Insomnia
Are there solutions for insomnia? All the information about this sleep disorder: causes, types, and treatments.
Symptoms and Causes
Insomnia is a sleep disorder characterized by the difficulty or inability to fall or stay asleep, which significantly reduces the quantity and quality of rest. It is a very common disorder that affects approximately 30% of the population and has a negative impact on health, mood, and quality of life.
Sleep needs vary from person to person, but generally, an adult requires an average of seven to eight hours, and an elderly person around six and a half hours. Also, latency (the time it takes to fall asleep) can vary, but it is considered normal in adults to take up to 30 minutes.
Depending on its duration, two types of insomnia are distinguished:
- Acute Insomnia: appears for a period of less than three months.
- Chronic Insomnia: lasts longer than three months.
Based on the moment of the sleep cycle affected, the classification is as follows:
- Sleep Onset Insomnia: difficulty falling asleep (increased latency).
- Maintenance Insomnia: frequent awakenings with difficulty or inability to fall back asleep.
- Terminal or Early Awakening Insomnia: the person wakes up on their own before the expected time without having rested enough.
- Mixed Insomnia: two of the above types occur together.
- Global Insomnia: a combination of all three types of insomnia. It is a severe form of insomnia because the number of hours slept is very low.
Symptoms
The most frequent symptoms of insomnia are:
- Taking more than 30 minutes to fall asleep.
- Frequent awakenings, with difficulty falling back asleep.
- Waking up much earlier than expected without being able to fall back asleep.
- Fatigue, lack of energy, drowsiness.
- Bad mood, irritability, or depression.
- Problems with concentration, attention, or memory.
Causes
Among the main causes of insomnia are:
- Stress: The most common cause of acute insomnia is stressful situations and personal worries.
- Circadian Rhythm Disruptions (responsible for the natural sleep cycle), usually due to travel across time zones or frequent changes in daily routines.
- Poor Sleep Habits: including a sedentary lifestyle, not maintaining a consistent bedtime and wake-up schedule, taking long naps, and engaging in physical activity or eating large meals before bedtime.
- Stimulant Consumption: such as caffeine, tobacco, alcohol, or cocaine.
- Medications that cause insomnia: such as thyroid hormones, corticosteroids, antihypertensives, diuretics, some bronchodilators, some antiarrhythmic drugs, stimulants for ADHD, and some antidepressants.
- Mental Health Disorders: such as anxiety, depression, post-traumatic stress disorder, obsessive-compulsive disorder, bipolar disorder, or schizophrenia.
- Diseases that cause pain, fever, or physical discomforts that prevent sleep: such as gastroesophageal reflux, cancer, hyperthyroidism, Parkinson's disease, Alzheimer's disease, asthma, diabetes, and any condition causing chronic pain.
- Sleep Disorders: such as sleep apnea or restless legs syndrome.
Risk Factors
The risk of developing insomnia increases in the following conditions:
- Gender: insomnia is more common in women.
- Age: after 60 years old, sleep patterns often change.
- Excessive consumption of caffeine and other stimulants.
- Lack of regular sleep schedules.
- Frequent exposure to stressful situations.
Complications
Not getting enough sleep has a very negative impact on daily life. It can not only result in reduced performance in studies or work but also decrease reflexes and increase the risk of work accidents or traffic accidents. Irritability caused by insomnia can also affect personal relationships. Additionally, inadequate rest can trigger or exacerbate the symptoms of chronic diseases such as depression, anxiety, hypertension, or heart disease.
Prevention
Preventing insomnia involves maintaining good sleep hygiene:
- Maintain daily routines, with set times for going to bed, waking up, having breakfast, lunch, and dinner.
- Avoid stimulants in the afternoon.
- Avoid long naps.
- Exercise daily, but never right before bed.
- Avoid large meals before sleeping.
- Don’t leave stressful tasks for the end of the day.
- Create relaxation routines before bed, such as taking a bath, reading, or listening to calming music.
Which doctor treats insomnia?
Insomnia is treated in the sleep unit by specialists in neurology, psychiatry, and psychology.
Diagnosis
The diagnosis of insomnia and its underlying cause is primarily based on the information provided by the patient:
- Review of Sleep Routines and Habits: personal and family history is studied, as well as stimulant consumption, bedtime habits, frequency of insomnia episodes, type of insomnia, presence of other sleep disorders, symptoms during the day, etc. The patient may be asked to keep a sleep diary for two weeks, noting all these details.
- Clinical Examination: medical history is reviewed for mental health disorders or other diseases that might cause insomnia. A physical exam or blood test may also be performed to rule out the presence of pathologies.
- Polysomnography: Electrode placement is used to record bodily functions during sleep, such as respiratory effort, breathing frequency, blood oxygen levels, body position, brain waves, muscular electrical activity, heart rate, and eye movements. This test is performed when the cause of insomnia is unclear or there is suspicion of other sleep disorders like sleep apnea or restless legs syndrome.
Treatment
In addition to addressing the underlying cause, there are various options for treating insomnia:
- Sleep Hygiene: In cases of mild insomnia, changing daily habits may be sufficient. It can also be supplemented with natural sleep aids, such as linden tea, valerian, and other relaxing herbs.
- Cognitive-Behavioral Therapy: Techniques and strategies are provided to prevent the onset and chronicity of insomnia by restructuring physiological, psychological, and behavioral factors that affect sleep. For this therapy to succeed, significant patient involvement is required to follow the professional's recommendations.
- Pharmacological Treatment: If the above treatments do not work, sleep medications may be prescribed. It is recommended to avoid prolonged use and only use them as a last resort, as they may cause dependency, daytime drowsiness, and potentially lead to cognitive deterioration in the long term.
- Antihistamines: These have a hypnotic effect, but tolerance develops, causing them to lose effectiveness relatively quickly.
- Benzodiazepines and Analogs: These have anxiolytic, hypnotic, muscle relaxant, and anticonvulsant effects. They are also used to treat anxiety. They are effective for insomnia but alter sleep architecture, reducing deep sleep and REM sleep.
- Melatonin: A hormone naturally secreted by the pineal gland responsible for synchronizing circadian rhythms of sleep and wakefulness. It improves latency and sleep quality without reducing deep sleep or REM sleep.
