Insomnia is a prolonged condition in which it is difficult to fall asleep and / or not wake up at night, despite the fact that the situation is at rest. With insomnia, you wake up and do not feel rested, so it prevents you and throughout the day. Insomnia not only drains you morally and emotionally, but also physically undermines health, performance and quality of life.
Different people have different amounts of sleep. Most adults need 7-8 hours of night sleep.
Many adults at one time or another experience insomnia, but in some, it becomes chronic (long-term). Insomnia can be an independent condition or be secondary to other disorders, for example, a disease or drug.
You should not tolerate the fact that you do not sleep well. Often simple changes in everyday habits help to cope with insomnia.
In case of insomnia, the following symptoms may occur:
- It’s hard to sleep at night
- You wake up at night
- You wake up too early
- You do not feel that you have rested after a night’s sleep
- During the day you feel tired and sleepy
- Irritability, depression or anxiety
- It is difficult to maintain attention, focus on tasks or remember something
- You often make mistakes, hit or fall into a mess because of inattention
- Headache of tension
- Discomfort in the stomach and intestines
- Experiences about sleep
When insomnia takes 30 minutes or more to fall asleep. Sleep lasts only 6 hours or less for three or more nights a week for at least a month.
All symptoms: drowsiness, increased sleepiness, sleep disorder, sleep disturbance
When to see a doctor?
If, due to insomnia, you find it difficult to do your usual tasks, consult a doctor to find out the possible cause and methods of treatment. If the doctor thinks that you have a sleep disorder, then he can send you to a specialized center for the appropriate diagnostic procedures.
Common causes of insomnia are:
- Stress. Anxiety due to work, school, health or family can occupy your head at night, making it difficult to fall asleep. Stressful situations, such as death or illness of a loved one or losing a job, can lead to insomnia.
- Anxiety. Everyday anxiety and more serious disorders associated with anxiety, such as post-traumatic anxiety disorder, can disturb sleep. Anxiety about falling asleep can also make it difficult to go to sleep.
- Depression. With depression, people can sleep too much, and may have trouble sleeping. Insomnia often accompanies other mental disorders.
- Diseases. If you have chronic pain, shortness of breath or frequent urge to urinate, insomnia may develop. Insomnia often involves diseases such as arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), thyroid hyperthyroidism, stroke, Parkinson’s disease and Alzheimer’s disease.
- Change the environment or work schedule. Traveling, working in the early morning or late evening can shift the daily rhythms of your body and cause problems with sleep. Your daily rhythms work like an internal clock, controlling the cycle of sleep and wakefulness, metabolism and body temperature.
- Bad habits associated with sleep. These include an irregular sleep schedule, arousing activity before bed, uncomfortable sleeping conditions, bed use for activities not related to sleep or sex.
- Medicines. Many prescription drugs can interfere with sleep, including antidepressants, drugs for hypertension and heart disease, antiallergic drugs, stimulants (such as ritalin), and corticosteroids. Many OTC drugs, including some painkillers, cold remedies and weight loss products, contain caffeine and other stimulants.
- Caffeine, nicotine and alcohol. Coffee, tea, cola and other drinks containing caffeine are known stimulants. Coffee in the evenings can make it difficult to go to sleep. Nicotine, contained in tobacco, is also a stimulant that causes insomnia. Alcohol calms and can help to fall asleep, but it prevents the onset of deep sleep and often causes awakening at night. Many people also experience heartburn, return food and acid from the stomach into the esophagus, which can cause awakening.
- Overeating in the evenings. A light snack before going to bed does not hurt, but overeating can cause discomfort when you lie down and make it difficult to fall asleep.
Insomnia and Aging
Insomnia becomes more common with age. As you grow older, you can experience:
- Changing the nature of sleep. With age, sleep often becomes more restless, more sensitive to noise and other irritants. With age, the internal clock often “runs forward”, that is, you get tired earlier in the evening and wake up early in the morning. But older people generally require the same amount of sleep as young people.
- Change of activity. You can become physically or socially less active. Lack of activity can interfere with a healthy sleep at night. Also, the less active you are, the more likely you will sleep in the day, which can interfere with a night’s sleep.
- Health problems. Chronic pain, arthritis, back problems, depression, anxiety and stress can disturb sleep. Older men often develop a benign prostate tumor, which is why they are forced to often go to the toilet, which also breaks sleep. In women, the tides caused by menopause, disturb sleep in no less degree. Other sleep disorders, such as sleep apnea and restless leg syndrome, also become more common with age. Sleep apnea can cause periodic stopping of breathing during sleep. The restless legs syndrome causes unpleasant sensations in the legs and an almost irresistible desire to move them, which can prevent falling asleep.
- Action of many medicines. Elderly people tend to take more prescription drugs than younger people, which increases the likelihood of drug insomnia. Sleep problems can also occur in children and adolescents. However, for some of them, the difficulty of falling asleep and protesting against the regime of the day is due to the fact that their internal clocks “lag behind”. They want to go to bed later in the evening and get up later in the morning.
Almost everyone sometimes has a sleepless night. But the risk of insomnia rises if:
- You are a woman. The probability of insomnia in women is much higher. Her role here can play hormonal changes during the menstrual cycle and menopause. During menopause, night sweats and hot flashes often break sleep. Insomnia is also common in pregnancy.
- You are over 60 years old. The likelihood of insomnia increases with age, due to changes in the nature of sleep and the appearance of health problems.
- You have a mental disorder. Many mental disorders, including depression, anxiety, bipolar syndrome and post-traumatic syndrome, disturb sleep. Early waking up in the morning is a classic symptom of depression.
- You have stress. Stress can cause temporary insomnia. Serious or prolonged stress, such as the death of a loved one or divorce, can lead to chronic insomnia. Poverty and unemployment also increase the risk of insomnia.
- You work at night or in shifts. Working at night or frequently changing the time of work increases the risk of insomnia.
You travel long distances. A sharp change in the time zone can cause insomnia.
Sleep is just as important to your health as proper nutrition and regular exercise. Whatever the reason for the loss of sleep, insomnia affects both mental and physical health. People with insomnia have a worse quality of life.
Complications of insomnia include:
- Deteriorating performance at school or at work
- Slowdown response while driving and increasing the likelihood of an accident
- Psychiatric problems such as depression or anxiety disorder
- Overweight or obesity
- Increased risk of occurrence or aggravation of chronic diseases, such as hypertension, heart disease and diabetes.
- Alcoholism or drug addiction
How to prepare for a doctor?
If you have trouble sleeping, you should start with a therapist’s appointment.
What can you do
Before taking a doctor, follow these steps:
- Find out if you need somehow to prepare in advance, for example, to have a diary of sleep monitoring. In this diary you record the characteristics of sleep: the time to bed, the duration of sleep, nightly awakenings and the time of waking up, as well as the daily routine, daytime sleep and well-being during the day.
- Write down all the symptoms that you are experiencing, including those that seemingly are not relevant to the purpose of admission.
- Write down the main personal information, including new or old health problems, any serious stressful effects or recent lifestyle changes.
- Make a list of all medicines, vitamins or food (including herbal) supplements that you take, including their dosage. Tell the doctor if you take any sleeping pills.
- Bring your spouse along if possible. The doctor may want to talk with your partner to find out more about how much and how well you sleep.
- Write down the questions that you plan to ask the doctor to use the time of reception effectively.
In the case of insomnia, the main key questions that should be asked to the doctor include the following:
- What, most likely, caused my insomnia?
- What is the best way to be treated?
- I have other health problems. What is the best way to combine their treatment with insomnia?
- Should I go to a clinic specializing in the treatment of sleep disorders? Will this cover my insurance?
- Are there any brochures or other printed materials that I can take to read? What websites do you recommend about my disease?
In addition to the questions that you prepare in advance, do not hesitate to ask questions that arise during the reception.
What to expect from a doctor
The main role in the study of insomnia is a detailed anamnesis, so the doctor can ask you many questions.
- How often do you have trouble sleeping when there is insomnia?
- How long have you been asleep?
- Are you snoring? Do you wake up from being panting?
- How often do you wake up at night and how long do you fall asleep after you wake up?
About the daily routine:
- Do you feel cheerful after awakening or do you feel tired all day long?
- Do not you begin to doze, do not you struggle with sleep when you sit or drive quietly?
- Do you sleep during the day?
- What is the nature of your work?
- What is your exercise regimen?
- Are you worried about how to sleep or how not to wake up at night?
On the order of retirement:
- What is your order of bedtime?
- What do you usually eat and drink in the evenings?
- Do you take any drugs or sleeping pills before going to bed? Have you used sleeping pills in the past?
- What time do you go to bed and what time do you get up? Is this time different on weekends?
- Where do you sleep? What is the noise level, temperature and lighting in the room?
- How many hours do you sleep?
On other factors that can affect sleep:
- Have you recently experienced stressful situations such as divorce, loss of work or increased demands at work?
- Do you use tobacco or alcohol?
- Do you have relatives with a sleep disorder?
- Have you traveled recently?
- What drugs do you take on an ongoing basis?
A doctor can not only ask you a few questions, but also offer a questionnaire to fill in to determine your sleep and wake schedule, as well as the level of sleepiness during the day. You may also be asked to keep a sleep diary for a couple of weeks if you do not already have it.
The doctor is likely to conduct a medical examination for symptoms of illness that may be the cause of insomnia. Sometimes a blood test is required, for example, to identify thyroid problems.
If the cause of insomnia is unclear or if you have symptoms of another sleep disorder, such as sleep apnea or restless leg syndrome, you may need to spend the night in the hospital. During your sleep, doctors will monitor the electromagnetic waves of your brain, breathing, contractions of the heart, eye movements, body movements and other body activities.
In most people, a healthy sleep can be restored by changing the way of life and correcting the cause of insomnia (eg, a disease or medication). If these measures are not enough, the doctor can prescribe medications that will help to relax and fall asleep.
Behavioral (behavioral) therapy for insomnia includes the following approaches:
- Developing useful habits. Useful sleep habits include a constant sleep schedule, avoidance of stimulating activity at bedtime and the creation of comfortable sleeping conditions.
- Cognitive-behavioral therapy. This therapy helps you to control or completely get rid of unpleasant and restless thoughts that prevent you from falling asleep. It can also include getting rid of false or disturbing ideas about sleep (for example, that, one night without sleep, you will be turned into a sick person).
- Relaxation techniques. Progressive muscle relaxation, reverse biofeedback techniques, breathing exercises – all these methods allow to reduce anxiety when going to sleep. These techniques help you control breathing, heart rate, muscle tension and mood.
- Control over irritants. Generation is achieved by limiting the time you spend in bed while awake. Thus, bed and bedroom will be associated only with sleep and sex.
- Restriction of sleep. With this method of treatment, the time of sleep is limited, causing a partial lack of sleep, as a result, you will become more tired by the next night. As soon as sleep normalizes, sleep time gradually increase.
- Passive wakefulness. This approach is also called paradoxical intention. If you are worried about how to sleep, you can instead try to go to bed and, on the contrary, try to stay awake.
- Light therapy. If you fall asleep too early and then wake up too early, you can use the light to translate the arrows of your internal clock. You can go out in the evenings in the light of the year or use special medical artificial light sources.
For prescription sleeping pills include zolpidem, eszopiclone, zaleplon and ramelteon. Doctors, as a rule, do not recommend taking prescription sleeping pills for more than a few weeks, but some of them can be taken for longer.
Over-the-counter sleeping pills contain antihistamines that cause drowsiness. Antihistamines can initially cause weakness, they can also reduce the quality of sleep and cause side effects, such as daytime drowsiness, dizziness, urinary retention, dry mouth and disorientation. These effects can be more pronounced in the elderly. Antihistamines can also worsen problems with urination, causing you to wake up more often at the toilet at night.
Changing lifestyle and home treatment
Insomnia can be treated at any age. Often the most important is changing the daily routine and the order of retirement. Good habits contribute to deep sleep and cheerfulness during the day. The following tips can help you:
- Physical activity and activity. Activity promotes a healthy sleep at night. Every day, give at least 20-30 minutes of active exercise, but no later than 5-6 hours before bedtime.
- Check your medications. If you regularly take any medications, ask your doctor if they can contribute to insomnia. Also study OTC labels: they can contain caffeine or other stimulants, such as pseudoephedrine.
- Refuse daytime sleep or limit his time. Daytime sleep can make it difficult to fall asleep at night. If you can not do without daytime sleep, it should be no more than 30 minutes and not later than 15 hours.
- Refuse or limit the consumption of caffeine and alcohol, completely abandon nicotine. All these substances can worsen sleep. Do not drink coffee after dinner. Refusal of alcohol will avoid restless sleep and frequent awakenings.
- Do not put up with the pain. If you are concerned about any pain, make sure that the pain medication you take is effective enough to minimize pain during sleep.
- Observe the daily routine. Go to bed and get up at about the same time each day, including the weekend.
- Do not eat or drink too much before going to bed. A bit of a snack before bedtime does not hurt. But do not eat too much: so you reduce the risk of gastroesophageal reflux disease (GERD) and improve sleep. Do not drink too much before bed: so you will rarely get up in the toilet.
- Use bed and bedroom only for sleeping and sex. Do not eat, do not work and do not read in bed. Immediately before going to bed, avoid the TV, computer, video games, smartphone, etc., as light from the screen can disrupt your sleep cycle.
- Make the bedroom comfortable for sleeping. Close the door to the bedroom or create a quiet background noise, such as fan noise, to drown out sounds. Maintain a comfortable temperature in the bedroom (usually lower than during the day) and darkness. Do not keep a computer or TV in the bedroom.
- Hide all the clocks in the bedroom. Get an alarm clock, but then hide all the watches, including the wristwatch and mobile phone, so as not to worry, which hour.
- Find a way to relax. Try to leave behind all your worries and plans after you go to bed. A warm bath or massage can help to relax. Create a retirement ritual, such as reading, soothing music, breathing exercises, yoga or prayer.
- Do not force yourself to fall asleep. The harder you try, the further you will be from sleep. Read in another room, until you become very sleepy, and then go to bed.
- If you do not sleep, get up. Sleep as much as you need to rest, and then get up. If you can not sleep, get up after 20 minutes and do something to relax, for example, read. Then try to sleep again.