A closer look at insomnia
“The victim mindset will have you dancing with the devil, then complaining that you’re in hell.”
– Steve Maraboli

Insomnia is estimated to be prevalent in about 35% of the adult American population, as per the estimate of CDC. The condition, other than its disturbing features, leads to serious health problems like chronic hypertension, cardiac conditions, obesity diabetes, cancer, and the likes. It also leads to a fall in work standards and creates more stress, leading to psychological conditions like depression, anxiety, etc., forming a vicious cycle. All the three together constitute sleep difficulty. Every one need not and does not suffer from all three.

The American Academy of Sleep Medicine, AASM, have given one of the most comprehensive definitions of insomnia. To quote them, “Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.”

What is the criteria to diagnose insomnia?

• People who have sleep difficulty for three nights in a week and which has been continuing for three months, along with disruptions in their daytime activities are suffering from insomnia.
• Disturbances in sleep are of three types. The difficulty may be faced in sleep initiation, in getting undisturbed sleep for the required duration, or in getting back to sleep after an interruption.

What are the causes for insomnia?

• Insomnia generally has some underlying medical conditions like cardiac diseases, allergies or Atopic eczema, nocturnal polyuria caused by prostate diseases, arthritis, or pain in general. Psychological conditions like anxiety, depression, stress, and financial or relationship problems are all causes of insomnia.
• Crossing different time zones in a short period of time.
• There are independent causes, like circadian rhythm disorder. It is a misalignment between the internal rhythm requirement of the body clock and the social requirement of the individual.

What are some independent causes of insomnia?

• Delayed Sleep Wakeup Phase Disorder or DSWPD is an example of this. This is the difficulty in falling asleep at the socially demanded time and waking up on time. This is found in people with job loss or academic failure.
• Crossing too many time zones in a short period is also a reason for this and is commonly found in frequent long distance international travelers.
• Another type is found in night shift workers, like healthcare and industrial workers. This is called Advanced Phase Sleep Disorder, and in this, the usual habitual time to fall asleep is advanced by two to three hours prior to the required time. These patients also have evening sleepiness and inability to get continuous sleep (sleep maintenance insomnia).
• Obstructive Sleep Apnea, OSA, is a stoppage, either partial or complete, of respiration due to the collapse of upper respiratory tracts. This results in low oxygen levels in blood, hypoxemia, and sleep disturbance (micro arousals).

What are the best sleep aids for insomnia in terms of behavioral therapy?

• The initial approach to sleep aids for insomnia is to undertake behavioral therapy. In this scheme of treatment, the first step is to educate the patient about the conditions normally conducive to sleep.
• These include not to consume any caffeine at least 6 hours prior to sleep, not undertake physical exercise, and any activity that increase excitement, like watching TV or scanning the web either on computer or smartphone, should be avoided. The blue light from the screen interferes with the entire sleeping process.
• Keep the bedroom ambience cozy and relaxing to turn the room itself into a sleep aid for insomnia.
• Construct a schedule of sleeping every day at the same time, irrespective of weekdays, weekends, or holidays. This helps the body form a habit of inducing sleep at a fixed time.
• Keep the bed and bedroom exclusively for sleeping. This helps as the body will automatically be trained to induce sleep once you lie down on the bed, which won’t be the case if you sit on the bed and watch movies, for example.

What are some medicines for insomnia?

• An initial sleep aid for insomnia makes sure that any underlying medical conditions, including psychological conditions, if any, are resolved.
• The normal medications are antihistamines. Antipruritics and topical applications that modulate immunoreactions, hypnotic, and sedatives, and neurostimulants that increase the production of neurochemicals like serotonin and GABA all have serious side effects.
• Proprietary wave forms applicator that is FDA approved is effective. It needs an authorization from a doctor.
• These are some of best sleep aids for insomnia.
• Some pure herbal preparations and some supplemented with melatonin are also available, which are some of the best over-the-counter sleep aids for insomnia.