Insomnia is diagnosed on the basis of patient complaints and physical condition. In this case, the actual length of sleep is not critical; 5-hour line is a kind of minimum: a less long sleep for 3 days is equivalent to one night without sleep.
There are two clear diagnostic criteria for insomnia: a delay of more than 30 minutes of sleep and a drop in sleep efficiency of up to 85% or less (the ratio of the actual sleep time to the time the patient spent in bed).
Violation of the circadian rhythm (early falling asleep and early ascent – the “lark man” or later falling asleep and the late ascent – the “owl” person) are diagnosed as pathologies if a person experiences post-somnolent disorders and does not have the opportunity to sleep or fall asleep earlier.
Sometimes a person suffering from chronic insomnia is offered to keep a diary for a month, in which periods of wakefulness and sleep are recorded. In cases where insomnia is accompanied by a violation of breathing (obstructive apnea) and motor activity, as well as in the ineffectiveness of drug therapy, prescribe a counseling somnologist and polysomnography. Computer research provides a complete picture of sleep, determines the duration of its phases and assesses the work of the entire body during sleep.
Diagnosis of insomnia does not cause difficulties, it is often more difficult to determine the true cause or a combination of factors that caused insomnia. Often, consultations of narrow specialists are required in order to reveal a somatic pathology.
Treatment of insomnia
Transient insomnia usually goes on its own or after eliminating the causes of its occurrence. Subacute and even more chronic insomnia require a more careful approach, although the treatment of the underlying cause is a fundamental factor.
Successful disposal of insomnia provides for the hygiene of sleep. Daily falling asleep at the same time, excluding daytime sleep, active daytime wakefulness can completely relieve insomnia of the elderly without the use of medications.
Psychotherapy can eliminate psychological discomfort and restore sleep. Good results in the treatment of insomnia showed acupuncture and phototherapy (treatment with white light of high intensity).
The use of hypnotics helps to quickly fall asleep and prevents frequent awakenings, but hypnotics have a number of adverse effects, from addiction to dependence and the effect of recoil. That is why the medicamentous treatment of insomnia begins with herbal preparations (motherwort, mint, oregano, peony and other medicinal herbs with sedative effect) and means containing melatonin. Drugs with sedative effect (antipsychotics, antidepressants, antihistamines), are prescribed to increase the duration of sleep and reduce motor activity.
Preparations of imidazopyridines (zolpidem) and cyclopyrrolones (zopiclone) have a short duration of exposure, do not cause post-somnolum disorders – these are one of the safest chemical sleeping pills. A group of tranquilizers – benzodiazepines (diazepam, lorazepam) to a greater extent inhibits brain processes, thereby reducing anxiety and increasing latency to sleep. These drugs are addictive, seriously affect the speed of the reaction, while increasing the effect of barbiturates and analgesics.
Rules for taking medications for insomnia include: observing the duration of treatment with sleeping pills – an average of 10-14 days (not more than 1 month); drugs can be administered in combination with their compatibility; this or that drug is selected depending on the concomitant somatic pathology and the minimal set of side effects. For preventive purposes, sleeping pills are prescribed 1-2 times a week. It is important to understand that the use of sleeping pills is an exclusively symptomatic treatment. This fact and the mass of undesirable consequences force them to limit their reception as much as possible.
Prognosis and prevention of insomnia
To completely get rid of insomnia, one should adhere to the following rules: do not delay the visit to the neurologist with obvious signs of insomnia; Do not take drugs without prescribing a doctor. It is necessary to observe the regime of the day (proportional loads, walks and sufficient time for sleep) and the formation of their own stress-resistance; should focus on psychological techniques and minimum use of medicines.
The prognosis for acute and subacute insomnia is favorable, its treatment in most cases does not require the use of hypnotics and tranquilizers. Treatment of neglected chronic insomnia is a long process; only close interaction of the patient with the doctor will allow to choose an effective scheme of treatment and to reach a positive result.