What do we mean by insomnia?
Insomnia literally means absence of sleep. From a practical point of view, it generally refers to a sleep that is considered insufficient, unsatisfactory or unrefreshing. In this context, the problem referred to may be difficulty in falling asleep initially (insomnia of conciliation), difficulty in maintaining continuity of sleep (maintenance insomnia, which may be due to several long awakenings, early final awakenings, or both), light sleep or a shallow or restless “sleepless feeling” during all or part of the sleep period, and combinations of the above problems in the same person.
For practical purposes of characterization of the condition, insomnia can also be arbitrarily classified as transitory if it covers a short period of time, at most one month, or chronic if it lasts more than 6 months, with a transitional period or a period in the process of possible chronification being considered the time between 1 and 6 months. Chronic insomnia or insomnia in the process of chronification has the most repercussions and is generally the most complex to manage.
What causes insomnia?
Insomnia, at least initially, is a symptom associated with different medical and psychological-psychiatric disorders, as well as with situational or experiential disturbances. Hypervigilance or excessive arousal, sometimes 24 hours a day, is considered to be the basic characteristic of insomnia.
Insomnia can be primary (cases in which the cause cannot be clearly established) or secondary (the cause is more or less identifiable).
Primary insomnias include:
- Idiopathic insomnia (onset in childhood and persistence over time with little or no remission, probably related to poor learning of sleep habits).
- Poor perception of sleep quality (they claim not to sleep at all or almost not at all, staying all night in bed).
- Psychophysiological insomnia (fear of not falling asleep after turning off the light, which causes negative conditioning with anxiety and the subject is unable to fall asleep at the desired time no matter how many strategies he or she implements, often incorrectly; it usually improves when sleeping away from home).
And among secondary insomnia:
- A wide variety of medical causes, such as psychological-psychiatric problems, other sleep disorders, metabolic and hormonal alterations and/or changes, painful processes, respiratory, digestive, neurological and cardiovascular diseases, allergies, frequent nocturia, etc.
- Environmental or external causes such as bad sleeping habits, substance intake (drugs, alcohol, tobacco, excess coffee, etc.) and certain medications.
The classic known consequences of insomnia are physical fatigue, lack of concentration with decreased performance, and, if it evolves, daytime sleepiness and frequent mood alterations. It is also known that the lack or poor quality of sleep lowers the pain threshold (increases painful sensations). In recent years, lack of effective sleep has been linked to predisposition to cardiovascular and metabolic problems. There is some very recent scientific evidence that also links poor sleep quality with future predisposition to cognitive impairment and Alzheimer’s disease.
How can insomnia be treated?
The first step is to identify the causes and factors that perpetuate it and contribute to its chronification. No two people with insomnia are alike, so each case needs to be individualized. It is not a good idea to apply to oneself what has helped an acquaintance or relative, nor is it a good idea to simply prescribe a medication without first investigating the specific problem. Psychological and behavioral measures should always be applied in persistent insomnia, with the aim of modifying perpetuating factors (hypervigilance, inadequate sleep habits or anti-insomnia strategies, irregular sleep-wake schedules, misconceptions about sleep, etc.) and teaching the affected person self-management skills for residual problems after treatment. These measures include temporary programmed sleep restriction, stimulus control, relaxation techniques, cognitive therapy, sleep hygiene education, and combinations of these.
Pharmacological treatment, always combined with previous measures, should be reserved for specific cases, always for the shortest possible time and always controlled by a professional. There are several types of medication that can be useful, some of them only for short term use, others of possible medium term use. There is no one medication that works all the time or for all insomnia, its effectiveness and the possible occurrence of adverse effects depends on what the type of problem is.
What advice can you give to someone with insomnia?
Avoid naps during the day. Use the bed only for sleeping (avoid TV and all types of luminous screens, radio, reading and eating in bed). Go to bed only when you feel sleepy, and if after turning off the light you do not fall asleep within 30 minutes and you feel very alert and tense, get out of bed for a while and try to distract yourself and relax (avoiding exercise and concentration tasks), returning to bed when you feel sleepy (it may be necessary to do this several times in the same night).
Get up in the morning at about the same time every day, continuously. It is about accumulating all the sleep at night and being in bed only when you fall asleep, it is preferable to be in it 4-6 hours but sleeping than 8 hours despairing and turning it into our enemy. Do not look at the clock at night, even if you do not sleep, it does not bring you anything but tension.
It is necessary to go to sleep rested physically and psychologically (the frequent idea that getting tired during the day helps you sleep is false). Physical exercise is beneficial, but never strenuous and never at night, at least 4 hours before going to bed and always with daylight if possible. Avoid very bright environments, worry and activities that require concentration at least two hours before turning off the light. Avoid heavy dinners and go to bed with digestion done. Avoid stimulants, caffeine and alcohol, especially after noon.
For more information on insomnia contact a specialist.