What is an insomnia?

Sleep is the basic necessity of life to get the boost of energy back in your tired nerves and brain after a full day of heavy work burden and exercise. Whether you work as a laborer, a teacher, a doctor, a farmer, a child caretaker, or as a housewife, irrespective of your gender and age, irrespective of your working environment or even staying at home doing nothing, you need a proper sleeping time and hours that are required by a daily day and night cycle of living beings. Any disturbance in the sleeping habits or sleeping patterns or no sleep at all, all falls under the same flag that is insomnia.

Insomnia is a type of sleep disorder in which individuals suffer from difficulties falling asleep or staying asleep or both. Such patients with sleep disorders are unable to keep themselves fresh due to decreased sleep and whenever they wake up they feel tired and sleepy. These symptoms sometimes lead to other complications as fatigue, headache, vertigo, fever, etc.

About one-third of all adults report insomnia symptoms although they neither take any medication for it considering it as an age factor nor try to overcome it by changing their lifestyles. Between six to ten percent of all adults have symptoms that can be considered enough or diagnose sleep disorder or insomnia for them. Clinical diagnosis is done by the doctor if they fall under certain criteria. The criteria may refer to symptoms as:

  • Sleep difficulties: If the patient feels difficulty in sleeping for more than at least three nights a week for a minimum of three months.
  • Distress creating sleep disorder: Major stress or any other functional difficulties in one’s life creates sleep difficulties.

Types of insomnia

Insomnia is a sleep disorder that has certain types and kinds depending upon the duration, intensity of disturbance, causes of disturbance, and underlying reasons. These types may be treated according to the reason and base, but must be diagnosed by your physician before starting any DIY or medical treatment.

Acute or short-term insomnia:

We all sleep daily and many times a day, some people sleep only once at night, some people sleep in the day time too in the evening for an evening nap, others may choose to sleep late at night and get up late in the morning. Whatever the pattern one follows, it becomes the biological cycle for them. Whenever any disturbance occurs in that routine of sleep and awake pattern, a disturbing phase of sleep pattern occurs called acute insomnia. Usually, it lasts for a month and is commonly known as adjustment insomnia. It occurs due to occasional stress as a new job, deadline, or exams.

Transient insomnia:

Transient insomnia lasts for less than a week. The reason behind this are another disorder, changes in sleep disorder, stress or depression.

Chronic or long term insomnia:

If the sleep patterns get disturbed for a long period of time, sometimes more than three months, sometimes more than six months, then it is called chronic or long-term insomnia. Chronic insomnia may be further subdivided into two categories:

Primary chronic insomnia: Any sleep pattern that prolongs for more than three months but it has no underlying disease or reason behind it, it is called primary chronic insomnia. This sleep pattern is diagnosed and studied by MRI scans. Primary insomnia may be related to certain changes in levels of certain brain chemicals but still, it needs a lot of research to confirm the details.

Secondary chronic insomnia: Asleep pattern that has some underlying disease or some base of origin that bears the outcome as chronic insomnia is called secondary chronic insomnia. This problem goes in association with some medical issues as emotional stress, any physical or mental trauma, any stressful past event, any ongoing health problems as diabetes or sleep apnea, certain lifestyle patterns, certain types of drugs and medications creating drug abuse, etc.

Causes of insomnia:

A number of causes and reasons can be attributed to the occurrence and persistence of insomnia in elderly or young patients, either males or females. The causes of insomnia may also vary according to the sleeplessness patterns and types you experience. The possible causes of insomnia may be:

Causes of acute insomnia:

The number of reasons for acute insomnia or short-term insomnia may be:

Stress: Daily-based working tension or routine stress of everyday life creates an imbalance of all the neurotransmitters of the brain and causes disturbance of sleep patterns as insomnia.

A traumatic event: Any upsetting or traumatic event of life that may have impacted your life in a major drastic way may lead to long-term thinking and sleepless nights for a long time. The disturbance in the pattern of sleep for long may lead to insomnia.

Change of sleeping habits: You travel to a certain area and change the sleeping habit as in a hotel room or in an unknown place as of some relative\’s house, then your body and mind take a long time to adjust to that place. Meanwhile, sleeplessness for long leads to insomnia.

Physical pain: A person cannot sleep if one has any physical pain or physical trauma creates a disturbance in the whole body and causes distress mentally as well as physically. Mental disturbance leads to distorted sleep patterns creating tension and slowly it becomes impossible to go back to normal sleeping patterns.

Malnourishment: Poor eating habits may cause weak digestion and weakened metabolism of the whole body creating imbalance leading to disturbed sleeping patterns. The weak nourished body and mind lead to decreased sleep and insomnia.

Periodical hormonal imbalance: Menstrual cycle causes a hormonal imbalance on a monthly basis which may create an abnormal sleep sequence. Some women suffer from insomnia before periods and some suffer from extra sleeping hours to cover the weakness of the body. If the sleeping pattern distortion occurs at every cycle, then it leads to insomnia.

Jet lag: The body\’s circadian rhythm is a biological cycle that follows a normal pattern of day and night at a certain place. Whenever you change your destination or physically move from a certain continent to another that is far from the original place you used to live, your body needs to take a certain time period to adjust according to the pattern of the new place. Often it creates disturbed sleep patterns leading to insomnia.

Certain medications: Certain types of antibiotics and other medicines create sleeplessness that may be short-term and finish on its own after leaving the medicine. Occasionally it may continue for sometime after finishing the medicines.

Birth Control Pills: An abnormal change in the physiology of the body occurs by using birth control pills. These pills always give unpredictable side effects to each person. Sometimes long-term use of these pills creates sleeping patterns out of order indicating the occurrence of insomnia.

Pregnancy: During pregnancy, the sleeping patterns change and the women suffer a lot due to the gastric condition caused by the baby\’s weight and hormonal changes that don\’t allow the mother to sleep. The sleeping patterns may change in any trimester and may continue up to the last day of pregnancy and may waive off after delivery.

Causes of chronic insomnia:

Chronic insomnia may last for three to six months and may be primary or secondary. Primary insomnia may be of no origin and it may be called idiopathic too. Secondary insomnia may occur due to certain underlying conditions or may be associated with certain other symptoms. The number of reasons for chronic insomnia or long-term insomnia may be:

Physical conditions that may cause chronic insomnia:

Chronic insomnia may be caused due to a number of underlying physical conditions of the person including:

Arthritis or other aches: Backache, arthritis or inflammation of joints, or other medical conditions which may create a disturbance of sleep patterns as insomnia.

Physiological issues: Certain physiological issues as anxiety, stress, or other mental disorders due to social issues or any domestic issues lead to chronic insomnia or long-term sleeplessness.

Drug abuse: A health condition called substance use disorder is also known as drug abuse. With certain prescription or non-prescription drugs, substance use interferes with the person\’s ability to function normally on daily basis.

Sleep apnea: A physical condition in which your breathing patterns and beats feel a pause when you are asleep. Sleep apnea causes you to suddenly wake up during sleep to resume your breathing and these multiple sleep interruptions cause you to awake again and again and may lead to chronic insomnia.

Diabetes: Diabetes either juvenile or old age, either D. Mellitus or D. insipidus, may lead to sleeping patterns disturbance due to lack of insulin in the body. The disturbed hormonal balance in the body creates sleep pattern disturbances.

Change of sleeping habits: You travel to a certain area and change the sleeping habit as in a hotel room or in an unknown place as of some relative\’s house, then your body and mind take a long time to adjust to that place. Meanwhile, sleeplessness for long leads to insomnia.

Asthma: A respiratory disease that manifests itself with difficult breathing with a number of other symptoms as coughing, tightness in the chest, shortness of breath, anxiousness, panic, fatigue, etc. which all create hindrance to the sleeping routine. Asthma may be chronic or acute caused by dust, pollens, or any other mold, etc. whatever the situation, it creates breathing difficulties and once the breathing pattern is disturbed during sleep, then long-term insomnia prevails which needs to be treated.

Chronic obstructive pulmonary disease: A group of progressive lung diseases is known as chronic obstructive pulmonary disease. It includes emphysema and chronic bronchitis. Shortness of breath, needing to clear your throat more times, mild but recurrent cough are all the symptoms of chronic obstructive pulmonary disease that causes interrupted sleep and ultimately developing insomnia which may continue for long becoming chronic insomnia.

Congestive heart failure: A chronic progressive condition of the heart that reduces or enhances the pumping power of your heart muscle. Fluid builds up within the heart and causes it to pump inefficiently. Fatigue, irregular heartbeat, chest pain, rapid breathing, wheezing, weight gain, shortness of breath, increased need to urinate are all the symptoms of congestive heart failure that create disturbed sleep patterns ultimately leading to insomnia.

Acid reflux: A fairly common condition that occurs due to the back travel of stomach acids and stomach contents into the esophagus through the lower esophageal sphincter. Heartburn, sour taste, regurgitation, dyspepsia, difficult swallowing, sore throat, dry cough are the symptoms of acid reflux that creates disturbed sleeping patterns leading to insomnia.

Hyperthyroidism: A disease of the thyroid gland creating abnormal levels of thyroid hormone that exhibits symptoms like nervousness, restlessness, fatigue, increased appetite, irregular heartbeat, itching, hair loss nausea, vomit, dizziness, shortness of breath, loss of consciousness, etc. are the symptoms of hyperthyroidism that creates interrupted sleep patterns and insomnia if the pattern continues.

Fibromyalgia: Pain of the muscles causing dull aches all over the body creating symptoms like fatigue, trouble sleeping, headaches, depression all the symptoms that create troubled sleeping patterns creating insomnia.

Restless leg syndrome: A neurological disorder causing an unpleasant sensation in the leg causing the powerful urge to move the leg. It interferes with sleep causing daytime sleep and fatigue. Emotional and physical health destruction creates sleep deprivation and disturbed patterns of sleep causing chronic insomnia.

Menopause: Absence of menstruation consecutively for twelve months in women of age fifty plus is a medical condition that is called menopause. Weight gain, depression, sleeplessness, and irregular sleep patterns are the outcome of menopause that may prolong to cause chronic insomnia.

Urinary incontinence: Losing control over your urine by weakness in the bladder either urging you to urinate suddenly or frequently urinating without drinking a lot of water creates disturbed sleep patterns leading to long-term insomnia.

Bipolar disorder: Alternating symptoms of depression and mania creating suicidal thoughts, attempts to kill yourself, sadness, extremeness in every aspect of thinking and acting are all the symptoms that cause sleeplessness for many months. Continuously disturbed sleep creates insomnia.

Alzheimer’s disease: A progressive form of a disease known as Alzheimer\’s disease is a mental disorder creating dementia, loss of memory, disturbed sleep, loss of sleep, sleep patterns irregularity causing long-term insomnia.

Parkinson’s disease: A progressively degenerative disease causing disrupted or abnormal muscle movement, difficult visual-spatial relationship, psychosis, hallucinations, anxiety, etc that cause sleeplessness and insomnia.

Medications and stimulants that may cause chronic insomnia:

Certain medications and stimulants that are used for a number of medical reasons may become the underlying cause of chronic or long-term insomnia. These medications include alcohol, anti-depressants, beta-blockers, caffeine, chemotherapy drugs, cold and allergy medications, diuretics, illicit drugs as cocaine, nicotine, and stimulant laxative drugs.

Lifestyle patterns that may cause chronic insomnia:

A lot of diseases are considered lifestyle diseases due to changes in a life pattern that may affect the outcome of the diseases. Insomnia is one of the diseases that is also affected by lifestyle changes. These changes may include rotating shift work, frequent travel across multiple time zones, physical inactivity, frequent daytime napping, lack of routine for waking and sleeping and poor sleeping environment, etc.

Symptoms of chronic insomnia:

Insomnia either chronic or acute may be manifested by a number of signs and symptoms which need to be diagnosed properly by the doctor before prescribing any medication. The most common signs and symptoms of chronic insomnia are:

  • Trouble falling asleep: If you feel uncomfortable at the bed while you go to sleep and you change your sides to let sleep come. But after a certain time lapse, you fall asleep.
  • Waking up throughout the night: The sleep pattern disturbance makes you awake longer and sleeps less while waking up throughout the night means you are suffering from severe insomnia and you awake the whole night trying to fall asleep but remain unsuccessful to achieve the target.
  • Trouble staying asleep or trouble returning to sleep: Sometimes you fall asleep and wake up. After waking up it becomes impossible to get sleep again under this condition.
  • Waking up too early: You fall asleep daily trying to stay asleep for the whole night to fulfill your sleep demands but automatically you get up too early in the morning without any reason, unable to sleep again.
  • Grogginess or daytime sleepiness: You awake the whole night due to sleeplessness and remain sleepy throughout the day, feeling uneasiness, vertigo, and sleepy.
  • Not feeling rested after a night’s sleep: You sleep the whole night but still feel uneasy and sleepy although there was no sleeplessness or trouble falling asleep.
  • Irritability: You remain irritated even you fall asleep but due to uneasy sleep you remain irritated.
  • Mood changes as depression: You feel depressed and suffer from mood ups and downs due to irritability although you fall asleep
  • Difficulty concentrating: You sleep but after you get up you don\’t feel easy and feel it difficult to concentrate or focus on anything.
  • Problems in memory: You sleep well but after getting up you still feel that you need more sleep and you feel a problem memorizing anything.
  • Increase in making mistakes and accidents: You make a lot of mistakes and sometimes face accidents due to uneasiness created by disturbed sleep.

Treatment strategies for insomnia:

Insomnia either chronic or acute needs treatment, either DIY strategy or over-the-counter medications or prescribed medications depending upon the intensity, duration, reason behind, and many other basics.

Prescription medicines available for insomnia:

A visit to the doctor before taking any drug might help you to diagnose proper sleep pattern disturbance and all the associated symptoms to prescribe proper drugs that can help to combat the side effects of insomnia. These drugs include zolpidem, eszopiclone, zaleplon, doxepin, ramelteon, suvorexant and temazepam, etc. which help to alleviate and ultimately finish the symptoms of chronic insomnia.

Over-the-counter medicines for insomnia:

Insomnia causes severe uneasiness for which a number of over-the-counter drugs and sleeping aids are available for treating the outcomes of insomnia. These include diphenhydramine, doxylamine succinate, melatonin, valerian root, and chamomile tea, etc.

DIY Treatment Strategies and Essential Oils for insomnia:

A lot of people experience short-term insomnia and sometimes these symptoms prolong to become chronic and are converted into long-term insomnia. The sleep disorder makes it difficult to fall asleep and to stay asleep until it\’s time to wake up. Most adults need seven to eight hours of sleeping time a night although the amount of sleep varies from person to person. If your sleeping patterns and modes affect the quality of life, then certain home remedies may help you to cover the symptoms. A number of essential oils as roman chamomile, cedarwood oil, sandalwood oil, lavender oil, neroli oil, and bitter orange, etc are used to improve sleep modes and patterns and to cover the symptoms of insomnia.

Similarly, a number of exercise models and meditation techniques are used to help you better understand your sleep styles and ways to adapt to healthy sleep patterns. These include:

  • Mindfulness meditation: Slow and steady breathing while sitting quietly is mindful meditation. You should observe your breath, body, thoughts, feelings, and sensations as they arise and pass through your body. A healthy lifestyle and mindful meditation have numerous health benefits that go hand in hand with promoting good sleep. It reduces stress, improves concentration, and boosts the body\’s immunity. Mindful meditation can be done as often as you can. If you are short of time then you can aim to do almost fifteen minutes in the morning and the same time in the evening. It\’s safe to practice meditation but it has the potential to bring up strong emotions. The practice should be discontinued if you feel angst or turmoil or further emotional feelings.
  • Mantra repetition: To make your mind positive and calm, a mantra may be repeated or positive affirmation may be repeatedly done. Mantras cause a relaxed and healthy mind by quieting the mind. A mantra may be chosen in any language like English, Sanskrit, Chinese, Hindi, or any other native language that please and calm you. The mantra should be simple, a positive and enthusiastic statement in the present tense. A good and deedful mantra allows you to focus on the sound repetition, which enables you to relax and go to sleep. The mantra or soothing words should be chanted aloud or mentally, but you should focus on your words. You can play music with chanting to attract the beauty of music to your heart.  You must feel free to recite your mantra as often as you like. You may choose different mantras for daytime and nighttime. If by any means you feel that mantra is agitating your feelings or causing stress, then stop it immediately.
  • Yoga exercise: A very effective treatment for insomnia to improve the quality of sleep is yoga. Slow and controlled movements of body parts allow you to stay focused and stay present. Yoga relieves stress, improves physical functioning, and boosts mental focus. Restorative yoga and yin are great options. At least twenty minutes of daily self-practice and few longer sessions each week must be done to see the best results. If you perform the posture before bed helps you to relax and unwind. If a pose doesn’t feel right for you then do not do it by force lest it may cause injury.
  • Exercise: Overall health is boosted with the help of exercise. It can enhance your mood, gives you more energy, makes your shape better by reducing weight, it promotes the best sleep patterns by making healthy sleep healthy life. Moderate exercise for at least twenty minutes per day gives a lot of benefits. Some vigorous aerobic exercise a few times per week gives some strength training. Taking into account your body condition and accessing similar pattern exercise boosts your health and sleep.
  • Massage: A great therapy to benefit insomnia conditions by improving its qualities and daytime dysfunction is massage therapy. It may reduce anxiety, pain, and depression by improving the flow of blood in the body. Self-massage in addition to a professional massage or the unavailability of the latter allows a great improvement of your body\’s health, general sleep awake behaviors, and overall sleep patterns. Head massage, as well as body massage, are the best options to improve sleep conditions. A skin patch test must be done for your skin if your skin is sensitive to certain oils, creams, or lotions.
  • Magnesium: Magnesium is a naturally occurring mineral that helps muscles to relax and relieve the body\’s stress. It encourages healthy sleep patterns. Almost five hundred milligrams of magnesium daily for two months improve sleep patterns and helps to cover insomnia. Men may take four hundred milligrams daily, while women may take three hundred milligrams daily depending upon the nutritious needs and weight of the body. Doses may be divided between morning and evening or maybe taken before bed. A cup of magnesium flakes can be added to your evening bath allowing absorption of magnesium from your skin motivating sleep patterns and covering insomnia symptoms to a great extent. Taking magnesium with food greatly reduces abdominal discomfort and the magnesium supplements should not be taken constantly. You must take a break for few days after every two weeks.
  • Lavender oil: Lavender oil is used to reduce pain, improve mood, improve sleep and improve the overall health of the body. The oil has proven to be a great anti-depressant too since it reduces anxiety and promotes better sleep. almost twenty to eighty milligrams of lavender can be taken orally. The oil can be added to a diffuser or a spray and may be applied under a pillow to improve sleep after lying down. Lavender tea is a great food item to improve sleep. The lavender is very safe to use since it is natural essential oil.
  • Melatonin: Melatonin helps to make you fall asleep quickly and enhances the quality of sleep by making it deep and stress-free. Almost one to five milligrams of melatonin taken thirty minutes to two hours before sleep improves insomnia. Higher doses must be avoided to be safe from any side effects of headache or depression.

Cognitive-behavioral therapy option for insomnia:

A number of research publications and work from scientists have confirmed cognitive behavioral therapy to be the more effective and healthy treatment to treat chronic insomnia rather than sleep medications. Behavioral therapy involves educating you on sleep, sleep advantages, sleep patterns rhythmicity, better sleep habits and also asks to change the beliefs and behaviors that interfere with your utmost ability to sleep. Some of the treatment strategies that help to improve the symptoms of insomnia in cognitive behavioral therapy also known as CBT-I include:

  • Cognitive technique: Before going to bed using journaling to write down worries or concerns may help you from actively attempting to work out while also trying to sleep.
  • Control of stimulus: The strategy entails altering behaviors that condition your mind to fight with sleep and sleep patterns. Setting a sleep and awake time and pattern and making it a part of the biological cycle is part of the above-mentioned strategy. Leaving your bedroom when unable to sleep to reduce the sleep phobia is also included in it.
  • Sleep restriction: The therapy involves limiting the time period you spend in bed including avoiding naps. The goal is to make you tired and sleepy before actually going to bed so that your body demands sleep to get energy back. Your bedtime gradually improves as your sleep improves.
  • Relaxation techniques: Yoga, breathing exercises, guided meditation, and many other such wonderful soothing techniques are used to reduce muscle tension and control your breathing and heart rate to make your body relax.
  • Paradoxical intention: The strategy involves focusing on staying awake in bed instead of expecting to fall asleep. It helps to cover anxiety and reduce worries over being able to fall asleep. It is one of the most effective ways to treat learned insomnia

Dos and Don’ts to reduce the symptoms of  insomnia:

A number of dos and don’ts must be considered for the improvement of symptoms of insomnia and must be followed to help improve your sleep quality and hours. These factors include:

  • Narcotics: Avoiding narcotics and chemicals that may disturb your sleep either by direct intake or through any food containing those chemicals like nicotine, caffeine, or alcohol.
  • Dietary influences: Must eat a heavy meal in the morning and a lighter meal in the evening to take gas-free and healthy sleep and eat at least two hours before going to bed to help the metabolism processes to free you from all burden before falling for sleep.
  • Healthy sleep: Must stay active to be healthy and get healthy sleep.
  • Hygienic: Must keep yourself hygienic and active, so must take a shower with hot water before going to bed to make your body light.
  • Static media: Avoid all static media and screens two hours before going to bed.
  • Dark bedroom: Keep your bedroom dark and cool to make a healthy sleep.
  • Proper timings: If you are tired, must not wait for the proper time and go to bed right away to fall asleep.
  • Move around: If you are unable to fall asleep within twenty minutes of lying down then come out and perform some yoga or exercise to help you get to sleep.

Pregnancy and insomnia:

Insomnia is a common problem that affects pregnant ladies, especially in the first and third trimester a lot. Fluctuating levels of all hormones in the body, additional symptoms of nausea, an increased need to urinate due to increased weight of uterus and baby within the expecting mom, a gastric condition due to indigestion created by additional life running in the body are all the governing symptoms of expecting mom that make her awake during pregnancy. All the three trimesters are different and unique from each other in these aspects and thus create a different type of anxiety and; levels of sleeplessness in moms.

Pains as cramps, back discomfort, baby’s body adjusting in your own self, certain emotional tresses to deal with the day to day activities while being pregnant as well as thinking of future responsibilities make you stressed and thus create anxiety that reduces sleep time and sleep patterns are greatly disturbed leading to insomnia. Active metabolism, increased progesterone, accommodating the new life inside are all the reasons for insomnia.

Lifestyle changes to help you improve the symptoms of insomnia in pregnancy are:

  • Stay active during pregnancy
  • Maintain a healthy and balanced diet.
  • Keep yourself well hydrated.
  • Maintain a constant sleep schedule.
  • Practice relaxation techniques during the day or take a warm bath before bedtime.

Lifestyle factors increasing the risk for insomnia:

Disturbance of sleep affects a lot many people for several background reasons sometimes known and sometimes unknown. Whatever the situation may be, the risk factors that may make you prone to be a prey of insomnia must be avoided in order to be safe from this long-term issue. Many of these underlying issues are mostly related to your lifestyle changes, habits, eating and drinking styles, the general atmosphere of your home, etc. These circumstances include:

  • An irregular sleep schedule: If you don\’t have a proper schedule for your day-to-day work then how to maintain a healthy well-balanced sleep.
  • Sleeping during the day: Sleeping during the day delays your need for sleep early at night. The time of proper sleep passes awaken and then you feel unable to sleep at all.
  • A nighttime job: If you have a job that has to be done at night and you have to sleep in the daytime to cover your sleep, then it leaves a permanent impact on your sleeping time and capacity as well as creating insomnia.
  • Lack of exercise: Sitting continuously, eating, drinking, and remaining idle doesn\’t make your muscles move and doesn\’t make you tired so light exercise must be a part of your day-to-day routine to keep you healthy and alert.
  • Using electronic devices: The use of gadgets as laptops, tablets, cell phones, or any such device at bedtime takes your sleep away and the patterns of sleep are changed.
  • Too much noisy sleep environment: If the dark/light combination and environment of your sleeping place are not that healthy or soothing as if it is too noisy or too much enlightened then it may cause disturbed sleep patterns and ultimately insomnia.
  • Recent mental torture as the death of someone: If someone dearly has passed away recently, then whenever you try to sleep, you get back the memories that don\’t allow you to sleep.
  • Job loss trauma or burden for the source of income: If you have any job loss or trauma for the source of income then the memory or worries may take away your sleep causing insomnia.
  • Excitement for an upcoming event: If you are excited for any upcoming event as some public ceremony or any other lime-lighted news, then your sleep runs away quite long before that.
  • Recent travel between different time zones: If you have traveled to an area where your time zone has changed and you are facing a time difference of twelve to eighteen hours, then you will have disturbed sleeping patterns and ultimately insomnia.

Insomnia and seniors:

A common sleep disorder that is characterized by a persistent difficulty of sleeping, difficulty falling asleep, or difficulty retaining sleep is known as insomnia. Such people who face symptoms of insomnia at night also have extreme daytime sleepiness and other cognitive impairments while they are awake and these impairments can be referred to the sleep loss aftereffects. People age sixty and older are more susceptible to insomnia and a number of life factors contribute towards this effect.

Senior citizens at any place of the world are more prone to be attacked by all kind of challenging situations and conditions as medical and psychiatric conditions can attack them far more than youngsters, other sleep disorders as sleep-disordered breathing or restless leg syndrome are all the syndromes that attack the seniors more than the juniors. Age is a limiting factor that changes the circadian cycle as well as our biological cycle and all these changes then affect our sleeping routine, pattern and habits. Certain medical prescriptions also alleviate symptoms of geriatric medical conditions and can cause sleep disturbances.

Sleep and aging:  As a human being, our body has to decay after a certain groomed time period when we grow enough to be healthy and happy. Like all other parameters of life as hunger, thirst, wish to roam, activeness, etc. our sleep also reduces with enhancing age. Initially, people fall asleep and then their sleep gets interrupted, they wake up, and then no more force on earth can bring back their sleep. That is the case with most of the old-age seniors. Sleep latency that is the time it takes to fall asleep also increases in advanced age. According to too psychological sleep awake pattern cycle studies, an average person starting from middle age loses twenty-seven minutes of sleep per night for each subsequent decade.

The internal changes within the body make these changes and the changes in the circadian cycle etc. are unable to be processed in the same way as they used to be previously. These all slow and progressively degenerative changes make old people go to bed and wake up at an early time.

The mechanism of the normal sleep cycle is divided into four stages. These stages include:

  1. The initial stage of light or non-rapid eye movement (NREM) sleep.
  2. The final stage of light or non-rapid eye movement (NREM) sleep.
  3. The initial stage of heavy or slow-wave non-rapid eye movement (NREM) sleep.
  4. Final stage of rapid eye movement (REM) sleep
  5. The cycle begins again from the first stage.

The polysomnographic studies are done to exhibit the functions of eye movements in old age people have shown that the elderly people experience a low percentage of both slow-wave NREM and REM sleep than their younger counterparts. This is the reason that old age people suffer more from insomnia and all its types and stages, as they fall asleep hardly and if by mistake they get up then it becomes quite difficult to resume sleep.

Diagnosis and recognition of insomnia in old age: While many citizens experience a dysrhythmic scenario in the circadian cycle and biological clock of their bodies with advanced age, still a proper diagnosis is mandatory for treatment of the symptoms. The notable symptoms are:

  • Difficulty falling or staying asleep
  • Waking up earlier than desired and repeatedly incidence of such happenings
  • Always reluctant to go to bed at sleeping time
  • Difficulty getting sleep without any intervention from a caregiver.

Daytime impairments as cognitive impairments, fatigue, and malaise throughout the day, mood disturbances and irritability, trouble concentrating, paying attention, and excessive daytime sleepiness are the inclusions associated with insomnia in seniors. People with chronic insomnia are at higher risk for accidents and irritability in social and family situations.

Insomnia rather primary or secondary but it needs proper diagnosis by the physician to prescribe or to go for any medication since all the underlying reasons and unknown hidden causes might be brought into attention by the physician during history examination of a patient that may throw a deep light on all the causes of persistent insomnia. Then it would become easy to diagnose the real causes, factors, lifestyle habits and the treatment mode would be easy to prescribe and be followed by the patient.

Treatment strategies of insomnia in old age: The very initial step to managing chronic insomnia in old age people is the focus on sleep education and improved sleep hygiene. The doctor consults the patient about creating a healthy cozy sleep environment with an optimum dark and quiet atmosphere with a temperature lower than seventy-five degrees Fahrenheit. The restrictive approach to use the bed only for sleeping rather than for playing video games or other such activities plays a positive role to provide a sleepy environment for elders.  The facilitated environment as the use of air conditioners in hot weather and heater in cold weather etc. are encouraged to make a healthy sleeping environment. Doctors promote the patients and their morale is raised high to induce daily exercise in their routine life with balanced meals and discourage the use of stimulants as tea, coffee, tobacco, etc. Non-pharmaceutical approach to enhance sleep tendencies without prescription medicines include:

Control of stimulus: The patient should visit the bed only for sleeping when they are tired. If the patient is unable to sleep even after twenty minutes of lying down, the bed must be left immediately and should make yourself busy until you become tired again. Daytime napping should be avoided to get disturbance-free sleep at night.

Sleep restriction: Sleep efficiency is the ratio between time asleep versus time awake in bed each night. The asleep diary is maintained by the patient to note down daily to keep a record of their awake and sleep ratio and time that makes it easier for the doctor to advise further based on that information.

Cognitive-behavioral therapy: The therapy helps to improve seniors about their incorrect beliefs’ that keep them awake for long.

Bright light therapy: Timed exposure to bright lights for seniors who go to bed and wake up early can help them stay awake a bit longer to become tired till night and then fall asleep.

If all the interventions and therapies don\’t work for the elderly then the doctor must prescribe medications with much care and dedication to make the elders least dependent on drugs and must try to make them habitual to normal sleep patterns rather medicines. A lot of care and consideration is needed to prescribe appropriate insomnia medication as benzodiazepines, non-benzodiazepines, etc produce hypnotic effects and can increase the risk of falling for older people. These drugs create tolerance and dependence and withdrawal risk, so doctors should take into account the prescription of patients to prevent any negative drug interactions.

Some drugs interact with natural hormones in the body as ramelteon that acts as an agonist for receptors of melatonin, a hormone produced in the pineal gland that includes feelings of sleepiness after sunsets. Similarly, suvorexant suppresses orexins, the neuropeptides that cause arousal and wakefulness.

Can you die from insomnia:

Although looking like a common disorder, people who suffer from insomnia have know-how about its horrible outcomes and its havoc nature. If you want to sleep and you are unable to sleep, it means you are the one who is most miserable on earth. Yet no one ever dies due to lack of sleep. There are some reported cases of deaths from sleep deprivation that had some other underlying diseases too in the mainstream of reasons. Such cases were reported of two people watching football matches and remained alert and sleepless for more than eleven nights consecutively and passed away. In such cases, the death was announced due to other reasons as a mixture of alcohol intake, tobacco intake, and sleep deprivation, etc.

A fatal condition associated with lack of sleep is fatal familial insomnia where patients progress from complete insomnia to dementia and mostly die between seven and thirty-six months after onset. However, it is a degenerative brain disease and affects other body regulatory functions like heart rate, temperature regulation. So alone insomnia doesn’t create havoc here too rather many other causes combine under its flag to cause death.

The Science of sleep via cannabis:

Marijuana is a sleep aid that has a greater impact on the sleep cycle. Marijuana has analgesic properties that provide relief from chronic pain and its anti-anxiety properties provide smoothness from the stressed out mind and body. Ingesting marijuana with higher levels of THC reduces the dream part of the brain and reduces nightmares. If we spend less time dreaming then we spend more time in a deep sleep state since deep sleep is the most restorative part of the sleep cycle. Marijuana changes the sleep cycle but the change is positive or negative depends upon the amount of marijuana you take and the duration for how long you take.

Things to consider before deciding on marijuana:

Marijuana is a deep-acting drug and is hazardous for the lungs too especially for asthmatics and other respiratory conditions. Marijuana must be avoided while pregnant or breastfeeding. Marijuana is used for the long term changes the amount of gray matter in the brain and thus affects brain conditions and functions. Marijuana must be used with precautions and care for the long term and under the age of twenty-five years.

Indica vs Sativa vs hybrid: The marijuana plant is available in three strains like Indica, Sativa, and hybrid. The three strains have different characteristics that can affect the state of mind accordingly.

  • Indica:  This strain is soothing and relaxant.
  • Sativa: Sativa generally makes people feel excited, happy, and energized.
  • Hybrids: A combination of both Indica and Sativa, hybrids are blends that are left up to the dispensary or manufacturer.

Different strains of cannabis have a different amount of cannabinoids in them which induce sleep. Mostly marijuana is taken as a joint or a pipe, vaping devices, or THC-rich tinctures dropped under the tongue. You would need a bit of experimentation to get a true dosage for you so it would take a week to discover the proper working dose for you. Don\’t try during the workweek rather try in your off days and start with just a few puffs.

Timing your intake for bedtime: Timing is very important when you try to intake marijuana before bedtime. Everyone\’s physiology works differently and varies a lot from person to person not only in basics but also in response to certain medications and drugs. So marijuana must be taken at least an hour before bedtime since cannabis takes three to four hours to help you fall asleep. People with recent heart attacks or cardiovascular issues must refrain from taking marijuana.

Interference of sleep deprivation with body’s internal systems:

Sleep deprivation is a common disorder that affects a number of people around the globe. It may lead to insomnia if persists permanently. Insomnia affects all the internal systems of the body including vital organs, their functions, regularity, and durability. How the internal body is affected includes:

  • Central nervous system: Central nervous system is the computer of our body and is the higher brain center that controls and deals with all other functions of the body. Sleep is a peculiar symptom that keeps proper functioning of the body but chronic insomnia disrupts the incoming and outgoing processes of the brain to a great extent. Pathways are formed during sleep between the nerve cells in your brain that help you to memorize the new information you have learned. Sleep deprivation leaves your brain exhausted and tired and the brain becomes unable to perform its duties well. It becomes impossible to focus on new things or concentrate on any unknown thing. The signals become delayed decreasing coordination and increased the risk for accidents.

Sleep deprivation negatively affects mental abilities and emotional state and you become prone to mood swings. It makes you compromised on decision-making processes and creativity. The ultimate outcome of these negative effects cause hallucinations, bipolar disorder, etc. Other psychological risks may be anxiety, impulsive disorder, depression, paranoia, and suicidal thoughts. Microsleep during the day becomes out of control and becomes extremely dangerous if you are driving. You can become prone to injury if you work at heavy machinery during microsleep episodes.

  • Immune system: Immune system is the fighting spirit of the body and produces protective, infection-fighting substances like antibodies and cytokines. The immune system combats foreign invaders like bacteria and viruses. Certain cytokines help you sleep giving the immune system great efficiency to defend your body against illness. Sleep disturbance prevents the immune system from building up forces. If your sleep is not enough your body may not be able to fend off invaders and you may take longer to recover from illness. Long-term sleep deprivation increases the risk for diabetes mellitus and heart diseases.
  • Respiratory system: Sleep and respiratory system go hand in hand with each other. Obstructive sleep apnea is a nighttime breathing disorder that can interrupt your sleep and lowers sleep quality. Waking up at night causes sleep deprivation and leaves you more vulnerable to respiratory infections like flu and the common cold. The respiratory symptoms worsen with chronic lung illness.
  • Digestive system: Sleep deprivation along with eating too much and no exercise at all are risk factors for obesity and overweight. Sleep has an effect on levels of two hormones, leptin, and ghrelin that controls feelings of hunger and fullness. Leptin is a brain hormone that acts as a satiety center of the brain and body and tells that you have had enough o eat. Ghrelin is the hormone of appetite stimulant t which forces you to eat and fill up your stomach. Without enough sleep, your brain reduces leptin and enhances ghrelin.  These hormone fluctuations up and down explain nighttime snacking and over the midnight dinner table.

Lack of sleep makes you feel tired to exercise which reduces your movement and over time the reduced physical activity makes you gain weight because you don’t burn enough calories. Sleep deprivation reduces the release of insulin after you eat from the pancreas since insulin helps to reduce the blood sugar level after you eat. Sleep deprivation lowers the body\’s tolerance to levels of glucose and is often associated with insulin resistance. These all disruptions ultimately cause diabetes mellitus and obesity.

  • Cardiovascular system: Sleep affects almost all systems of the body and keeps your heart and blood vessels healthy. It affects the blood sugar value of your body, blood pressure of your body, inflammation levels of the body. It plays a vital role to give power to the body to get healed and repair the blood vessels and heart.

Cardiovascular diseases are more common in people who don’t have enough sleep and they become more prone to heart stroke and heart attack.

  • Endocrine system: Hormone production and regulation are dependent upon sleep.  Three hours of uninterrupted sleep is needed for testosterone production that is the time of the first REM episode. If you keep awake the whole night or for days then the hormone production would be affected badly. This interruption affects growth hormone production, especially in children and adolescents. These hormones help to build the mass of muscle in the body, repair the cells and tissues of the body in addition to other growth functions. The pituitary gland is the home of all hormone production throughout the whole day but still proper sleep and rest help the release of these hormones in an adequate manner.

How to prevent insomnia:

Sometimes there is no reason for insomnia and it occurs at any age group without any underlying reason or with a reason, you never know. Whatever the reason may be, the conditions and behavioral patterns that lead to insomnia must be prevented and be taken proper care of to avoid its occurrence in order to stay healthy and get healthy sleep. A number of factors must be taken into consideration to prevent insomnia including:

  • Observe regular sleep hours: Programming a daily sleep and wake cycle and following it on regular basis makes a base for your sleep and wake patterns. The time must be chosen when you feel sleepy and tired.
  • Create restful ambiance in the bedroom: Temperature, lighting, noise, hygienic conditions, all these parameters must be controlled to maintain a healthy and nice sleepy environment in your bedroom where you feel at peace and healthy.
  • Comfortable bed: The best thing to be taken into consideration is the most peaceful and light bed at which when you lie down doesn’t make you throw yourself outside rather it gives you peaceful time at bed. The bedsheet or bedcover must be of the best cotton fabric that gives you sleepy touch rather than any polyester or irritating material which may not allow you to lie peacefully.
  • Regular exercise: You should make a routine habit of a certain type of exercise like walking, swimming, cycling or some other form of exercise that gives you a healthy mind over a healthy body. The exercise before going to bed should not be vigorous enough to cause extreme tiredness.
  • Cut down caffeine etc.: Reduce or totally cut down the caffeinated products, caffeine, tea, or other materials since it interferes with the sleep pattern. Rather must take warm milk or milky drink before going to bed because milk contents induce sleep.
  • Avoid overindulging: Too much alcohol or too much food before bedtime creates problems like disturbed sleep or gastric issues creating sleep patterns disturbance. Must avoid overindulging so that the sleep is regular and at the proper time.
  • Quit smoking: A mind stimulant is nicotine that is an ingredient of cigarettes and cigars. It is a stimulant that interrupts sleep patterns and makes you awake for longer time periods.
  • Try to relax before going to bed: A warm healthy bath, a drink of a warm cup of milk, listening to light music, and some gentle yoga relaxes your mind and gives you a healthy peaceful sleep.
  • Night diary: Maintaining a night diary and noting everything on your diary about your worries and anxieties make you stress-free for the time being. Try to note down your plans for the next day along with a time schedule to make yourself ready for the next day and make your mind and body ready to get sleep.
  • Leave your bed if you cannot sleep: You lie down for twenty minutes and even then you are unable to sleep in spite of following all the bits of advice and tactics, then leave the bed immediately, take a nice roam around the house and try to relax by taking open air and relaxing. Go to bed again after some time when you are tired by roaming or make gentle exercise again to become tired then you may feel tired and get sleepy.

Acupressure, still a new but effective technique covering five pressure points for sleep:

Insomnia is a common condition occurring at especially old age when you feel difficulty getting sleep but with a number of treatment strategies available over the counter and medications, the theory of acupressure also provide some relief of symptoms. Acupressure is a technique whereby physical touch to stimulate the pressure points gives some relief from the symptoms of the problem. These pressure points correspond to different aspects of mental and physical health. Rather than visiting the hospital, again and again, you can have some pressure on your pressure points yourself by diagnosing them and trying to get relief and peaceful sleep.

  • Spirit gate: Below your pinkie finger at the crease of your outer wrist lies the spirit gate.  We mention it as the first pressure point of the body since it is the first and foremost area very effective once pressed or applied pressure properly to enhance sleep and treat sleep inefficiency. You must feel for the small hollow space in this area and must apply gentle pressure in this area in a circular or up and down movement. It must be continued for two to three minutes. Then you must hold the left side of the point gently applying a bit of pressure for few seconds and then holding the right side. The entire process must be repeated on the same area of your other wrist. When you stimulate this part of your body it is associated to quit your mind, you feel relaxed and it makes you fall asleep.
  • Three yin intersection: The next pressure point is located just above your ankle on your inner leg side. If you want to treat insomnia with acupressure therapy, then locate the highest point on your ankle. Then count your finger widths up your leg above your ankle to locate the proper pressure point. Apply deep pressure slightly behind your tibia, massage the area in circular or up and down motions for five to six seconds to deeply affect the system.  This applied pressure can heal insomnia as well as several other ailments in addition to pelvic disorders and menstrual cramps. Although special care must be taken to treat insomnia like this during pregnancy since it may induce labor before time.
  • Bubbling spring: The third important and very effective pressure point for the treatment of insomnia is the bubbling spirit that is located on the sole of your foot almost in the middle. It’s a very small depression that appears in the middle of your foot when the toes are curled inwards. To apply the pressure at this point, you have to lie on your back with your knees bent so that you can reach your feet with your hands. Take only one foot in your hand curl the toes, you will feel the depression on the sole of your foot by touching and even without touching. Apply firm pressure over the bent area and massage the point for a few minutes using circular or up and down movement. Your body energy is believed to be grounded and sleep is enhanced by proper pressure at this point.
  • Inner frontier gate: The next important and fragile pressure point for treating insomnia is the inner frontier gate that is found on your inner forearm between the two tendons. If you turn your hands up so that your palms of the hands are facing up then you can have a clear-cut view of the pressure point for the treatment of insomnia. To mention it properly, take one hand and count three fingers width down from your wrist crease. Then apply a steady downward pressure between the two tendons in this location. Use a circular or up and down motion to massage the area for five to six seconds so that the pressure wave moves forward and gives some relief in your mind enhancing the need for sleep. Along with treating insomnia, the pressure point is also used to treat the associated disturbances like nausea, headaches, and stomach pain which may arise due to disturbed sleep patterns.
  • Windpool: The last and not the least of the five discovered pressure points for the treatment of insomnia is the wind pool. The wind pool is located on the back of your neck. You can feel and find it easily by feeling the mastoid bone behind your ears and just following the grooves around to the place where your neck muscles attach to the skull. In order to apply pressure, you must clasp your hands together and then gently open your palms with your fingers interlocked to create a cup shape with your hands. Use your thumbs to apply a firm and deep pressure towards your skull using up and down movement and circular movements to massage this area for four to five seconds. During the massage, you must take deep breaths to accommodate the flow of pressure deep inside. This pressure point is deeply effective to treat insomnia as well reduces respiratory symptoms like cough and tightness in the chest. It is also found to be very effective to treat stress and calming the mind. Once the mind is peaceful, then naturally it is very easy to fall asleep without pressure or any disturbance.

Whatever the reason may be, insomnia must be prevented and if still, it occurs in spite of following all the preventive measures then it must be diagnosed properly by the doctor and then treated accordingly. The treatment may include over-the-counter drugs, DIYs or pressure point techniques, or medications prescribed by the doctors. Peaceful sleep is worth the best wealth on earth. Acute stages of insomnia and reasons as pregnancy or any other minor symptom which can be overcome without any medication must be tried to eradicate by lifestyle habit development that may alter certain physiological orders of body and give you a healthy peaceful sleep.

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