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Insomnia (Sleep Disorders) Causes, Symptoms and Treatment

In medicine, insomnia is part of the larger family of sleep disorders, which includes narcolepsy (sudden and unpredictable inputs into a state of falling asleep), hypersomnia (an excessive need for sleep), and disorders. Circadian rhythms .

The insomnia (Latin somnus = sleep) is difficult to define precisely because there is no “standard” for sleep.

Insomnia is characterized by difficulty getting enough sleep, to the point where it impedes activities of daily living (drowsiness, less attention, irritability, etc.). Some people sleep naturally few hours per night without adverse repercussions: they are not insomniacs.

Generally, by tackling the cause of insomnia, most people find restful sleep after a few weeks.

Types of insomnia

There are 2 types of insomnia:

  • the transient insomnia  : Symptoms are connected to a specific situation often easily identifiable (a stressful time at work, divorce, etc.) – this type of insomnia may still take several weeks;
  • The chronic insomnia: difficulty sleeping must occur at least 3 nights a week, for at least 1 month.

Note that the boundary between these 2 types of insomnia is not always clear.

Who is affected?

According to the latest Canadian Community Health Survey, approximately 13% of Canadians aged 15 and over experience chronic insomnia 1. According to the same survey, 36.5% of insomniacs do not usually feel rested on waking, while only 9.2% of people who say they do not have insomnia are tired in the morning. The survey also reveals that people with insomnia sleep on average 1 hour less per night than people who do not.

However, statistics on the prevalence of insomnia vary from one source to another because the “insomnia criteria”used in the surveys are not always the same. Some researchers rely on the duration of symptoms; others, on their degree of gravity; still others, on their presence or not. The most commonly used criterion is the frequency of insomnia symptoms.

Causes of Insomnia

Insomnia is a symptom, not a disease in itself, a bit like fever. Before thinking of treating it, we must find the cause or causes.

Physical and environmental factors that have a great influence on sleep include brightness and ambient noise, as well as the content and timing of meals.

The psychological factors such as stress or anxiety also play an important role. They account for 50% of all cases of insomnia evaluated in a sleep laboratory.

In addition to lifestyle and environmental factors (see the Risk Factors section for more information), all kinds of acute or chronic health problems can disrupt sleep:

  • the syndrome of restless legs , characterized by cravings to move the legs, especially during periods of relaxation or inactivity;
  • sleep apnea, which usually occurs in people who are overweight or have significant snoring; it causes breathing pauses of a few seconds or more several times during the night, which may or may not cause conscious awakenings;
  • chronic pain caused by arthritis or cancer, for example;
  • the Depression;
  • Breathing difficulties (in case of heart failure or lung disease), need to urinate at night (nocturia), gastro-oesophageal reflux, and hyperthyroidism, Parkinson’s disease or Alzheimer’s disease.

When a physical or mental health problem makes it difficult to sleep well, it is important to get adequate treatment first.

Sleep needs with age

The elderly do not actually need less sleep than other adults, although many sleep less, depending on the sleep specialist Charles Morin, a psychologist and researcher at Laval University in Quebec. With age, periods of deep slow sleep are continuously decreasing. As sleep is more fragile, older people are more likely to be awakened by external stimuli, be it noise, light or body pains. However, by napping when necessary and respecting the rules of sleep hygiene (described in the Prevention section), it is quite possible to get enough sleep.

                              Average sleep needs 
Age groups                         Hours per day                        
0 to 2 months
2 to 12 months
12 to 18 months
18 months to 3 years
3 to 5 years
5 to 12 years
Adolescents
Adults
16.5 to 18.5
14 to 15
13 to 15
12 to 14
11 to 13
9 to 11
8.5 to 9.5
7 to 9

Possible consequences

The consequences of insomnia are quickly felt and include: fatiguedrowsinessirritabilitymemory loss and difficulty concentrating during the day. The degree of daytime sleepiness can be assessed using a standardized test of 8 questions. Insomnia tends to accentuate the symptoms of certain health problems: migraines, pains, digestive problems, etc.

If spending a few sleepless nights occasionally is not a concern, a chronic lack of sleep can disrupt daily activities and cause:

  • of educational difficulties , especially among elementary students;
  • at work , absenteeism or presenteeism (being present in body and not mind);
  • Of accidents at work and road accidents: driver fatigue is involved in 20% to 25% of fatal road accidents.

 

Sleeping is crucial; it’s all but a waste of time!

Sleeping well is important, not only to feel good and energetic, but to enjoy long-term health. During sleep, several physiological processes are accomplished: the tissues of the liver and muscles regenerate, the immune system resumes its strength, the memory is consolidated, and so on. It is during sleep that the secretion of growth hormones is highest. The brain also benefits from this respite to eliminate its “waste” through antioxidants . However, we still do not know much about how sleep triggers these restorative mechanisms.

Symptoms of Insomnia

  • Difficulty falling asleep
  • Intermittent waking up during the night.
  • A premature awakening.
  • Fatigue awakening.
  • Fatigue, irritability and concentration problems during the day.
  • A decrease in alertness or performance.
  • Anxious anticipation of the arrival of the night.

People at risk

  •  The women would be more likely to suffer from insomnia than men, among other due to some hormonal changes prior to menstruation (see our profile premenstrual syndrome), and in the years before and after menopause.
  • People aged 50 and over.

Risk Factors for Insomnia (Sleep Disorders)

  • Vulnerability to stress, a tendency to anxiety, depression, trauma or other psychological or psychiatric problems.
  • An environment that is not conducive to sleep: inadequate temperature, too much light and noise, a high-altitude sleep or snoring, etc.
  • The time difference, the night work or frequent changes in the work schedule.
  • Poor sleep hygiene (too long naps, lack of daytime physical activity, overactive nights, irregular sleeping hours, etc.).
  • The changes in routine (one night in a hotel room, in the house of a friend, etc.).
  • Excessive consumption of caffeine during the day or before bedtime: for example, tea, coffee, cola, energy drinks and chocolate. The herbal mint can also have an exciting effect.
  • Alcohol consumption in the evening. Alcohol can help you fall asleep. However, as the body metabolizes alcohol, sleep becomes fragmented and of lower quality.
  • Over-the- counter medications, such as certain decongestants, certain pain relievers and certain weight loss products (often containing caffeine and other stimulant substances), or prescription medications, such as certain anti-depressants, anti-inflammatory medications hypertension and corticosteroids .
  • The use of central nervous system drugs, such as methamphetamine (including crystal meth) and cocaine. These substances reduce the feeling of tiredness or the feeling of needing sleep, as well as the appetite.
  • withdrawal (when you stop smoking, sleeping pills, antidepressants, anxiolytics , tranquilizers).
  • Smoking, especially in the evening.
  • For people with insomnia, the anxiety of having trouble falling asleep is the problem. We then begin to calculate the number of hours we have to sleep, to think of how insomnia will harm us the next day, and so on.

Prevention of insomnia (Sleep Disorders)

Basic preventive measures
Here are some tips that encourage sleep. The risk factors mentioned above should be avoided as much as possible.

Do 20 to 30 minutes of exercise a day

– People who exercise regularly, even moderately, would sleep better than others. A study from Stanford University (California) showed that adults aged 50 to 76 years with moderate insomnia could improve sleep quality by regularly practicing intensity exercises average. The active subjects fell asleep twice as fast as the sedentary subjects and slept another hour per night.
– However, many people sleep less well when they do vigorous exercise less than 2 to 3 hours before bedtime.

Arrange the bedroom to promote sleep

– Sleeping on a good mattress and in a dark room helps sleep.
– In the city, you can bring curtains or blinds cutting the outer rays of light, as thin as they are (those of the lampposts, for example). Light acts directly on the pituitary gland, a gland that exerts a major influence on the biological clock. A room that is too bright or too dark affects the waking process.
– If necessary, you can attenuate the surrounding noise by arranging the bedrooms in the quietest rooms of the house or soundproofing the walls, ceilings and floors. You can also simply use earplugs.
– Some people sleep better when there is a light and constant background noise (like a fan), which covers louder noises coming from the outside.
– It is advisable to ensure that, at night, the temperature of the bedroom is slightly lower than the daytime temperature, and also to ventilate the room. A temperature around 18 ° C is generally recommended.

Pay attention to the evening meal

– Feed at regular times.
– Avoid eating late at night, as digestion keeps you awake. This advice becomes more important with age, because digestion is slower.
– Take a light and spicy meal at dinner, which promotes sleep. To compensate, have a breakfast and a more hearty dinner. Rich suppers help to break up sleep, especially if they are well watered.
– A supper rich in carbohydrates and low in protein would contribute to a good sleep by stimulating the production of 2 hormones involved in sleep: melatonin and serotonin .

Avoid the consumption of excitants

– During the few hours before bedtime, avoid consuming excitants, such as coffee, tea, chocolate, nicotine or colas. In general, it is recommended not to take more than 2 or 3 cups of coffee a day. Even if they drink only one coffee for several hours before going to bed, some people, very sensitive to caffeine, will not be able to sleep.
– Monitor the labels of medications consumed. Look for stimulants, such as pseudoephedrine . Ask your pharmacist if you are not sure.

Relax before going to bed

– Some relaxation routines can help you fall asleep. The relaxation of body and mind facilitates sliding in the arms of Morpheus.
– In the hours before bedtime, prefer quiet activities, which require little energy: a walk in the open air, some yoga postures, a little reading or relaxation, a bath, a massage, meditation, etc.
– Beautiful music, inspiring reading, or enjoyable images are better than a newsletter or a violent film.

Aim for regularity

– Try to get up at about the same time each morning, even on holidays. This helps to regulate the biological clock and makes it easier to fall asleep in the evening.

Medication to control: what treatment against insomnia?

Nsomnia requires a treatment adapted to each situation. The first step is to look for the cause. Often, insomnia present for several months needs to reorganize the lifestyle to promote sleep.

To sleep better, start by changing your habits

Treatment with behaviors called “stimulus control  ” is particularly effective. It aims to habituate the body to a routine conducive to sleep. It creates; however, sleep deprivation, which sometimes makes it difficult to apply. Once we have a deep and regular sleep, and wake and sleep cycles are resynchronized, we can gradually return to a less restrictive routine.

Are some behavioral rules to scrupulously observe?

  • Go to bed only when you want to sleep. There is nothing worse than trying to fall asleep at all costs.
  • Do not stay in bed when you have been awake for more than 20 to 30 minutes. When this happens, get up, get out of the room, do a relaxing activity and go back to bed when you feel sleepy. Repeat these actions as often as necessary.
  • To get up in the morning at a fixed time, whatever the day of the week, including Saturday and Sunday, and even if we slept badly. It is true that it reduces the sleep time, but it helps to sleep in one stroke. In the beginning, do not delay getting up to catch the hours when you could not sleep: in the long run, this may aggravate the problem. When you finally have a regular and uninterrupted sleep, you can slightly extend your nights (in 15-minute increments).
  • Do not go to bed less than 5 hours.
  • Do not do any other activity in bed (ideally in the bedroom) other than sleeping or having sex.
  • With regard to the nap during the day, the opinions diverge. Some experts proscribe it because it would fill a part of sleep needs. At bedtime, it would be more difficult to fall asleep. Others say that a short nap of 10 minutes can be beneficial. To experiment.

Several scientific studies show that this method has proved its worth. An improvement in sleep is observed at the end of the first month. Its disadvantage is that it requires discipline and motivation. You can try it yourself, but it can also be done as part of a cognitive-behavioral psychotherapy.

Drugs to sleep

If insomnia still persists, sleeping pills (also called hypnotics) may be prescribed. These medications may be useful in the short term to recover a little (not more than 3 weeks), but they do not treat insomnia and do not eliminate its cause. They work by slowing the activity of the brain. Note that after 1 month of use, they often lose much of their effectiveness.

Benzodiazepines

These are the most commonly prescribed sleeping pills. If they are used regularly, they lose their effectiveness. These all have a sedative and anxiolytic effect, at various intensities. Benzodiazepines specifically indicated for the treatment of insomnia are flurazepam (Dalmane), temazepam (Restoril), nitrazepam (Mogadon), oxazepam (Serax) and lorazepam (Ativan). Diazepam (Valium), marketed in the early 1960s, is almost no longer used, especially because it causes significant residual sleepiness the next morning.

Non-benzodiazepine sleeping pills

Including zopiclone (Imovane) and zaleplon (Starnoc), they have been on the market for a few years. Their duration of action is shorter than that of benzodiazepines, which eliminates the effect of falling asleep that can occur the next morning, during the first hours.

The agonists of melatonin

C An s ramelteon (Rozerem) helps sleep induction by increasing the rate of natural melatonin. They are used especially in case of difficulty falling asleep.

The antidepressants

At low doses they can also be used to help sleep better.

Benzodiazepine and non-benzodiazepine sleeping pills have several side effects. For example, they can slow reflexes and interfere with coordination during the day, which increases the risk of falls and fractures, especially in the elderly. In the long term, they are likely to cause physical and psychological dependence. Finally, sleep induced by sleeping pills is less restorative, because these drugs shorten the period of REM sleep (the period during which dreams occur).

Note. It is important to consult your doctor when you want to stop taking sleeping pills or tranquilizers to avoid suffering from withdrawal syndrome. According to one study, cognitive-behavioral therapy (see above) facilitates complete weaning of chronic insomniacs who have taken benzodiazepines; it also improves the quality of sleep. The results were visible after 3 months of treatment.

Other treatments

In case of deep anxiety, depression or any other psychological disorder, the doctor may prescribe antidepressants that will relieve insomnia. He can also refer the patient to a psychologist or psychiatrist.

If a physical health problem explains insomnia, you must of course get adequate treatment.

In cases of insomnia caused by pain, analgesics may be used. That said, some of them can cause insomnia. If so, do not hesitate to ask your doctor to change the prescription.

Caution. When you have insomnia, it is not recommended to use antihistamines that cause drowsiness , in order to sleep better . These drugs have little effect on chronic insomnia. They can even cause a state of awakening.

Behavioral therapy

According to the most recent studies, cognitive behavioral type of psychotherapy is often more effective than  medication  to control insomnia. This  therapy  helps to deconstruct erroneous associations or beliefs fueling insomnia-related distress (for example, “I have to sleep at least 8 hours a night, otherwise I will not be fit the next day”).

The therapy, personalized, can include:

  • advice on sleep patterns
  • work on unrealistic beliefs and thoughts related to insomnia or the psychological causes of insomnia;
  • Learning a relaxation technique.

The number of sessions varies from one individual to another, but generally, the improvement is seen after 2 to 3 months of weekly treatments (8 to 12 sessions) . Its efficiency rate  would be 80%, on average. People who already take sleeping pills can also benefit.

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