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SLEEPLESSNESS/INSOMNIA: FACT FILES

What is insomnia?

Insomnia results when an individual start experiencing the following: difficulty falling asleep at bedtime, undue wakefulness in the night, early morning awakening (earlier than usual) without being able to return to sleep till dawn. Sleep is also sometimes described as light, unrefreshning and of poor quality. Meaning both the quantity and quality of sleep are affected adversely. When these are experienced by an individual on about three or more nights in a week lasting more than one month duration and leading to poor daytime functioning, it can then be described as being of clinical significance.

Types

Essentially two types: Primary and Comorbid/Secondary insomnia. Primary insomnia are those not associated with other health problems while Comorbid insomnia are those due to another health condition, pain, medicine (drugs)  or substance abuse.

What are the symptoms of insomnia?

Insomnia can cause sleepiness during the day, general tiredness, irritability and problems with concentration or memory. Insomnia varies in how long it lasts and how often it occurs. It may be short-term (acute) or long-term (chronic). Insomnia is considered chronic when it occurs at least three nights a week for a month or longer. Psychophysiological (mind-body) insomnia is a disorder in which people cannot sleep because their minds or bodies are not relaxed.

Average Number of hours of sleep needed per night considered normal?

Newborn: 16 hours average

Ages 5 – 12 years: 10 to 11 hours

Ages 13 – 18 years:  8.5 to 9.25 hours

Adults: 7 to 9 hours

60 years old: 6 hours average

How common is this problem?

About one in every three adults have one or more of the symptoms of insomnia highlighted above while about one in every ten adults in the general population have symptoms bad enough to impair their daytime functioning. Women, older adults, shift job workers and people with psychological or medical disorders have higher risk of insomnia. Infants and children are also not left out of the problem of insomnia as it affect nearly a third of them.

What are the main causes of insomnia?

Commonest on the list are psychological problems like; depression, anxiety and stress while medical disorders are also common. Others include medications (prescribed and OTC), substances like caffeine, alcohol and nicotine among others. A breathing disorder during sleep called Sleep Apnoea though more associated with excessive daytime sleepiness can also cause insomnia. There also seems to be a genetic component to insomnia, especially in cases where insomnia starts early in life.

How is diagnosis made?

A comprehensive assessment detailing history (sleep diary for a week or two might be requested), examinations and investigations of the individual will eventually lead to a diagnosis of the precise cause of insomnia. Specialized sleep studies might be needed for precision diagnosis when available.

What are the treatment options?

Once diagnoses and/or aetiology have been established, treatment is focused on the underlying cause. Available treatment option for persistent insomnia despite having treated the underlying cause can be use of medications (short term) or behavioural interventions. Expert advice should be sought before commencing medication as most of the drugs in use are not devoid of certain side effects. Behavioural treatment however is helpful in as much as 70% of cases. This follows a concept of Sleep Hygiene as highlighted below: Learn to relax, get at least one hour period to unwind before bedtime, go to bed only when sleepy, get out of bed if you can’t sleep, arise at the same time every morning, reserve your bed and bedroom for sleep only, avoid daytime napping, limit the amount of time you spend in bed to your actual sleep time. Cognitive Behavioural Therapy for Insomnia (CBT -I) is another psychological treatment technique with proven effectiveness and sometimes the mainstay of treatment.

Complications secondary to Insomnia?

Psychological: slowed reaction time, increased depression anxiety risks, poor memory, incoordination

Medical: poor immune system function, high blood pressure, risk of heart diseases, risk of diabetes mellitus, overweight or obesity

What are Good sleeping habits?

Before getting into bed –

  • Establish a routine for bedtime
  • Create a positive sleep environment
  • Relax before getting into bed
  • Avoid alcohol, smoking and caffeine for at least a few hours before bedtime
  • Do not go to bed unless you are sleepy

While in bed –

  • Turn your clock around and use your alarm, if needed
  • If you can’t fall asleep in 20 minutes, get out of bed and do something

relaxing until you are sleepy

  • Use your bed for sleep

In the morning and daytime –

  • Wake up at the same time each morning, even on weekends
  • Avoid daytime naps
  • Avoid caffeine, especially in the late afternoon and evening
  • Exercise regularly, but not within four hours of bedtime

Nb: With persistence of symptoms, it is important you consult your Doctor.

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