Insomnia Disorder

Introduction

Insomnia is a sleep disorder in which a person is not able to fall asleep or stay asleep for long. Characterised by daytime fatigue and mood deterioration, insomnia is usually caused because of stress and some other medical conditions. However, there are many Insomnia disorder causes and various types of Insomnia disorders that a person can suffer from. Nevertheless, many types of treatment for Insomnia disorder have proved to improve the life of patients.
The article extensively describes what are the various Insomnia disorder symptoms, What are the risk factors for Insomnia, How is Insomnia diagnosed, How is Insomnia treated

What is Insomnia?

Insomnia is a sleep disorder that makes it difficult for a patient to fall asleep. Patients may find it difficult to stay asleep or go back to sleep after waking up. Insomnia also makes a person feel tired upon waking up. A person feels drained upon waking up instead of feeling refreshed which has an adverse effect on the mood and overall health.

Statistics and Facts

On a global level, 1 in 3 people exhibit symptoms of brief insomnia. 75% of adults above the age of 65 exhibit symptoms of sleep maintenance insomnia and more than 40% of teenagers also suffer from some form of insomnia.

Common Myths and Misconceptions

• A common misconception is that alcohol can effectively make a person fall asleep faster. However, it is false as it can make a person restless.
• Exercising regularly can tire a person physically which leads to better sleep is the second misconception. Insomnia is mainly caused because of stress. Therefore, until stress is resolved, patients cannot recover from the problem fully.
• Sleep aids and increased screen time can solve the problem is the third myth. Although it is true that sleep aids are effective. However, these are not sustainable and permanent treatment plans.

What are the risk factors for Insomnia?

Chronic Insomnia is likely to happen to people who are light sleepers and consume alcohol or any other substance. They are unable to sleep in unfamiliar environments especially the ones who are suffering from anxiety and depression. Patients suffering from nocturnal panic attacks or nightmare disorders are more prone to this disorder.

Types of Insomnia Disorder

• Short-Term Insomnia
  Short-term insomnia lasts only a few days. It is generally caused because of short-term life changes like change in job or change of place. This disorder gets resolved as soon as the changes are addressed.
• Chronic Insomnia
  Chronic insomnia persists for more than three months and these episodes occur more than three times a week. This disorder can be caused because of mental health disorders, change in medication or a poor lifestyle.
• Sleep Onset Insomnia
  Patients suffering from sleep onset insomnia are often anxious or stressed. There are episodes of staying wide awake during bedtime which reduces the duration of sleep.
• Sleep Maintenance Insomnia
  Sleep maintenance insomnia is characterized by waking up in the middle of the night and struggling to fall asleep again. It is a common kind of insomnia which often results from apnea, ageing or stress.
• Terminal Insomnia
  A patient suffering from terminal insomnia, also called early waking insomnia, involves waking up too early in the morning. Patients suffering from depression are more likely to suffer from this disorder.
• Mixed Insomnia
  Patients suffering from mixed insomnia have trouble maintaining a proper sleeping pattern. Identifying a single root cause of the disorder can be difficult in such cases.
• Comorbid Insomnia
  Comorbid insomnia occurs with other psychological disorders. It can be caused because of depression, anxiety or any other health problem. However, treating this health problem often treats comorbid insomnia.

Causes of Insomnia Disorder

• Stressful Lifestyle
  Long working hours and irregular meal times can cause insomnia. Other stressful events like a divorce, a drastic change in job, financial problems and so on are other similar causes.
• Work Schedule
  Patients who have to travel for work often have a warped circadian rhythm. This can lead to irregular working hours that interfere with sleep patterns leading to insomnia.
• Health Disorders
  Various mental health disorders like Post-Traumatic Stress Disorders (PTSD), depression and anxiety can prevent deep sleep. Overthinking can also delay sleep and lead to short-term insomnia.
• Medication
  Certain medications when consumed with caffeine can cause sleep disruption. Prescription drugs and over-the-counter drugs (like weight loss supplements and painkillers) can lead to insomnia.
• Substance Abuse
  Addiction to drugs and alcohol can cause insomnia disorder. Patients who consume stimulants like caffeine and nicotine experience disrupted sleep. Alcohol and other such beverages prevent deep sleep and do not allow restorative sleep.
• Faulty Diet
  Eating food at odd hours like late at night can interfere with sleep. This is harmful for the digestion process and can also lead to heartburn and discomfort.

What are the Symptoms of Insomnia?

• Troubled Sleep
  - Initial Insomnia includes falling asleep in the beginning of the evening.
  - Middle Insomnia happens when a patient wakes up during the night but falls asleep later.
  - Late Insomnia is when a patient wakes up during the early hours of the morning and is not able to sleep again.
• Daytime Effects
  Chronic exhaustion, tiredness and difficulty in remembering things clearly is one of the main symptoms of insomnia. Patients often feel confused, develop a slow thinking process and end up suffering from anxiety and depression.
• Chronic Insomnia
  Symptoms of chronic insomnia occur at least three times a week. This happens even when a patient is in his or her comfort zone and there is no reasonable explanation for the problem.

How is Insomnia Diagnosed?

Physical Examination

Physical examination of a patient includes multiple tests of a patient to ensure that it is not caused by another physical health problem.

• Polysomnogram Test
  Polysomnogram test is a sleep study for which a patient either has to spend a night at a facility or use a portable home kit. This kit comprises sensors that monitor brain activity, rate of breathing, level of oxygen and muscle movements. Certain Polysomnogram tests are also conducted during the day to analyse sleep latency or level of alertness. These procedures are painless and non-invasive.
• Actigraphy
  Actigraphy tests involve wearing a wrist or an ankle sensor at home for 3-14 days. The aim is to monitor the sleep-wake patterns for a long period of time. This test is helpful in diagnosing insomnia, other disorders related to circadian rhythm, sleep apnea and so on.
• Blood Tests
  Blood tests are used to determine if the thyroid gland is malfunctioning as it is a leading cause of insomnia among women. Anemia or hormonal imbalances can also cause sleeplessness.

Reviewing Sleep Habits

Psychologists can also review sleep habits of patients by asking them questions about their routine. A detailed interview on sleeping during the day and the duration of sleep at night helps them to determine their potential triggers. Mental health experts can even suggest patients to maintain a diary and record the duration of their sleep.

How is Insomnia Treated?

Psychotherapy is an effective method of treatment for Insomnia Disorder. Cognitive Behavioural Therapy (CBT-I) helps a patient to deconstruct the cause of the problem and ensures long-term recovery. The therapy works cognitive abilities of a patient and also covers the behavioural aspect:

• Cognitive Component
  This strategy focuses on altering beliefs and thought patterns of a patient. The aim is to focus on those thoughts or worries that prevent sound sleep. This effectively reduces overthinking and rests the anxiety cycle related to not feeling asleep.
• Behavioural Component
  With CBT, patients are organically made to adopt a healthier lifestyle. Behaviour of a patient is analysed to understand what exactly is causing sleep disruption and changes are suggested accordingly to eliminate faulty behaviour.

CBT Strategies

The following strategies under CBT help treat insomnia completely:

• Stimulus Control Therapy
  Stimulus control therapy encourages patients to follow a strict sleep cycle. The aim of this therapy is to avoid naps and introduce simple changes like using the bed to sleep and not sit. Patients are encouraged to stay motivated and distract themselves so that they do not sleep during the day.
• Relaxation Techniques
  Relaxation techniques under CBT include muscle relaxation techniques and breathing exercises. Patients who are not able to sleep at night because of anxiety, depression or any other comorbidity are encouraged to breathe and relax before going to bed.
• Passive Awakening
  Passive awakening is one of the best techniques to promote overall healing of patients. Remaining passively awake makes a patient fall asleep naturally. Thoughts and worries are sorted out which calms a person and ensures uninterrupted sleep, extending the duration.
• Light Therapy
  Light therapy regulates the internal clock of a body. Patients are exposed to bright light in the morning or even evening to adjust the sleep-wake cycle. This therapy is useful in treating delayed sleep phase syndrome. Patients are able to stay alert during the day and sleep properly at night.

Medication

Non-Benzodiazepine sedative-hypnotics can effectively treat insomnia. Other groups of drugs called melatonin-receptor agonists and Benzodiazepine are also prescribed depending on the severity of the problem. Medication must also complement the therapy being administered to prevent relapse.
However, patients suffering from anxiety and depression must not take any pills without professional consultation. Potential side-effects like increased dependency or drowsiness make it unsafe for casual consumption.

Living with Insomnia Disorder

• Living with Insomnia Disorder can be challenging as it can affect the mental, emotional and physical health of a patient.
• Frequent mood swings can harm personal relationships and professional connections. The emotional quotient gets weak and patients are not able to cope with routine normally.
• A patient is more susceptible to serious health problems like diabetes and heart diseases. This can severely impact productivity at work and affect the overall quality of life.
• A change in lifestyle is essential to treat the problem. A healthy diet, proper exercise regime and stress-busting activities must be included in the routine.
• Make sure that all your health issues are sorted to avoid wrong diagnosis. A more proactive approach must be adopted that is sustainable. Consistency is essential to see the best results.

How to Support Loved Ones Suffering From Insomnia Disorder?

• Being a good listener can help the patients. Listen to the problems patients are facing so that they feel validated and better solutions come up.
• Help them in establishing a consistent routine. A consistent routine is essential for a patient to recover from insomnia disorder, so friends and family can adopt the same and motivate a patient.
• Participate with them when they are trying to relax. Patients who are suffering from anxiety or depression must practice meditation and other grounding techniques. Participating in similar activities will make them feel less isolated.
• Encourage them to seek professional help when necessary. Discourage them when they want to self-medicate and avoid giving advice when they do not ask for it. Professional counselling and therapy is the most effective treatment plan.

Jagruti Treatment and Recovery

Therapists at Jagruti Rehab Centre offer a comprehensive treatment plan tailored according to the severity of the problem. Patients are prescribed medication that complements therapy and with minimum side effects.
Balanced meals and provision of 24/7 nursing staff ensure complete recovery of patients. Patients who are working or studying also have the option of attending counselling sessions online. Families are informed about the treatment at every stage and patients are briefed about the treatment plan beforehand. Privacy of patient information is maintained at all times.
Relapse prevention is a part of the treatment. Therapists analyse the symptoms and behaviour of patients periodically to check for re-occurrence. The facility is equipped with CCTV cameras to ensure maximum safety and vitals of each patient are monitored to understand their progress.