Insomnia

What is Insomnia?

Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality that occurs despite adequate time and opportunity for sleep and that results in some form of daytime impairment. According to the third edition of the International Classification of Sleep Disorder, insomnia is classified as:

• Chronic Insomnia Disorder: The sleep disturbances occur at least three times a week and have been present for the last 3 months.
• Short-Term Insomnia Disorder: The sleep disturbances have been present for over a period of 3 months.
• Other Insomnia Disorder: Difficulty in initiating or maintaining sleep that does not meet the criteria of chronic insomnia or short-term insomnia disorder.

Insomnia is prevalent in 10% to 15% of the general population. It affects all age groups but women of perimenopausal and post-menopausal phase experience the condition.

Causes

There is a high rate of association between insomnia and psychiatric disorders like depression, anxiety, and post-traumatic stress disorder. Certain comorbidities like restless legs syndrome, chronic pain, gastroesophageal reflux disease (GERD), respiratory issues, and immobility also predispose an individual to develop insomnia.

Also, people with certain personality traits like perfectionism, ambitiousness, neuroticism, low extraversion, and susceptibility to depression and worry are more likely to develop insomnia over time.

Sign and symptoms

It is important to differentiate whether the sleep disturbances are from difficulty in initiating sleep or maintaining sleep or both. Patients may present with symptoms like waking up too early in the morning (early morning insomnia). Other sleep-related disorders like restless leg syndrome (RLS), sleep apnoea, periodic limb movements, nocturnal leg cramps can contribute to sleep fragmentation and should be evaluated while eliciting the sign and symptoms.

Diagnosis

The diagnosis must involve a comprehensive evaluation that includes a history of sleep-related disturbances, associated underlying medical and/or psychiatric problems, medications or other sleep-related disorders. Laboratory investigations can provide data on the underlying medical conditions and must include parameters like thyroid function tests, glycosylated haemoglobin, complete blood count, serum iron studies, liver function tests, and renal function tests.

Also, self-evaluating assessment scales and questionnaires are important in documenting the sleep disturbances and the quality of sleep. Sleep logs or diaries are also very important to assess the sleep-wake cycle in an individual. Sleep logs are maintained for 2 to 4 weeks and also include documentation of alcohol and caffeine consumption, bedtime activities, and daytime napping.

General management

Non pharmacological interventions include maintaining sleep hygiene, sleep restriction therapy, stimulus control therapy, relaxation therapy and Cognitive Behavioural Therapy for Insomnia (CBTi). Pharmacological management can be advised by the physician accordingly.

Disclaimer: The information provided herein on request, is not to be taken as a replacement for medical advice or diagnosis or treatment of any medical condition. DO NOT SELF MEDICATE. PLEASE CONSULT YOUR PHYSICIAN FOR PROPER DIAGNOSIS AND PRESCRIPTION.