Insomnia is subjective perception of difficulty with sleep initiation, duration, maintenance, quality, or non refreshing sleep, despite adequate opportunity or situation for sleep. It must be present for at least 3 nights per week for at least 3 months, and not be related to other sleep, medical &surgical or mental disorders. Studies showed the prevalence of insomnia is 10%–30% of the adult population. It is common in older adults, females, and people with medical and mental ill health. Sleep serves a restorative, homeostatic function and appears to be crucial for normal thermoregulation and energy conservation. As NREM sleep increases after exercise and starvation, this stage may be associated with satisfying metabolic needs.
10-15% of adult people experience long-standing, 25-30% has occasional sleepless nights.
It is an easy-to-diagnose condition but still unrecognized in a significant number of patients attending outpatient department (OPD) for other medical conditions.
What Are REM and Non-REM Sleep?
A sleep cycle lasts about 90 minutes, and during that time we move through five stages of sleep. The first four stages make up our non-rapid eye movement (NREM) sleep, and the fifth stage is when rapid eye movement (REM) sleep occurs.
NREM (75 percent)
Stage 1 : 5 %, eyes are closed, but it’s easy to wake you up, very light sleep, transition from wakefulness to sleep, last 5 -10 minutes.
Stage 2: 45 %, body temperature drops and heart rate begins to slow, body is getting ready for deep sleep, lasts about 20 minutes.
Stage 3 : 12%, deeper sleep, arousal, body muscles relax, decrease of heart rate and blood pressure.
Stage 4: 13%, most of stage 4 sleep occurs in the first third of the night, deepest sleep, difficult to arouse, if someone woke you up, you would feel disoriented for a few minutes.
REM (25 %)
Most REM periods occur in the last third of the night, brain becomes more active, body become relaxed and immobilized, and dream occurs, eyes move rapidly.
During the deep stages of NREM sleep, the body repairs and re-grows tissues, builds bone and muscle, and strengthens the immune system. With age NREM sleep get less, and REM sleep duration increases.
GENERAL SYMPTOMS OF INSOMNIA
- Difficulty falling or staying asleep
- Daytime fatigue
- Headache or heaviness of head
- Generalized body ache
- Poor attention and concentration
- Strong urge to take naps during the day
- Irritability or anxiety
- Poor work performance
- work- related/motor vehicle accidents
- overall poor quality of life
WHAT PEOPLE FEELS ABOUT TREATMENT
People ignores treatment of insomnia, they think it is normal with aging, increased responsibility. They remain afraid from the treatment that these medicines will be addicted, after stopping of medicine again sleepless, will harm the brain activities, dementia will develop, and will make insane.
BENEFITS OF TREATMENT
- Makes easy and comfortable sleep
- Relaxes mind
- Reduces the clinical symptoms of insomnia
- Improves immunity
- Increases work potential
Detailed history of insomnia is the first step of diagnosis. Investigation like polysomnography (sleep study) should be done if required. Anti anxiety, anti depressants, melatonin supplements, sleep inducing medicines, are helpful. Treatment of underlying health issues, allergy or cold medication, use of breathing device or surgery (usually for sleep apnea), a dental guard (usually for teeth grinding) is useful.
LIFE STYLE CHANGES:
Udgam has a team of qualified and expert team professionals who help for various mode of treatment of insomnia. Life styles changes, cognitive behavior therapy, behavior therapy, relaxation techniques are very helpful method to treat insomnia if it is related to stress and mental health problems.
Sleep hygiene a set of guidelines and tips which are designed to enhance good sleeping, and provide long-term solutions to sleep difficulties.
There are many medications which are used to treat insomnia, but these tend to be only effective in the short-term. Ongoing use of sleeping pills may lead to dependence and interfere with developing good sleep habits independent of medication, thereby prolonging sleep difficulties.
Talk to your health professional about what is right for you, but we recommend good sleep hygiene as an important part of treating insomnia, either with other strategies such as medication or cognitive therapy or alone.
SLEEP HYGIENE TIPS
1) Fix sleep time. This is the best ways to train body and mind to sleep well, even on weekends and days off! Go to sleep only when feel sleepy, or tired, rather than spending too much time awake in bed.
2) Get up & try again. If you haven’t been able to get to sleep after about 20 minutes or more, get up and do something calming until you feel sleepy, then return to bed and try again. Sit quietly on the couch with the lights off, read something. Avoid doing anything that is too stimulating or interesting, as this will make you alert and wake you up even more.
3) Avoid caffeine & nicotine. It is best to avoid consuming any caffeine (in coffee, tea, cola drinks, chocolate, and some medications) or nicotine (cigarettes) for at least 4-6 hours before going to bed. These substances act as stimulants and interfere with the ability to fall asleep
4) Avoid alcohol. Many people believe that alcohol is relaxing and helps them to get to sleep at first, but it actually interrupts the quality of sleep.
5) Bed is only for sleeping. Don’t try to use your bed for anything other than sleeping and sex, so that your body comes to associate bed with sleep. Don’t use to watch TV, eat; read, work on your laptop, and other things.
6) No day time naps. It is best to avoid taking naps during the day.
7) Sleep rituals. You can develop your own rituals of things to remind your body that it is sleeping time.
8) Bath time. Having a hot bath 1-2 hours before bedtime can be useful, as it will raise body temperature, making sleepy.
9) No repetitive clock-watching. Many people who struggle with sleep tend to watch the clock too much. Frequently checking the clock during the night can induce negative thoughts makes you alert and wakeful. Thoughts are like “Oh no, look how late it is, I’ll never get to sleep” or “it’s so early, I have only slept for 5 hours, this is terrible” making them more difficult to sleep.
10) Use a sleep diary. This worksheet remains very useful way of making sure you have the right facts about the sleep, rather than making assumptions. it also helps to track the improvement.
11) Exercise. Regular and light exercise is a good idea for good sleep. Morning walks are a great way to start the day feeling refreshed.
12) Eat right. A healthy, balanced diet will help to sleep well, but timing is important. Too light and too heavy meal is not good for sleep. A warm glass of milk, which contains tryptophan, acts as a natural sleep inducer. Avoid fat and spice rich meal.
13) The right space and surroundings. It is very important that bedroom should quiet and comfortable for sleeping.
14) Keep daytime routine the same. Even if you have a bad night sleep and are tired it is important that you try to keep your daytime activities the same as you had planned. That is, don’t avoid activities because you feel tired. This can reinforce the insomnia.