DailyNews Online Edition

Insomnia: Difficult falling asleep

Insomnia is difficulty falling asleep or staying asleep or a disturbance in sleep that makes sleep seem inadequate or unrefreshing.

Insomnia is not a disease. It is a symptom that can have many different causes, including an irregular sleep-wake schedule, physical disorders, drugs use or withdrawal, drinking large amounts of alcohol in the evening, emotional problems, and stress. Often, the cause is anxiety, nervousness, depression, or fear.

Some-times the cause is lack of fatigue. Some people have long standing (chronic) insomnia that has little or no apparent relationship to a physical disorder, use or withdrawal of drugs or any stress.

Difficulty falling asleep is common among young and old. About ten per cent of adults have chronic insomnia, and about fifty per cent have insomnia sometimes.

Because sleep patterns change as people age, older people may think they have insomnia when they do not. As people age, they tend to sleep less at night and to nap during the day. The period of deep sleep, becomes shorter and eventually disappears. Also, older people awaken more during all stages of sleep. These changes are normal and usually do not indicate a sleep disorder.

There are several types of insomnia. Difficulty falling asleep, called sleep-onset insomnia, often occurs when people cannot let their mind relax and they continue to think and worry. Difficulty staying asleep, called sleep maintenance insomnia is more common among older people than among younger people.

People with this type of insomnia fall asleep normally but wake up several hours later and cannot fall asleep again easily. Sometimes they drift in and out of a restless, unsatisfactory sleep. Early morning awakening, another type of insomnia, may be a sign of depression in people of any age.

Sleep-wake schedule disorder may occur in people whose sleep patterns have been disrupted: They fall asleep at inappropriate times and they cannot sleep when they should. These sleep-wake reversals often result from jet lag (especially when travelling from east to west), working irregular night shifts, and frequent changes in work hours, or excessive use of alcohol.

Sometimes sleep-wake reversals are a side effect of drugs. Sleep-wake reversals are common among people who are hospitalised because they are often awakened during the night. Damage to the brain’s built-in biologic clock (caused by inflammation of the brain-encephalitis, stroke-kiharusi or any other disease affecting the brain cells) can also disrupt sleep patterns.

Symptoms include irritability, fatigue during the day, and problems concentrating or performing under stress. To diagnose insomnia, doctors evaluate a person’s sleep pattern, use of drugs (including alcohol and illicit drugs), and degree of psychological stress, medical history, and level of physical activity. Some people need less sleep than others, so the diagnosis of insomnia is based on person’s individual needs.

The treatment of insomnia depends on its cause and severity. If insomnia results from another disorder, treatment of that disorder may improve sleep. For most people who have insomnia, some simple changes in life style, such as following a regular sleep schedule, can improve sleep.

Bright light therapy (which exposes a person to bright light at appropriate times) can help reset the biologic clock. This therapy is especially useful for people who have sleep-wake reversal due to jet lag, those who have sleep-onset insomnia, and those who go to sleep and wake too early.

When a sleep disorder interferes with a person’s normal activities and sense of well-being, the intermittent use of sleep aids (also called hypnotics) for up to a week may be helpful. Most sleep aids require prescription; please make sure you get a properly prescribed drug. Some people prescribe themselves for drugs like anti-histamines (like piriton and phenergan) even at times Valium. These drugs may have side effects, especially in older people.

Older people experiencing age-related sleep changes usually do not need to take sleep aids. Because total nighttime sleeping time tends to decrease with age, older people may sleep better if they go to bed later, get up earlier, or nap less during the day. Even when older people have insomnia, treatment with sleep aids often causes more problems (such as confusion, falls, and incontinence – failure to control urine) than insomnia.

If emotional stress (msongo) is causing insomnia, treatment to relieve the stress is more useful than taking sleep-aids. A doctor should evaluate people who have insomnia and depression, and the depression should be treated. Treating depression (sonona) often relieves insomnia, but some antidepressant (drugs for treating depression) can improve sleep directly because they have sedating effect.