Insomnia

Symptoms

Doctors associate a variety of signs and symptoms with insomnia. Often, the symptoms intertwine with those of other medical or mental conditions.

• Some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.
  
  
• Most often daytime symptoms will bring people to seek medical attention. Daytime problems caused by insomnia include the following:
  
  
  • Poor concentration and focus
    
    
  • Difficulty with memory
    
    
  • Impaired motor coordination (being uncoordinated)
    
    
  • Irritability and impaired social interaction
    
    
  • Motor vehicle accidents because of fatigued, sleep-deprived drivers
  
  
• People may worsen these daytime symptoms by their own attempts to treat the symptoms.
  
  
  • Alcohol and antihistamine may compound the problems with sleep deprivation.
    
    
  • Others have tried nonprescription sleep aids.

Treatment

Non-medical treatment and behavioral therapy

Non-pharmacologic or non-medical therapies are sleep hygiene, relaxation therapy, stimulus control, and sleep restriction. These also referred to as cognitive behavioral therapies.

Sleep hygiene

Sleep hygiene is one of the components of behavioral therapy for insomnia. Several simple steps can be taken to improve a patient's sleep quality and quantity. These steps include:

• Sleep as much as you need to feel rested; do not oversleep.
  
  
• Exercise regularly at least 20 minutes daily, ideally 4-5 hours before your bedtime.
  
  
• Avoid forcing yourself to sleep.
  
  
• Keep a regular sleep and awakening schedule.
  
  
• Do not drink caffeinated beverages later than the afternoon (tea, coffee, soft drinks etc.) Avoid "night caps," (alcoholic drinks prior to going to bed).
  
  
• Do not smoke, especially in the evening.
  
  
• Do not go to bed hungry.
  
  
• Adjust the environment in the room (lights, temperature, noise, etc.)
  
  
• Do not go to bed with your worries; try to resolve them before going to bed.

Relaxation therapy

Relaxation therapy involves measures such as meditation and muscle relaxation or dimming the lights and playing soothing music prior to going to bed.

Stimulus control

Stimulus control therapy also consists of a few simple steps that may help patients with chronic insomnia.

• Go to bed when you feel sleepy.
  
  
• Do not watch TV, read, eat, or worry in bed. Your bed should be used only for sleep and sexual activity.
  
  
• If you do not fall asleep 30 minutes after going to bed, get up and go to another room and resume your relaxation techniques.
  
  
• Set your alarm clock to get up at a certain time each morning, even on weekends. Do not oversleep.
  
  
• Avoid taking long naps in the daytime.

Sleep restriction

Restricting your time in bed only to sleep may improve your quality of sleep. This therapy is called sleep restriction. It is achieved by averaging the time in bed that the patient spends only sleeping. Rigid bedtime and rise time are set, and patient is forced to get up even if they feel sleepy. This may help the patient sleep better the next night because of the sleep deprivation for the previous night. Sleep restriction has been helpful in some cases.

Other simple measures that can be helpful to treat insomnia include:

• Avoid large meals and excessive fluids before bedtime
  
  
• Control your environment.
  
  
  • Light, noise, and elevated room temperature can disrupt sleep. Shift workers and night workers especially must address these factors. Dimming the lights in the bedroom, relaxation, limiting the noise, and avoiding stressful tasks before going to bed may be beneficial. (Refer to sleep hygiene and relaxation therapy above.)
    
    
  • Avoid doing work in the bedroom that should be done somewhere else. For example, do not work or operate your business out of your bedroom and avoid watching TV, reading books, and eating in your bed.

A person's body's circadian rhythm (biological clock) is particularly sensitive to light. Parents who need to sleep during the day may have to make child care arrangements to allow them to sleep.

Medications and Medical Therapies

There are numerous possible medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies. In a study, it was noted that when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone.

• Benzodiazepine sedatives: six of these sedative drugs have been used to treat insomnia. There are reports of subjective improvement of quality and quantity of sleep when using these medications. These include temazepam (Restoril), flurazepam (Dalmane), triazolam (Halcion), estazolam (ProSom, Eurodin), lorazepam (Ativan), and clonazepam (Klonopin).
  
  
• Nonbenzodiazepine sedatives: These include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
  
  
• Melatonin: Melatonin is secreted by the pineal gland, a pea-sized structure at the center of your brain. Melatonin is produced during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. At night, melatonin is produced to help your body regulate your sleep-wake cycles. The amount of melatonin produced by your body seems to decrease as you get older. Melatonin may be beneficial in patients with circadian rhythm problems.
  
  
• Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the Food and Drug Administration (FDA) for treatment of insomnia characterized by difficulty falling asleep.
  
  
• Some antidepressants [for example, amitriptyline (Elavil, Endep) and trazodone (Desyrel)] have been used for the treatment of insomnia in patients with co-existing depression because of some sedative properties. Generally, they may not be helpful for insomnia in people without depression.
  
  
• Antihistamines with sedative properties [for example, diphenhydramine (Benadryl) or doxylamine] have also been used in treating insomnia as they may induce drowsiness, but they do not improve sleep and should not be used to treat chronic insomnia.
  
  
• Valeriana officinalis (Valerian) is a popular herbal medication used in the United States for treating insomnia, however, to date there are no convincing studies to show any real benefit in patients with chronic insomnia.

sumber: emedicinehealth.com