Insomnia is defined as difficulty falling asleep, difficulty staying asleep or unrefreshing sleep. In general, people with insomnia sleep less or sleep poorly despite having an adequate chance to sleep and this may lead to trouble functioning during the daytime.
Insomnia is not defined by the number of hours slept because “sufficient sleep” can vary from one person to another. Sleep requirements may also decrease with age.
Insomnia is the most common sleep complaint. While almost everyone has an occasional night of poor sleep, approximately 10 per cent of adults have chronic insomnia. Insomnia is more common in women
Common symptoms of insomnia include: Difficulty in falling asleep or staying asleep, variable sleep such as several nights of poor sleep followed by a night of better sleep, daytime fatigue or sleepiness, forgetfulness, Poor concentration, irritability, anxiety, depression, reduced motivation or energy, increased errors or accidents and Ongoing worry about sleep
For many people, the symptoms of insomnia interfere with personal relationships, job performance, and daily function. People who experience chronic insomnia have a doubled increased risk of automobile accidents compared with people who for fatigued for other reasons.
People with insomnia have an impaired sense of sleep that may be related to a problem with the body’s sleep-arousal system, which normally helps you feel awake after sleeping and feel tired before going to bed.
One result of poor sleep is that one becomes concerned about sleep-deprivation and suffers from serious consequences of lost sleep. This concern may grow as one is unable to sleep, which in turn makes it increasingly difficult to fall asleep. It is important that one doesn’t get caught in this cycle and understands that they are actually sleeping more than it seems.
Insomnia may have many causes
Short-term insomnia lasts three weeks or less and is usually caused by stressors such as; Changes in the sleeping environment, the loss of a loved one, divorce, or job loss, recent illness, surgery or sources of pain, use or withdrawal from stimulants e.g. caffeine, certain medications e.g. theophylline, and asthma inhalers, substances of abuse such as cocaine, or alcohol
Short-term insomnia often resolves when the stressor resolves.
Traveling across time zones is another common cause of short-term insomnia, known as jet lag and most people require several days to adjust their sleep pattern to the new time zone.
Long-term insomnia lasts longer than one month and can be caused by; Mental health problems such as depression, anxiety disorders (including panic attacks), and posttraumatic stress disorder, Medical illnesses especially those that cause pain, stress, or difficulty breathing. Neurological disorders, such as Parkinson disease and Alzheimer disease, other sleep disorders such as sleep apnea and medications or drugs of addiction use can cause long term insomnia.
Insomnia is common in individuals who work the night shift. This can be resolved by transferring from the night shift or by sleeping at the same time every day for several weeks.
It is important to know that though sleeping for only a short period of time is common among people who have insomnia, some people normally require little sleep and can function without difficulty after sleeping for only a few hours. People who sleep less but have no residual daytime sleepiness are called short sleepers and do not have a sleep problem. In addition, one may need less sleep as they get older. Needing less sleep does not necessarily mean that one has insomnia unless they also have daytime symptoms, such as sleepiness.
The diagnosis of insomnia is made by taking one’s history of their problem, physical examination may be performed to determine if there are medical or neurologic conditions causing or worsening one’s sleep problems.Laboratory tests may be recommended to help identify underlying medical or sleep disorders, although this is not required for everyone with insomnia.
How one can manage their insomnia
Try sleeping hygiene education activities such as; sleep only as much as necessary to feel rested and then get out of bed, maintain a regular sleep schedule (the same bedtime and wake time every day), Do not force sleep, avoid caffeinated beverages, avoid alcohol near bedtime, do not smoke (particularly during the evening), adjust the bedroom environment (light, noise, temperature) so that you are comfortable before you lie down, deal with concerns or worries before bedtime. Make a list of things to work on for the next day so that anxiety is reduced at night and exercise regularly.
As some people with insomnia have learned to associate the bedroom with staying awake rather than sleeping, if you cannot fall asleep within 20 minutes, get up, go to another room and read or find another relaxing activity until you feel sleepy again. Set an alarm clock and get up at the same time every day, including weekends and do not take a nap during the day.
Sleep restrictionshould be practiced. Do not stay in bed longer in the morning to “make up” some of the lost sleep as this additional sleep later in the morning may make it more difficult to fall asleep that night.
If behavioral changesdon’t help, sedative-hypnotic drugs which work in the brain to cause you sleep maybe prescribed. The most preferred are Nonbenzodiazepines. Benzodiazepines can also be prescribed. These drugs are not for long-term use
Dr. Ian Shyaka is a General practitioner based in Kigali.