Insomnia

Introduction:

A broader definition of insomnia is: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening
with difficulty resuming sleep, or unrefreshing sleep. The subject must also suffer some degree of impairment in
social, occupational, or other important areas of daytime functioning.
Daytime symptoms may include morning grogginess, memory problems, poor concentration, irritability,
mild depression, anxiety, somatic complaints such as headaches or aches and pains, and daytime fatigue.
Insomnia lasting less than 4 weeks is considered to be transient. Insomnia lasting longer than 4 weeks is chronic.
Insomnia Affects Quality of Life And Health
Insomnia may be a serious problem affecting quality of life, productivity and safety.
People with insomnia report problems with memory and concentration.
Daytime and work performance are impaired in those suffering from insomnia and lack of sleep.
People who suffer from insomnia are four times as likely to suffer depression.
Insomnia increases the risk of developing cardiovascular disease.
Sleep problems in the elderly have been associated with a heightened risk for institutionalization
 

Incidence:

One in three adults are believed to suffer from insomnia. According to National Sleep Foundation's (NSF) 1999 Sleep in
America survey, more than half (56%) of  adults reported experiencing symptoms of insomnia a few nights a week or
more, yet only half of those people were being treated by a healthcare provider for their condition.
Transient insomnia occurs in up to 50% of the population.
The prevalence of chronic insomnia is estimated to be about 10% to 15%.

The direct economic costs of insomnia are estimated at close to $14 billion in the USA alone.
The total cost of insomnia, including treatment, lost productivity and insomnia related accidents, may exceed
$100 billion per year. And the statistics is comparable world-wide.

Those at greatest risk for insomnia include the elderly, women, shift workers, and persons with comorbid medical
or psychiatric disorders. Nearly two thirds of adult psychiatric outpatients have disturbed sleep.
Chronic insomnia is, in turn, a significant risk factor for the development of psychiatric illness.
Victims of insomnia are more than twice as likely as noninsomniacs to have psychiatric disorders and are more prone to
subsequent depressive illness, anxiety, or alcohol abuse.

Decades of scientific research have shown that sleepiness and fatigue, as well as sleeplessness, affect everyone's health,
safety, productivity and well-being. Yet most people are slow to seek the advice and treatment of a healthcare provider
for sleep problems and excessive sleepiness. For example, of the two-thirds of Americans experiencing sleep disorders,
only four percent are seeing a doctor.

Insomnia disturbs your waking hours as well as your sleeping hours.
You are likely to feel sleepy during the day and have trouble concentrating on tasks after a poor night's steep.

Types of Insomnia

Insomnia may be described in terms of both duration and severity. It may be transient (lasting for several days),
intermittent (when transient insomnia recurs), or chronic (lasting for more than a month).

Transient insomnia

Transient insomnia is an inability to sleep well over a period of a few nights. This is usually brought on by excitement or stress.
You may find it hard to sleep before an important event such as a meeting, wedding, an examination, etc.
People find it hard to sleep when they are in a new location such as in a hotel room or when they have crossed several
time zones. A vigorous exercise close to bedtime (within four hours) or an illness can also temporarily disrupt sleep.

Short-term insomnia

Sort term insomnia is characterized by two to three weeks of poor sleep. It is believed to have been caused by stress.
Generally, sleep will return to normal when the stressful situation subsides or when the sleeper becomes accustomed to it.

Chronic insomnia

Chronic insomnia is manifested by poor sleep every night or most nights. In most cases this is due to excessive worrying.
However, not all chronic insomnia has its origin on worrying. According to a study by the Association of Sleep Disorders
Centers, physical ailments-such as disorders of breathing or muscle activity-are the cause of more than half of all cases of
persistent insomnia.

Narcolepsy

Narcolepsy is a rare sleep disorder characterized by attacks of irresistible drowsiness during the day.
A narcoleptic may not sleep well at night but suffer sleep attacks during the day, while talking, working, and even
when driving a vehicle.

Causes of Insomnia

Insomnia can originate by any of a number of factors such as physical illness, a stress-filled lifestyle,
excessive caffeine consumption, or chronic pain. It may simply be the result of poor sleeping habits,
such as napping during the day and going to bed at irregular hours.
Insomnia can often be linked to alcohol or drug abuse and to misuse of certain medications.

Sleep-Onset Insomnia	Sleep-Maintenance Insomnia
Anxiety or tension	Depression
Environmental change	Environmental change
Emotional arousal	Nocturnal myoclonus
Fear of insomnia	Hypoglycemia
Phobia of sleep	Parasomnias such as sleep apnea, restless-legs syndrome, etc.
Disruptive environment	Pain or discomfort Drugs
Pain or discomfort	Alcohol
Caffeine or Alcohol

Psychological factors account for about half of all insomnias. Numerous mental and emotional factors can precipitate sleep disorders, especially insomnia. These include grief, depression, anxiety, fear, and excitement.

Anxiety and depression are two common causes of insomnia. If the insomnia is simply due to a short-term reaction to a
situation in one's life, the insomnia will normally disappear as soon as the situation changes.
It is rare to see someone who has a severe case of insomnia due to purely emotional factors.

Insomnia, particularly sleep-maintenance insomnia and early morning awakening, is a hallmark symptom of major depression.
Some depressed individuals may instead exhibit excessive sleep, called hypersomnia.

Anxiety is another prevalent mental health problem that can disturb sleep.
Anxiety is a feeling of apprehension, worry, or fear.

Post-Traumatic Stress Disorder (PTSD) can cause insomnia.
In PTSD, a traumatic event (such as physical or sexual abuse, war, or a natural disaster) is continually re-experienced
emotionally. This chronic "reliving" of the trauma results in fear, anxiety, physical stress responses, insomnia, and nightmares.

Learned Insomnia, when you are under stress, you tend to sleep poorly. However, many people start worrying that
they are not getting enough sleep. They worry about not being able to function effectively during the day.
This creates anxiety that leads to further insomnia. So, the stress induced insomnia tend to feed on itself on people who
are susceptible to worrying.

Sleep problems are usually a biochemical problem. Biochemical breakdown can take place in many ways.
For example, if your digestive system is stressed and unable to digest protein, the amino acids which affect neurotransmission
will not be available to your brain.
You can become ill emotionally without having anything emotionally stressful going on in your life.

Vulnerability to insomnia, some people are more likely than others to experience insomnia during times of stress.

Persistent stress, stress plays a pivotal role in insomnia. Causes of stress such as a troubled marriage, a chronically ill child,
or an unrewarding career can contribute to poor sleep.

Lifestyle

Food and food Intolerance

Nocturnal Hypoglycemia

Medical Conditions

Prescription Drugs, Over-the-Counter Drugs, Illicit Drugs and Sleeping Pills


How To Avoid Nocturnal Hypoglycemia?

Nocturnal hypoglycemia (low nighttime blood glucose level) is an important cause of sleep-maintenance insomnia.
When there is a drop in the blood glucose level, it causes the release of hormones that regulate glucose levels.
These compounds stimulate the brain. They are a natural signal that it is time to eat.

Many people suffer from faulty glucose metabolism, either hypoglycemia or diabetes,
because of overeating refined carbohydrates. Good bedtime snacks to keep blood sugar levels steady throughout the night
are oatmeal and other whole grain cereals, whole grain breads and muffins, and other complex carbohydrates.
These foods will not only help maintain blood sugar levels, they actually can help promote sleep by
increasing the level of serotonin within the brain.


Conventional Treatment:

Medications Commonly Used for the Treatment of Insomnia:

Nonbenzodiazepine, selective benzodiazepine receptor agonists:  Zaleplon, Zolpidem

Traditional benzodiazepine hypnotics: Triazolam, Temazepam, Flurazepam

Anxiolytic benzodiazepines frequently used as hypnotics (off-label): Clonazepam, Lorazepam, Alprazolam

Sedating antidepressants frequently used as hypnotics (off-label): Trazodone, Amitriptyline, Doxepin, Fluvoxamine

OTC Sleep-Promoting Drugs; Examples of OTC sleep-promoting drugs are the use of sedating antihistamines alone
or in combination with analgesics.

Common Side Effects Of Prescription Or Over-The-Counter Sleep Aids

 Fatal overdose, especially when combined with alcohol or with other drugs that affect your central nervous system
 Impaired coordination, memory, driving skills, and thinking
 Interference with breathing
 Physical or psychological dependence (unable to sleep without the medication.)
 Tolerance (Need to take larger and larger doses to achieve the same effect.)
 Potential damage to kidney, liver, and lungs
 Confusion, hallucinations, and similar disturbances, particularly for the elderly.

Naturopathic Treatment:

Natural remedies, combined with improvements in lifestyle, may improve your sleep.
Treatment is aimed at restoring your mind, body, and emotions to a state of balance. This allows you to function more
efficiently,  and remain more in control of your waking and sleeping life.
Sleep disorders tend to be resolved as a consequence of this restoration of balance rather than as a direct result of taking a
sleep remedy.

Some people may see an improvement in their sleep problems in a very short time; for others it takes time.
Lifestyle modifications are an integral part of any complementary therapy. Causes for insomnia such as bad diet,
too many cigarettes, too much alcohol, too little exercise, and poor stress management have to be corrected.

Nutrition:

Food and diet is especially important when treating sleep disorders, and it is essential to rule out food intolerances as a cause.
In one study of infants, sleeplessness was eliminated by removing cow's milk from the diet and then reproduced by its reintroduction.
Certain types of food promote sleep while others inhibit it.

Deficiencies in certain vitamins, minerals, amino acids and enzymes may disrupt sleep.
Calcium, magnesium, B vitamins, folic acid and melatonin deficiencies may impair sleep.

Foods to Eat:

• Chlorophyll-rich foods, such as leafy, green. vegetables, steamed or boiled.
• Oyster shell can be purchased in health food stores and taken as a nutritional supplement.
• Whole grains: Whole wheat, brown rice, and oats have a calming and soothing effect on the nervous system and the mind. Carbohydrates also boost serotonin, which promotes better sleep.
• Fruit, especially mulberries and lemons, which calm the mind.
• Seeds: jujube seeds are used to calm the spirit and support the heart. Chia seeds also have a sedative effect.
• Dill, basil
• Lettuce has a long-standing reputation for promoting healthy sleep. 

This is due to an opium-related substance combined with traces of the anticramping agent hyoscyarnin present in lettuce.
Lettuce should be an integral part of your evening diet if you are suffering from sleep disorders.
The meal should also include legumes, fish or poultry. These foods contain vitamin B3 (niacin).
Niacin is involved in seratonin synthesis and promotes healthy sleep.
Mixed with a little lemon juice for flavor, lettuce juice is an effective sleep-inducing drink highly preferable to
the synthetic chemical agents in sleeping pills.

Foods to Avoid:

•  Coffee
•  Tea
•  Spicy foods
•  Cola
•  Chocolate
•  Stimulant drugs
•  Alcohol
•  Refined carbohydrates (They drain the B vitamins.)
•  Additives and Preservatives
•  Non-organic foods containing pesticides.
•  Canned foods or any source of toxicity or heavy metals.
•  Sugar and foods high in sugar and refined carbohydrates. These raise blood-sugar levels and can cause a
•  burst of energy that disturbs sleep.
•  Foods that are likely to cause gas, heartburn, or indigestion, such as fatty or spicy foods, garlic-flavored foods,
•  beans, cucumbers, and peanuts.
•  Foods such as meat that are high in protein can inhibit sleep by blocking the synthesis of serotonin, making us feel more alert.
•  Monosodium glutamate (MSG), often found in Chinese food. This causes a stimulant reaction in some people.
•  
•  Avoid cigarettes and tobacco. While smoking may seem to have a calming effect, nicotine is actually a neurostimulant and can cause sleep problems.
•  Alcohol and caffeine are two beverages/food that you must avoid for a healthy sleep.
•  Avoid caffeine in all forms (tea, coffee, cola, chocolate).

Even small amounts of caffeine such as those found in decaffeinated coffee or chocolate, may be enough to cause insomnia.
Alcohol produces a number of sleep-impairing effects. In addition to causing the release of adrenaline, alcohol impairs
the transport of tryptophan into the brain, and, because the brain is dependent upon tryptophan as the source for serotonin
(an important neurotransmitter that initiates sleep), alcohol disrupts serotonin levels.

Herbal Medicine:

Insomnia can be naturally relieved with herbal teas, infusions and baths. 
Herbs are prescribed not only to treat symptoms such as insomnia but aim to correct the imbalances within the body
that cause those symptoms. For example, sedative herbs such as hops and valerian are used to relax the nervous system
to that you enjoy natural, restorative sleep. Each herb contains a variety of active constituents and has a main action and
several subsidiary actions which determine the conditions for which it is most appropriate.
Numerous plants have sedative action.
Plants commonly prescribed as aids in promoting sleep include: passionflower (Passiflora incarnata), hops (Humulus lupulus), valerian (Valeriana officinalis), skullcap (Scutellaria lateriflora), and chamomile (Matricaria chamomilla).

Homeopathy

Homeopathic remedies are not generally prescribe to treat symptoms individually, as the symptoms are considered to be
only the outward sign that the vital force is struggling to overcome disease.
Instead a remedy is prescribed for the whole person. Accurate prescribing is essential to the success of homeopathy.


Hydrotherapy

Taking a bath before going to bed is much more relaxing than a shower.
The warm water raises body temperature that helps to sleep. Keep the water temperature slightly warmer than the body temperature. Do not make it too hot as this can make you feeling weak and sweaty. It can also dilate blood vessels,
putting a strain on the heart. Don't stay in a hot bath more than about 15 minutes to minimize the risk of becoming overheated. 
A few drops of essential oils into the bath water may add soothing and relaxing properties.

Because the temperature drop after a bath occurs more quickly than after exercise, the bath should be taken about
two hours before bedtime (baths taken too close to bedtime can make it harder to fall asleep because
body temperature may be too elevated).

A hot bath is a great way to relax before bedtime.


Traditional Chinese Medicine (TCM)

Views almost all sleep disorders as stemming from either a deficiency in qi or from a surplus of qi in body organs,
mainly the kidneys and heart.

Acupuncture:

Acupuncture is particularly effective in treating insomnia.
Many people report immediate improvements in their sleeping habits.
With acupuncture, the sensation of sleep comes easily, lasts without interruption, and is deeper and more refreshing.