Sleeplessness

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleepingInsomnia is also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.

About Normal Sleep

An average person spends about one third of his life sleeping. Normally people (adults) require about 7-9 hours of sound sleep to function well but some people can do very well even with 4-5 hours of sleep.

Infants require much more sleep as compared to adults and they can sleep for up to 18 hours a day (average between 16- 20 hours). By the time they are 3-6 months old they require about 15 hours of sleep. Children older than this require about 10-13 hours of sleep daily. Pre-teens and teenagers require anywhere between 9-10 hours of sleep.
As age advances above 50 years, the sleep duration reduces to about 5 ½ to 6 hours at night.

Normal sleep is of two types:
1. Slow-wave (non-REM) sleep
2. Rapid eye movement (REM) sleep

Slow-wave (non-REM) sleep:

Non-REM sleep lasts about 70-90 minutes. It has four stages as follows:
1. Transitional stage (lasting about 1-7 minutes)
2. Light sleep
3. Moderately deep sleep (about 20 min after falling asleep)
4. Deep sleep

Rapid eye movement (REM) sleep:

  • This is a very important stage of sleep
  • It usually occurs within 50-90 minutes of falling asleep
  • Initially lasts 5-10 minutes; gradually this stage lengthens until the final REM period lasts 50 minutes
  • Most dreaming occurs during this phase of sleep
  • The eyeballs of a sleeping person will make rapid side-to-side movements under the lids during REM sleep
  • The muscles of the body are very relaxed during this phase of sleep
  • REM sleep is particularly useful for growth and repair of the brain itself, while the non-REM sleep is useful for repair of the rest of the body

Sleeplessness: Introduction

What is sleeplessness?

Sleeplessness (Insomnia) is a sleep disorder in which a person has difficulty in falling asleep or experiences poor sleep.

Difficulty in falling asleep:

You are trying to sleep but you just can’t get any sleep. You may try counting sheep, reading a book, tossing about in bed or just anything but nothing seems to put you to sleep.

Difficulty in staying asleep:

You experience frequent breaks in the sleep at night due to any reason and then face difficulty in going back to sleep again.

Waking up too early in the morning and then not being able to get back to sleep again.

Unrefreshed feeling on waking up from sleep; feeling as if one has not slept at all at night.

Sleeplessness (Insomnia) can be of 3 types:

Transient Insomnia:

Transient insomnia may last from 1 night to a few nights. It is usually mild and does not severely hamper a person’s ability to function during the daytime. It passes off after a few days and the person functions normally.

Short-term Insomnia:

This type of insomnia may last for anywhere between a few nights to a month. This usually affects the daytime functions of a person though it may not be very severe. Usually some kind of irritability and tiredness may occur due to short term insomnia.

Chronic Insomnia:

This is the most debilitating amongst all the types of insomnia. It lasts for more than a month and may extend upto many months or even longer. It severely affects the mental capacities of an individual, his concentration, mood, task handling, etc.

Consequences of sleeplessness:

These may vary from person to person and include some or all of the following in varying intensities:

  • Impaired concentration for work
  • Difficulty in memorizing minor daily tasks
  • Irritability
  • Mood swings
  • Anxiety
  • Depression
  • Accident proneness
  • Fatigue
  • Inability to handle stressful situations effectively

In the long run, sleeplessness can also be the trigger for many gastro-intestinal disorders such as Irritable Bowel Syndrome, frequent heartburn, frequent indigestion, etc. Long term insomnia can also increase the risk for developing Hypertension and Diabetes (Type II).

The biggest impact of sleeplessness is that it reduces your quality of life and leads to daytime tiredness which makes you feel drained.

Sleeplessness Causes

Some of the common causes of sleeplessness are as follows:

  • Inappropriate sleeping environment such as: too hot or too cold bedroom, bed being too hard or too soft, noisy place, poor ventilation, change of sleeping place, mosquitoes, etc
  • Anxiety: Worrying about various things such as work, appointments, family or work stress, etc.
  • Depression, grief, etc
  • Emotional excitement (Euphoria)
  • Mood disorders
  • Too much of caffeine intake especially during the later part of the day (e.g. Strong coffee, cola, etc).
  • Sedentary lifestyle: When you have not worked enough during the daytime, your mind might be tired, but your body may not be tired, thus causing difficulty in sleeping
  • Hormonal changes: Around the time of menses, Pregnancy (especially during 1st trimester)
  • Overeating
  • Jet lag
  • Working in shifts
  • Systemic disorders such as Asthma, Hyperthyroidism, duodenal ulcers, arthritis, Diabetes, GERD, etc
  • Night urination frequency (due to diabetes, prostate enlargement, urinary infection, etc)
  • Alcohol withdrawal
  • Dehydration
  • Chronic pain (due to any cause): E.g.: Osteoarthritis, trauma, leg cramps, etc
  • Itching (due to any skin disorder, allergy, etc)

There are a large number of drugs that can causes sleeplessness.

  • Bronchodilators such as theophylline
  • Certain anticonvulsants such as Phenytoin
  • Nasal decongestants
  • Certain anti-depressants
  • Levodopa
  • Steroids
  • Estrogen drugs
  • Cocaine
  • Thyroid hormones
  • Nicotine
  • Amphetamine group of drugs

Do’s

  • Maintain regularity: make it a point to go to sleep at a fixed time and also wake up at a fixed time. Try not to break this schedule as far as possible.
  • Have a hot milk drink before going to bed. Hot milk has natural sedative compounds in it.
  • See to it that the environment in the room is ideal for sleeping (no noise, proper temperature, adequately dark, etc.)
  • Adequate physical exercise during the daytime usually ensures that you get a good sleep at night. However, avoid too much of exercising after evening as this may tend to keep you fresh and make you unable to fall asleep.
  • Try a relaxation exercise or meditation or listen to some soft, soothing music to relax your mind if you are not getting sleep.
  • Have a warm bath before you go to sleep.
  • If you can’t sleep, get up and do something for a while; later try to go back to sleep again.
  • Quit smoking- nicotine can contribute to sleeplessness.

Don’ts

  • Sleeping during the day: If you are very tired, make it a short nap (about 45 minutes), not a long sleep
  • Eating a heavy meal or drinking caffeinated beverages in the late evening or at night
  • Drinking alcohol few hours before bedtime: This will disrupt your sleep pattern and cause your sleep to be unrefreshing
  • Smoking before bedtime
  • Exercising vigorously in the evening hours
  • Reading or working in bed during the daytime
  • Thinking about stressful events before sleeping
  • Getting worried or excessively tensed if you are not able to sleep: This will worsen your insomnia.