Chronic Insomnia: Causes and Methods of Treatment. Sleep Hygiene

A person spends one-third of their life sleeping. Sleep regulates the regenerative functions of the body. It is necessary to rest mentally and physically in order to gain strength and to rework the information of the past day. Sleep contributes to recovery when a person is sick and soothingly affects the nervous system. Therefore, the need for sleep increases after physical work, sports, an illness, during pregnancy, stress or increased mental activity. People often take sleep for granted – until they begin to feel lack of it. Even a single night’s sleep lasting no more than 4-6 hours can affect the ability to think clearly the next day. And if insomnia lasts for two or three nights, then after a few weeks or months, serious problems appear. As a result, it can turn into chronic insomnia.

What Is Insomnia?

Insomnia (also known as sleeplessness) is a sleep disorder characterized by insufficient duration or unsatisfactory quality of sleep, or a combination of these phenomena for a considerable period of time. In general, insomnia is a sleep disorder where people have trouble sleeping. In this case, the absolute duration (the number of hours) of sleep is not critical, since in different people the normal, sufficient duration of sleep can be very different.

Insomnia occurs against the background of excessive activity of brain processes. The diagnosis of insomnia is made if a patient does not get enough sleep three times a week. But episodic insomnia usually passes by itself. And chronic insomnia appears when a person fixes on a sleep disturbance. This is called a syndrome of “waiting for insomnia”. Even strong sleeping pills cannot cope with it.

Test Yourself

One person is enough to get quite a bit of sleep to wake up relaxed, cheerful, and active. The other one needs 9-10 hours.

But physiologically any organism needs at least 5-6 hours of sleep. And the rest is the personal need of the individual.

Common signs necessary for the diagnosis of “insomnia” are:

• problematic falling asleep;
• sleep disorders are noted at least 3 times a week for a month;
• severe ailment or inability to perform the professional duties due to the lack of sleep.

If sleep disturbances do not pass within 3 months, there is a need to go to the doctor. This means that the body cannot cope with the problem on its own.

Causes

Some people think that they can easily deal with insomnia on their own. But it is not always so. Since the causes of insomnia can be very different, it is necessary to consult a somnologist, a neurologist or a psychotherapist for its adequate treatment.

In terms of duration, insomnia is classified into transient (duration is not more than a week), acute (duration from 1 to 4 weeks), and chronic.

The causes of transient insomnia are the following:

• emotional experiences, acute stress, anxious thoughts, preventing sleep;
• information overload;
• changes in life;
• change of time zones;
• violation of sleep regime.

Transient insomnia may appear against the background of acute physical illness (allergy, rhinitis, sinusitis). Since this form has a short-term character, it does not pose a health hazard and most often does not even require treatment. As a rule, such sleep disorders pass on their own after the cessation of the negative factors.

Causes of Acute Insomnia:

• continuing stress;
• psychological problems, the development of a conditioned reflex (“going to sleep – there will be insomnia”);
• chronic physical illness and pain syndromes;
• constant violations of sleep regime and wakefulness.

The consequences of this form of insomnia are more significant for human health. If you have used some remedy for insomnia but the treatment was unsuccessful you need to contact a specialist to determine the causes of the disorder.

Causes of Chronic Insomnia

Insomnia is called chronic when it lasts for more than a month and its symptoms are noted more than 3 times a week. With such insomnia, disturbances during night sleep are observed and daytime symptoms are quite pronounced: performance decrement, failure of attention, irritability, fatigue, daytime drowsiness, and headache.

It leads to:

• chronic mental diseases (depression, posttraumatic disorder, schizophrenia) and somatic diseases (emphysema, bronchial asthma, hypothyroidism, essential hypertension);
• serious sleep disorders: restless legs syndrome, obstructive sleep apnea, sleep apnea syndrome);
• abuse of alcohol and psychotropic substances (amphetamine, ephedrine, cocaine).

Sleep disorders can be caused by various reasons. For example, by the means that affect mental activity. These include stimulants of the central nervous system, antidepressants, sedatives. The stimulating effect of nicotine can also disturb sleep. A particularly adverse effect on sleep is caused by the abuse of sleeping pills. Most sleeping pills retain their curative effect if the period of their use does not exceed two weeks but they are often taken for months and even years. With the constant intake of these drugs, there develops an addiction. It means that you gradually increase the dose of sleeping pills to an extent that breaks the structure of sleep. As a result, this leads to an even worse sleep disorder.

Other Causes

Sleep disorders can also be caused by somatic diseases, for example, respiratory disease or gastrointestinal tract disorders. Mental illness is often accompanied by a bad sleep. For example, depressive states are characterized by early and night waking and a large number of dreams per night.

Another reason for the appearance of chronic insomnia is the forced violation of the sleep regime by the person themselves, for example, after experienced troubles, an unfavorable situation, night work, with constant nighttime entertainments, etc.

The reason for the violation of sleep can be any psychological problem, for example, problems in personal life, financial problems, troubles at work and many others. It is clear that the brain is always trying to solve the problem. Thus it can lead to insomnia. In this case, a good solution is to consult a psychoanalyst.

Chronic mental fatigue can also be the cause of insomnia. Signs of exhaustion are a constant desire to sleep during the day, fatigue and weakness, even after little activity.

Causes may even be minor: abundant meal before bed, consuming caffeinated beverages, alcoholic beverages, smoking, an uncomfortable bed and furnishings, bright light, noise, irritating sound or smell.

Chronic Insomnia Is the Body’s Signal of the Presence of a Mental or Physical Problem

Since various serious diseases can cause this type of insomnia, in this case, self-medication is unacceptable. Therapy should be performed by a specialist.

If sleep disturbances torture you more than one month, you can talk about chronic insomnia. In this case, other sleep problems may arise: somnambulism, twitching of the limbs, teeth-grinding, violation of the rhythm of the heart as well as feelings of anxiety and depression during the day.

The consequences of chronic insomnia are fatigue and mood disturbance, difficulties in work, communication, relationships, a decline in the quality of life, and much more.

Causes of Insomnia in Men and Women

Women are more likely to suffer from insomnia than men. First of all, this is due to the fact that they react more emotionally to everyday troubles, are more often irritated and nervous. The second reason is physiological: monthly changes in the endocrine system before menstruation, hormonal imbalance during pregnancy and menopause.

Insomnia in men often appears against the background of diseases of internal organs and the prostate gland. With adenoma, there is frequent urge to urinate at night which makes a full sleep impossible. Also, men are prone to drinking alcohol, with regular consumption of which night sleep can become restless and intermittent. Excessive enthusiasm for sports and power exercise late at night will also cause sleep disturbances. Nicotine is a stimulant, therefore smoking men need more time to fall asleep.

Insomnia in Old Age

The older the person by age is, the less is their need for sleep. It can be reduced by several hours without significantly affecting the health. A third of those over the age of 65 have serious sleep disorders.

What is the reason for the appearance of insomnia in old age? This is due to chronic diseases, taking medications (beta-blockers, diuretics, antidepressants, and others). The quality of sleep is affected by disorders of cerebral circulation, prostate disease, and cardiovascular diseases. One of the causes of insomnia in the elderly is the night restlessness of the legs and sleep apnea. Diagnostics and treatment of insomnia in the elderly have their own features, so there is a need to consult a somnologist.

Insomnia in Adolescents

In adolescence, various sleep disorders are noted more often than in small children. It’s worth noting the following causes of insomnia in adolescents:

• violation of sleep;
• psychological disorders;
• hormonal restructuring;
• experiencing stress due to the problems with peers, parents, and teachers;
• information overload (long work at the computer);
• excessive fatigue (a big load in school with little physical activity).

In adolescence, it is also necessary to exclude the presence of somatic diseases and possible mental disorders. In this case, only a doctor can help.

Chronic Insomnia Symptoms

What are the symptoms, besides the absence of sleep itself, that indicate the existence of insomnia? In general, it is quite simple to define them.

Sleep disorders, according to doctors, are a very common form of neurosis. Such a pathology always affects the general state of a person, violating their emotional balance, affecting their physical health, the energy of a person, and thus their working capacity.

The longer the sleep disturbances are, the more they affect the person’s health. So, chronic insomnia can cause much greater problems than, for example, a short-term loss of sound sleep.

What can be considered signs of insomnia?

• difficulties falling asleep;
• constant awakening of a person before the planned time;
• need for sleeping pills or alcohol;
• weakness, fatigue in the daytime, constant craving for sleep;
• absent-mindedness of a person associated with the lack of sleep;
• frequent unreasonable awakenings at night.

From all of the above, we can conclude that insomnia is usually a condition in which there is no full rest for a person. Accumulated fatigue will cause irritability.

Treatment for Chronic Insomnia

If acute insomnia is treated quite simply: that is, when the provoking factors stop, insomnia also gradually passes, – then chronic insomnia, lasting longer than three months, cannot be cured immediately. What to do in this case? For the treatment of chronic insomnia, medicamental and non-drug methods are used.

In 1999, the US Medical Academy of Sleep published experimentally confirmed methods of non-drug treatment of chronic insomnia. These included stimulus-control therapy, sequential muscle relaxation, cognitive behavioral therapy, sleep hygiene education, and so on.

Sleep Hygiene and Non-Pharmacological Techniques

The simplest techniques that promote sleep are called sleep hygiene. These are the rules that form the conditioned reflex to falling asleep. Among them, we can mention the following.

Sleep Hygiene Rules

• For those who suffer from chronic insomnia, it is not recommended to nap during the day.
• Also during the day, some physical activity with the help of which you can accumulate fatigue by the evening will be useful.
• You need to stop physical activity 2-4 hours before bedtime.
• Do not drink and eat before going to sleep. You can drink a glass of warm milk before bed.
• You shouldn’t drink alcohol and smoke before going to sleep.
• It is better not to take a cold or excessively hot bath or shower 2 hours before bedtime.
• Stop active mental activity one hour before sleep.
• Use meditative practices to relax and relieve anxiety before bed.
• It is necessary to go to bed only when drowsiness is felt. It is better to wake up the same time every day.
• There should be no distractions in the bedroom: loud sounds, bright light.
• What to do if you don’t fall asleep within 15 minutes? Get up and do a quiet activity for half an hour, then try to fall asleep.

All described above methods are rather difficult to apply because they require discipline and adherence to treatment. The use of diaries of sleep or the filling in of special questionnaires which include questions not only about the time of falling asleep, the time of waking up, the number of awakenings per night and their duration but also the questions about the periods of physical activity, the intake of medications, the time of ingestion of food and alcohol have become very effective for motivating patients .

Relaxation techniques are also effective (conscious thinking, imaginative thinking, meditation, concentration training). Their goal is not to reduce the time of falling asleep but to remove general anxiety before falling asleep.

Cognitive Therapy

Cognitive therapy is aimed at changing the patient’s destructive beliefs about sleep which are the main supporting factor of chronic insomnia. The tools of the method are the formation of correct judgments about sleep by the patient himself. The main tasks of cognitive therapy are:

• formation of correct ideas about a person’s need for sleep;
• refusal to aspire to fall asleep, so as not to cause excessive activation;
• denial to give a central importance to sleep;
• refusal to pay too much attention to consequences of insomnia.

If cognitive-behavioral therapy does not bring the desired result, then drug treatment is necessary. Cognitive behavioral therapy should not be carried out simultaneously with the use of sleeping pills since such a combined method worsens its benefits and effectiveness in the long term. There is an opinion that this is because insomniac patients are much worse at mastering the methods of cognitive therapy when they have the support of medications.

Medication Therapy

Medicinal treatment for those suffering from chronic insomnia is not as effective as short-term treatment and has its own characteristics. In clinical practice there is a dictate of 5 principles of pharmacotherapy of chronic insomnia:

 Use of the lowest effective doses.

 The use of intermittent doses.

 Medications are prescribed for short-term intake.

 Gradual withdrawal of the drug.

 Elimination of the effect of insomnia after withdrawal.

All existing groups of drugs have their advantages and disadvantages. An ideal means for treating chronic insomnia does not exist. The choice of the agent depends on the cause of the pathology of sleep and on the characteristics of the pharmacodynamics of the medication as well as on the individual reaction to it of the patient.

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