where one sleeps or the intake of caffeine etc.
- Correct the environmental disruptions such as noise or snoring partner.
- Keep the bedroom temperature comfortable
- Remove the bedside clock
- Do not use Alcohol, nicotine or caffeine few hours 4-6 hours before the bedtime
- Avoid the spicy, heavy or sugary food before the bedtime
- Do some exercises but not before 2 hours of going to sleep
- With the above techniques, about 50% of patients show improvement.
What is Depression? Depression as more than just a low mood, it is actually a serious illness. Of course we all feel sad, low or moody from time to time. That is part of being a human being. Some of us experience these feelings intensely for long periods of time and often for no good reason. People with Depression find it hard to function in everyday life and are possibly reluctant to engage in activities that they once enjoyed. It is actually one of the most common mental health problems. They believe 1 in about 5 people will experience Depression at one stage in their life.
What are some of the symptoms of Depression and Anxiety? Everybody has a blue day from time to time. That is not the issue. Firstly, Depression is over a longer period of time. It is usually for at least 2 weeks. Symptoms include
(1) Having a depressed mood for most of the day
(2) Less interest in the activities that you are doing
(3) Weight loss or gain
(5) Slowed or fastened movements
(6) Tiredness or loss of energy
(7) Feeling worthless
(8) Difficulty concentrating
(9) Thoughts of death or suicide
What is Anxiety? We all feel anxious from time to time but some people feel these feeling soo strongly and frequently that it can affect their everyday life. People often confuse Anxiety Disorders with Stress. Stress is a normal reaction to a situation. For example, work deadlines, sitting exams, speaking in front of people etc. However for some people these thoughts are ongoing after the event has passed.
What are some symptoms that can separate Depression from being Anxious?
Think back in the past month, have you felt
(1) Restless or on edge at one point in time?
(2) Felt easily tired?
(3) Had difficulty concentrating?
(4) Felt irritable?
(5) Had muscle pain?
(6) Had trouble sleeping?
The general rule is that if you said yes to 3 or more of these statements, it is quite possible that you are suffering from Anxiety
What can we do if you feel or think that you are suffering from Depression or Anxiety? I have some tips now. Tips to overcome Anxiety and Depression;
(1) Physical exercise is a huge thing for people. It releases feel good endorphins and the general rule is to do it 2-3 times per week for a least 30 minutes at a time.
(2) Relaxation exercises – there are plenty of good relaxation tapes out there. Also, controlling your breathing, through taking deep breaths will help.
(3) Eating well – that is a good one.
(4) Sleeping well – having 7-8 hours/ night sleep. Not over sleeping. A lot of people with Depression tend to oversleep.
(5) Maintain a healthy social life. The people who are happiest (according to the research) have a active social life.
(6) Minimise TV – I know I do this from time to time. You get home and you turn on the TV, even when there is noting really on. On average when people watch TV they are in a mildly depressed mood as they watch it. If you do want to watch TV, fine! Watch your programs but don’t watch TV for the sake of it.
(7) Having Hobbies is really worthwhile. For me, my hobby is playing the guitar and singing.
(8) To live in the moment as much as possible. One sure way to feel bad about yourself, is to over analyse your life and think about all the things that could go wrong. Mindfulness is the key. Being in the moment.
When it comes to psychiatry, choosing the right doctor can make the assessment and treatment a more pleasant experience. You need to find someone that fits well with your personality and will be able to meet the needs you have when it comes to treatment.
When it comes to psychiatry, choosing the right doctor can make the assessment and treatment a more pleasant experience. You need to find someone that fits well with your personality and will be able to meet the needs you have when it comes to treatment. There are several factors to consider when looking for a psychiatrist. Take your time and find the right person to get you back on track to a healthier state of mind.
Patient and Doctor Interactions
You want to find someone that is easy to talk to. Because of the subject matter of discussion, you need to feel comfortable sharing information and being honest. It can be sensitive to talk and discuss mental issues with another person and you want to feel safe and able to trust the other person. Think about setting up an initial appointment to get to know your doctor and find out if you think the two of you will work well together.
Patient and Doctor Views
It may help to find someone that shares your views on treatments. In the field of psychiatry, different doctors may feel differently when it comes to medication and various types of therapy. It may be difficult to assess this type of information up front, so be sure to ask as many questions as needed to determine where you and your doctor can agree. However, remember that the doctor is the professional and it may be necessary to change some of your thoughts on psychiatry as the appointments continue.
For many, the decision may come down to which provider the health insurance will cover. You can get a list of doctors in the field of psychiatry from your health insurance company or you can call a specific doctor to ask about insurance. When calling the insurance company, take notes on exactly what is covered under you plan.
Look for a Specialist
With psychiatry, different doctors may specialize in a different field. For example, some doctors may work with patients who have concerns about anxiety or addictions. You may want to look into finding someone who works with a specific age group if this applies. Because they only work with a certain age group, they may have more experience dealing with certain situations or issues. Also, they may be more up to date with the current research and findings because they are focusing on just one portion of the field.
Meeting with a Doctor
If you are meeting with a psychiatric doctor for the first time, be sure to write down a few questions that you have. Bring a pen and piece of paper to keep you focused on the information that you need and to ensure that all of your questions have been answered. A doctor will probably not be able to make a diagnosis at the first meeting, so it may be impossible to let you know how many appointments you will have and exactly what the outcome will be. Remember that it will take time to pinpoint the problem and begin treating it.