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Insomnia

Writer's picture: Dr. Karuturi SubrahmanyamDr. Karuturi Subrahmanyam


When sleep becomes elusive night after night, you may be experiencing insomnia—a common sleep disorder that affects millions of people worldwide. This article provides a comprehensive overview of insomnia, from understanding its causes to exploring both medical treatments and natural remedies.


What Is Insomnia?


Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite having adequate opportunity for sleep. It may be short-term (acute) or can last for months or even years (chronic).


People with insomnia often feel dissatisfied with their sleep and may experience one or more of the following symptoms:

- Difficulty falling asleep at night

- Waking up during the night

- Waking up too early

- Not feeling well-rested after a night's sleep


Types of Insomnia


Insomnia is typically classified into two main types:


Acute Insomnia: Brief sleep difficulties lasting for days or weeks, often triggered by life stressors or changes in environment.


Chronic Insomnia: Sleep difficulties occurring at least three nights per week for three months or longer.


Insomnia can also be categorized based on its cause:


Primary Insomnia: Sleep problems that aren't directly associated with any other health condition.


Secondary Insomnia: Sleep problems that are symptoms or side effects of another medical condition, medication, or substance.


Common Causes of Insomnia


Psychological Factors

- Stress and anxiety

- Depression

- Post-traumatic stress disorder (PTSD)

- Bipolar disorder


Lifestyle Factors

- Irregular sleep schedule

- Poor sleep habits

- Jet lag or shift work

- Excessive consumption of caffeine, alcohol, or nicotine

- Heavy meals close to bedtime

- Lack of physical activity


Medical Conditions

- Chronic pain

- Respiratory problems (e.g., sleep apnea)

- Neurological disorders (e.g., Parkinson's disease)

- Gastrointestinal issues (e.g., acid reflux)

- Endocrine problems (e.g., thyroid disorders)

- Sleep-related disorders (e.g., restless legs syndrome)


Medications

- Antidepressants

- Corticosteroids

- Thyroid hormone

- High blood pressure medications

- Some contraceptives

- Stimulants for ADHD

- Some pain medications


Symptoms and Impact


Common Symptoms

- Difficulty falling asleep

- Waking up frequently during the night

- Waking up earlier than desired

- Feeling tired upon waking

- Daytime fatigue or sleepiness

- Irritability, depression, or anxiety

- Difficulty paying attention or focusing

- Increased errors or accidents

- Tension headaches

- Ongoing worries about sleep


Impact on Daily Life

Chronic insomnia can significantly impact your quality of life and may lead to:

- Decreased performance at work or school

- Slowed reaction time while driving

- Mental health disorders

- Weakened immune system

- Increased risk of chronic health problems like heart disease and diabetes


Diagnosis


If you're experiencing persistent sleep problems, consider consulting a healthcare provider. Diagnosis typically involves:


Medical History and Sleep Evaluation

Your doctor will ask about your sleep patterns, medical history, and lifestyle habits.


Sleep Diary

You may be asked to keep a sleep diary for 1-2 weeks, recording:

- When you go to bed and wake up

- How long it takes to fall asleep

- How many times you wake during the night

- How you feel upon waking and throughout the day


Physical Examination

To identify any underlying physical conditions that might be causing your insomnia.


Sleep Study (Polysomnography)

For more complex cases, your doctor might refer you to a sleep center for a sleep study. This monitors your brain waves, breathing, heart rate, and body movements during sleep.


Medical Treatments


Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is considered the first-line treatment for chronic insomnia and typically includes:

- Sleep education

- Sleep hygiene training

- Stimulus control therapy

- Sleep restriction therapy

- Relaxation techniques

- Cognitive restructuring (changing negative thoughts about sleep)


Medications

For short-term use, your doctor might prescribe:

- Sleeping pills (e.g., zolpidem, eszopiclone)

- Antidepressants with sedative effects

- Melatonin receptor agonists

- Orexin receptor antagonists


Note: Sleep medications can have side effects including dependence, so they're typically recommended for short-term use only. Always use medications as prescribed by your healthcare provider.


Natural Remedies and Lifestyle Changes


Sleep Hygiene Practices

- Maintain a consistent sleep schedule

- Create a relaxing bedtime routine

- Keep your bedroom dark, quiet, and cool

- Use your bed only for sleep and intimacy

- Avoid electronic devices before bedtime

- Limit daytime napping to 20-30 minutes, preferably before 3 p.m.


Diet and Exercise

- Limit caffeine, especially after noon

- Avoid heavy meals and alcohol close to bedtime

- Engage in regular physical activity, but not too close to bedtime

- Stay well-hydrated throughout the day, but reduce fluid intake before bed


Relaxation Techniques

- Deep breathing exercises

- Progressive muscle relaxation

- Meditation or mindfulness practices

- Gentle yoga or stretching


Natural Supplements

Some people find relief with:

- Melatonin

- Valerian root

- Chamomile

- Magnesium

- Lavender


Note: Always consult with your doctor before taking any supplements, as they may interact with medications or have side effects.


Environmental Modifications

- Use blackout curtains

- Consider earplugs or white noise machines

- Ensure a comfortable mattress and pillows

- Keep electronics out of the bedroom


When to consult a Doctor


Consult a Doctor if:

- Your insomnia persists for more than a few weeks

- It interferes significantly with your daily activities

- It occurs alongside other concerning symptoms

- You feel depressed, anxious, or have thoughts of harming yourself


Prevention


While not all insomnia can be prevented, you can reduce your risk by:

- Managing stress effectively

- Practicing good sleep hygiene

- Addressing potential health problems promptly

- Maintaining a healthy lifestyle


Living with Insomnia


If you're dealing with chronic insomnia:

- Be patient – improvements in sleep patterns may take time

- Focus on quality of sleep rather than quantity

- Don't catastrophize occasional poor nights of sleep

- Seek support from healthcare providers, friends, and family

- Consider joining a support group


Summary


Insomnia can be frustrating and debilitating, but effective treatments are available. Most people can find relief through a combination of lifestyle changes, therapy, and sometimes medication. Work closely with your doctor to develop a personalized approach to managing your sleep difficulties.


Remember that good sleep is not a luxury—it's a necessity for your overall health and well-being. With proper diagnosis and treatment, you can overcome insomnia and enjoy restful, restorative sleep once again.




Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified doctor for diagnosis and treatment of medical conditions.

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