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.