A consultant physician with the Carolina Health Care System, Lincolnton, North Carolina, US, who is also the Medical Director, Sleep Medix, Nigeria Limited, Lagos, Dr. Don Ogu, discusses insomnia and the way out of it with ARUKAINO UMUKORO
What is insomnia?
By definition, insomnia is the difficulty in initiating or maintaining sleep. In general, insomnia is the most common sleep complaint in the population. It is estimated that about one-third of the population would report difficulty in sleeping at some point in their lifetime. Most of these complaints can be referred to as acute insomnia; which usually lasts from one night to about a month, and generally affects about 10 per cent of the population. There is also a type of insomnia called adjustment insomnia, which is an acute reaction to some type of acute, stressful condition. It may be the death of a loved one, loss of a job, breakup in a relationship, or something that a person reacts to that causes difficulty in falling asleep. Acute insomnia can invariably lead to chronic insomnia. As I mentioned previously, while acute insomnia lasts for less than a month, chronic insomnia lasts for more than one month.
What are the causes of insomnia?
There are several causes of insomnia. It could be caused by what we call psychosomatic pain, and medical conditions such as asthma. Psychiatric conditions such as depression and anxiety can also cause insomnia. Insomnia can be classified as a short-term medical condition which is usually caused by identifiable factors. For example, chronic insomnia will usually result from predisposing factors such as genetic, environmental and behavioural factors. Generally speaking, insomnia is not a neurological disease, except for a certain type of insomnia called prion disease, which is usually fatal and familial. Familial meaning it has a genetic predisposition.
What are the symptoms of insomnia?
This will include difficulty in falling asleep, in which case, we define that as sleep onset insomnia; or inability to stay asleep after one has fallen asleep, which is called maintenance insomnia. In order to describe someone as insomniac, these factors have to exist. In addition to that, there ought to be daytime symptoms, which include fatigue, poor concentration, altered mood, depression, headache and similar symptoms.
How can insomnia be diagnosed?
It is usually done checking through one’s history. When a doctor listens attentively to the patient, he or she should be able to make that diagnosis. Of course, it would be put in context of all the other symptoms that is expected when one has difficulty in sleeping. If identifiable medical, psychiatric, drug-related and other sleep disorders may be present, the expert would need to exclude these to make a proper diagnosis of insomnia. For instance, a person may have psychiatric issues and those issues are what keep the person awake. That person is not necessarily an insomniac, but is only reacting to the psychological problems.
How can insomnia be treated?
In terms of treatment and prognosis, usually, the cornerstone for treating insomnia is the maintenance of good sleep hygiene. This means that individuals should maintain a regular schedule each day; one should go to bed at the same time of the night and try to wake up at the same time in the morning. Also, one should avoid exposure to natural light because it disrupts circadian rhythm. Avoid rigorous exercises in the evening; instead try to exercise in the morning or early afternoon. Avoid taking daily naps, especially after 3pm. Naturally, one needs to avoid stimulants such as caffeine, nicotine or heavy alcohol intake, especially when it is very close to bedtime.
Drinking a glass of wine if one has an early dinner shouldn’t be a problem, but making it a habit of drinking alcohol late into the night on a daily basis could create problems of insomnia, even though we do know generally that some persons try to take alcohol in order to induce themselves to sleep. Also avoid eating large meals close to bed time, maintain a comfortable sleep environment; make sure your air-conditioner is set to an appropriate temperature – it should not be too cold or too warm. One should also maintain regular routine at bedtime, although I know it is difficult, considering the stressful environment most people live in, including the lack of electricity and other challenges. But, as much as possible, one should try to maintain a good routine before one goes to bed. It is equally important to ensure that one does not take one’s work to the bedroom.
The bedroom should be reserved strictly for sleep. Also, it is advisable not to have a television, listen to radio or read materials that are very intense, in one’s bedroom. Sleep when you feel sleepy, don’t force yourself to sleep. Everybody has problems and challenges in life, but one should try solving these problems as much as one can during the day. One should not let them linger on and keep one awake all night.
What kind of drugs can be used to treat it medically?
Generally speaking, there is also a pharmacological treatment of insomnia. We recommend, for the most part, that if one could do without taking medication; it would be the best thing. But people can try things like anti-histamines, which are usually over-the-counter drugs. But the limitations of anti-histamines is in their anti-cholinergic effect, which, in elderly patients, might result in urine retention; while in both elderly and younger patients, there is the effect of dry mouth and difficulty in swallowing saliva. In some persons also, it could cause a hangover of daytime sleepiness. However, for the most part, these medications are safe to use. A doctor may also prescribe a group of medications called benzodiazepines. But if one is placed on benzodiazepines, one should avoid taking it on a daily basis. If taken for a prolonged period of time, one should try to taper off it; otherwise the person would suffer what we call a rebound effect. A common medication that is very effective is melatonin, which affects one’s circadian rhythm. It helps to reset one’s sleep pattern. It is safe and doesn’t cause any significant side effect. But the key thing is, if one is having difficulty sleeping, it is important to see a physician as it could be a sign or symptom of an underlying medical problem that is a lot of more serious than just the difficulty in sleeping.
It is important that the physician take the time to get a detailed history of the person and ask other questions that would help unravel the issue.
Aside from insomnia, what are the other major sleep disorders?
There is what is called Obstructive Sleep Apnea. It is probably the most serious sleep disorder, but the good thing is that it is also treatable. OSA is a condition in which the individual that suffers from it stops breathing several times during the course of his or her sleep at night. It is caused due to an obstruction of the upper airway of that individual. It is a lot more prevalent than we know and has been there for a long time, but we have only started paying closer attention to it and treating patients aggressively in the last 10 years in the United States. In Nigeria, however, it is still a relatively new phenomenon and we are still trying to make efforts to educate members of the medical community about this condition for two reasons. One, it can be fatal if not diagnosed and treated early enough; secondly, there is proven treatment for it. It affects approximately 20 per cent of the population and more males than females. It affects all age groups. While persons suffering from obstructive sleep apnea tend to be obese or overweight, it does not mean that persons who are not obese cannot have OSA. Also, sufferers tend to have a crowded upper airway, which obstructs the flow of air in the lungs when the individual falls asleep. Some of the typical physical features they have include a round or short neck (Buffalo neck). This condition can only be properly diagnosed and treated in a sleep centre by sleep experts or specialists.
Health facts: on Insomnia
- Insomnia is not a sleep disorder in and of itself, but a related symptom of other problems, including an assortment of common physical and psychological disruptions in the sleep cycle.
- Symptoms of insomnia can be brought on by physical situations, such as medical conditions, hormonal changes, changes in diet, changes in work schedule, exercise or lack of; environmental situations including changes in time zone, changes in season, travel and cultural changes, and more; and psychological problems including stress, depression, and anxiety.
- Insomnia symptoms include the inability to fall asleep, the inability to stay asleep, the inability to concentrate and function in your daily activities. Common patterns of insomnia include onset insomnia, middle and late insomnia.
- Chronic, or long-term, insomniacs often exhibit signs of sleep deprivation.
- Types of insomnia include temporary, acute and chronic. The symptoms can last for one night or they may last months and even years.
- Many prescription medications may contribute to insomnia. Over-the-counter and prescription drugs often have additives intended to combat drowsiness and others simply have side effects that inspire symptoms of insomnia.
- Caffeine, a natural property of many coffees, teas, and chocolates, and also a common food and drink additive is one of the most common sleep inhibitors.
- Contrary to popular belief, alcohol can suppress your body’s natural sleep cycle and actually interfere with natural sleep patterns, leading to symptoms associated with insomnia.
- Symptoms related to insomnia are common among individuals that work night shifts or rotating shifts. Night shift work, while some people prefer it, is an unnatural human cycle.