Insomnia / Sleeping Difficulty - Symptom Evaluation

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Insomnia may be due to physiological, psychological, physical or environmental factors. Lifestyle and medication intake may also be responsible. Insomnia should be treated promptly in order to improve the quality of life and prevent other health problems.

Insomnia or sleeplessness is a common sleep disorder characterized by insufficient sleep. It could be due to difficulty in falling asleep, maintaining the sleep or both. Insomnia is not always a disease by itself. It is usually a symptom associated with other disease conditions that cause sleep disturbance.

Lack of adequate sleep affects daily activities. The patient feels tired the subsequent day and is unable to concentrate on his work, thus affecting his productivity at work and could affect his personal life as well. Nearly everyone experiences insomnia at different phases of their life. Women and elderly people are at higher risk of insomnia. It is necessary to deal with the cause of insomnia to improve the quality of life and prevent other health problems.

Diagnosis of insomnia is made based on the history and physical examination of the patient. The Epworth sleepiness scale is a questionnaire used to diagnose the type of insomnia and to plan for the treatment. A polysomnogram, an overnight sleep study, may be required in some cases.

Initial treatment of insomnia involves education of the patient about good sleep routines. Sleeping pills may be used to relieve from insomnia caused by stress, travel and other sleep disruptions. Commonly used drugs for insomnia are benzodiazepines like furazepam and triazolam, zolpidem and zopiclone. These drugs act by inducing sedation. Insomnia is also treated using behavioral therapies.

Causes of Insomnia

In some cases, it is difficult to detect the cause of insomnia. Common causes of insomnia or lack of sleep include:

• Psychological Factors: Psychological and psychiatric disorders could cause insomnia. Daily life events causing stress like work pressure, family issues and social relationships could affect sleep. Psychiatric disorders like anxiety, depression, schizophrenia and Alzheimer's disease may also affect the sleep pattern due to the chemical imbalances in the brain, thereby causing insomnia. A detailed examination by a psychiatrist could help to identify these conditions.

• Conditions Associated with Pain or Breathing Difficulties: Any conditions like injury, surgery, cluster headaches, arthritis and acidity that cause pain or discomfort could interfere with sleep. Breathing difficulties like asthma could make it difficult for the person to fall asleep. In obstructive sleep apnea, the throat muscles relax during sleep and cause temporary obstruction and snoring. The patient may be awakened repeatedly at night, resulting in disturbed sleep. Patients suffering from this condition are often overweight or obese. This condition is treated using a CPAP machine.

• Restless Legs Syndrome and Periodic Limb Movement Disorder: Restless leg syndrome is a condition where the person has an irresistible urge to move the legs. The symptoms are usually worse in the evening or night. Thus, these patients usually have a difficulty in falling asleep. In periodic limb movement disorder, the patient suffers from rhythmic movements of legs that occur periodically during sleep, which could disturb the sleep. Thus, these patients usually have a problem in maintaining their sleep.

• Life Style Habits: Improper lifestyle habits also affect sleep. People who do not have a sleep routine often suffer from insomnia. Some people stay up late due to parties or due to changes in work shifts. Eating late at night could also affect sleep. A patient with insomnia should be asked about these habits. Strenuous activities just before going to bed should be avoided. Patients should stick to regular sleep timings. It may also be a good idea to read or listen to music just before going to bed.
• Environmental Factors: Any condition in the environment that disturbs sleep results in insomnia. These include excessive heat, cold, noise and light. Staying in unfamiliar environment can also affect sleep.

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• Older Age: Older people have a tendency to feel sleepy earlier and get up very early in the morning. Sleep disorders in the elderly could also be due to associated health conditions or the multiple medications that they take.
• Other Disease Conditions: Other disease conditions may also cause insomnia. These include heart disease, high blood pressure, gastrointestinal problems, thyroid disorders, urinary problems, and cancer. Patients with urinary problems may have to frequently get up at night to empty their bladder.

• JetLlag: People who undertake international travel suffer from jet lag. This is because the internal biological clock of the body has to reset to the timings of the new place. Jet lag usually subsides on its own.
• Medications: Many prescription drugs can cause sleeplessness or insomnia as a side effect. These include antidepressants, antihypertensives, anti-allergic drugs, corticosteroids and stimulants like Ritalin. Certain over-the-counter drugs such as combination of pain killers, weight loss products and decongestants containing are reported to cause insomnia.
• Hormonal Changes: Hormonal changes in woman during menstruation, menopause and pregnancy affects sleep pattern leading to insomnia in some cases.

• Stimulants Containing Caffeine and Nicotine: Consuming stimulants like coffee, tea, cola and other caffeine containing drinks, and tobacco which contains nicotine during the late afternoons and evening may disrupt normal sleep.

• Drug Abuse: Sleep disruption is often complained by patients of drug abuse either during the period of intoxication or during the period of withdrawal.

Frequently Asked Questions (FAQs)

1. Which doctor should I visit in case I suffer from Insomnia?

You should visit a psychologist or a psychiatrist in case you suffer from insomnia.

2. How is insomnia treated?

The patient is initially suggested lifestyle changes. If there is an underlying cause, it is treated. Treatment also includes behavioral therapy like relaxation therapy, sleep restriction therapy, stimulus control therapy and cognitive therapy. Medications like hypnotics and melatonin may be necessary in some cases.