Insomnia is a disorder for which we do not have any biological marker, that is to say, there is no test that we can do in the laboratory as in other diseases, and neither do we have an imaging scan, such as a scanner, an X-ray or an MRI. Therefore, it is a disorder whose diagnosis is made in consultation through a clinical interview with the patient.
We will diagnose an insomnia disorder defined in those people who have problems to initiate sleep, to maintain it or who wake up before the desired time and this, this poor quality of sleep happens at least 3 times a week and involves a disorder during the period of wakefulness. If there is no disturbance during the waking period, i.e., they are very well, they feel like doing things, they are not tired, have no memory or concentration problems, and are not drowsy, we cannot diagnose or define an insomnia disorder.
It is important to know that this disorder has to happen at least three times a week, if it only happens once in a while, we cannot properly speak of insomnia as a disorder. From this definition, if this is prolonged for more than three months in time, we will speak of chronic insomnia. If we are within the period where the problems have begun and the three months have not yet passed, we speak of acute insomnia.
From when is it a problem that should be treated by a specialist?
Whenever it affects the patient’s quality of life. When the patient sees that his daily life is affected by this problem is when he should see a specialist, because if a person self-medicates the disorder becomes chronic and sometimes worsens. If a correct treatment is done from the beginning, it avoids that it gets longer in time and it will not need so much treatment.
What are the treatment options?
The option that is approved as the first choice, especially in chronic disorder, by all the European and American chias, is cognitive-behavioral therapy for insomnia. It is not a psychological therapy, but consists of 4 or 5 sessions with a professional expert in the technique, who sets very specific guidelines that can sometimes also be associated with drugs. Sometimes it is not necessary, but if it is a very acute or very strong insomnia, at the beginning it is good to accompany the drug treatment, always with the idea that the drug has to be able to be withdrawn at a certain time and the patient, using the strategies and knowledge acquired during this therapy, should be able to deal with the insomnia by himself. It is like an apprenticeship so that it does not happen again. The drugs currently on the market do not cure the insomnia itself, but they make the patient sleep, but trying to withdraw them becomes a very complicated task.
What does Cognitive Behavioral Therapy consist of?
As we have mentioned, cognitive behavioral therapy consists of 4 or 5 sessions where the sleep professional and the patient work on a series of tools, not only the hygienic sleep rules (not drinking coffee, regular schedule, not being with light late at night, not eating too much at night, exercising in the morning, etc.), but working on the biological processes that regulate sleep and trying to implement and internalize them so that the patient gets to sleep by recovering his or her normal biological sleep.
Is it a very long treatment?
These 4 or 5 sessions can be scheduled every week, every 15 days, depending on how the patient or the specialist sees it. The optimum would be at intervals between one and three weeks and, when the sessions are finished, the treatment is finished.
Can it be applied to all patients?
It can be applied to all patients with psychophysiological insomnia. As this therapy has no side effects, it can be applied to other types of insomnia, but in fact it is indicated for psychophysiological insomnia. Psychophysiological insomnia is the one where the patient has a predisposition to suffer it, that is to say, they are patients with a certain personality, they tend to be more perfectionist, more obsessive, that in a moment of their life have a precipitating and stressor factor (the loss of a relative, of a job, stress, an illness, etc.), that marks the beginning of the first symptoms and these are chronified in time.
If the insomnia is caused by changes in routine, therapy can help you to synchronize with it, but if the symptoms become chronic and last more than three months, it is advisable to see a specialist.
You can make an appointment with Dr. Odile Romero, specialist in Sleep Medicine, in her profile.