IDIOPATHIC INTRACRANIAL HYPERTENSION | 10.01.2023

INSOMNIA (SLEEPLESSNESS)

Sleeplessness, also known as insomnia, is one of the most common medical problems. It is frequently seen in internal, psychiatric, neurological or sleep-specific diseases. It may also be related to sudden stress, medication or substance use, bad sleep habits or a change in sleep environment.

insomnia sleeplessness treatment

Photo: Dilek Necioğlu Örken

What is Sleeplessness (Insomnia)?

Insomnia, which we can define as sleeplessness, is actually a sleep disorder. People with insomnia have trouble falling asleep or staying asleep. Sometimes they don't feel rested when they wake up. As we all know from our daily life, the need for sleep varies from person to person. Some people need 4 hours of sleep, while others need 8 hours of sleep a day. Therefore, the concept of insomnia is not related to the hours spent asleep. Insomnia can be a short-term condition that occurs due to a stressful situation and lasts for a few days and is resolved when the stress is removed, or it can be a long-term problem. Insomnia that lasts longer than three months is called chronic insomnia. Insomnia can often be a recurring and persistent problem. Risk factors that play a role in persistence are old age, female gender and increased severity of symptoms.

What are the Signs of Sleeplessness (Insomnia)?

People with insomnia have trouble falling asleep or staying asleep. They may be tired during the day. They may be forgetful and not be able to think clearly. They may have low energy and feel tense and depressed. They can make more mistakes and be involved in more accidents than normal people. These symptoms can be so severe that they can negatively affect a person's work and family life. These symptoms are sometimes seen even among people who get sufficient hours of sleep.

What are the Causes of Sleeplessness (Insomnia)?

Short-term insomnia lasts less than 3 months and is usually associated with stress. Situations that cause short-term sleep disorders can be loss of a loved one, divorce, unemployment, new surgery or illness and pain, use or quitting of some stimulants such as caffeine, alcohol, some drugs and illegal substances such as cocaine, or changing the sleeping place. It gets better when the stress factor is gone. Some conditions that disrupt the sleep cycle can also cause short-term insomnia. The most well-known are jet lag and shift work. Although jet lag is seen in all directions, it is more pronounced when traveling from west to east. If you're traveling east to reduce jet lag, set your wake-up and bedtimes half an hour earlier each day for 3 days before your trip. Try to sleep at night according to the time zone you are to go during the trip.

Long-term insomnia is a sleep disorder that lasts for more than 3 months and occurs at least 3 nights a week. It is usually due to medical problems and a physician must be consulted.

What are the Medical Conditions Associated with Insomnia?

1. Psychiatric Diseases

  • Depression
  • Anxiety
  • Post-Traumatic Stress Disorder

2. Neurological Diseases

  • Degenerative Diseases Such As Alzheimer's And Parkinson's
  • Painful Polyneuropathies
  • Strokes
  • Brain Tumours
  • Traumatic Brain Injuries
  • Headache Syndromes
  • Fatal Familial Insomnia

3. Internal Diseases

  • Chronic Obstructive Pulmonary Diseases
  • Asthma
  • Arthritis
  • Fibromyalgia
  • Chronic Pain
  • Heart Failure And Ischemic Heart Disease
  • Nocturnal Angina
  • Hypertension
  • Hyperthyroidism
  • Urinary Problems

4. Medicines And Substances

  • Central Nervous System Stimulants And Depressants
  • Bronchodilators
  • Antidepressants
  • Diuretics
  • Cortisones
  • Caffeine

The Relationship Between Sleep Disorders and Migraine Headache

Insomnia is 2-8 times more common among people with migraine headaches. On the other hand, those who have chronic migraine, that is, those who have pain for 15 or more days a month, are twice as likely to suffer from insomnia than those with less pain frequency.

The most common sleep disorder in people with migraine is difficulty falling asleep and staying asleep, and waking up early in the morning and without rest. Insomnia negatively affects daily life by causing fatigue, loss of attention and concentration, and lack of motivation. Insomnia may be associated with headache, depression, anxiety, lack of exercise and medications. After a long week of not getting enough sleep, sleeping on the weekends can cause you to wake up with a weekend headache. The clues that indicate that there may be a primary sleep disorder in addition to the headache are snoring, panting, daytime sleepiness and getting up tired. In addition, restless leg syndrome can further disrupt sleep.

How to Diagnose Insomnia?

It is helpful to keep a sleep diary when going to the doctor. In this diary, the activities done before going to bed, how long it takes to fall asleep, the number of awakenings, the total sleep time, whether you feel rested or not should be recorded every day. Dinner time, caffeine intake, energy drinks, migraine medications should also be specified.
In addition to questioning and examination, a test called polysomnography may sometimes be ordered. Polysomnography is usually an all-night study and you may need to sleep in a lab. During the examination, your movements, brain activity, breathing and other body functions are monitored through electrodes.

How to Treat Insomnia?

Treatment varies according to the underlying cause of insomnia. For example, if you can't sleep because of stress, pain, or any other medical problem, treatments for that problem can improve your sleep as well.
Sleep hygiene is the rules that should be followed for a healthy sleep. Paying attention to these rules can solve the problem in people who have sleep problems from time to time. To ensure good sleep hygiene;

1. Go to bed and wake up at the same time every day
2. When you get your sleep and feel rested, do not continue to sleep more
3. If you can't fall asleep, don't roll over in bed and force yourself to sleep, but instead get out of bed and try going back to sleep later
4. Consume beverages such as coffee and tea only in the morning
5. Do not consume alcohol after evening hours
6. Do not smoke, especially at night
7. Your bedroom should be dark, cool and quiet
8. Do physical activity but don't do heavy exercise just before bedtime
9. Stay away from phones, tablets, computer screens or electronic reading devices before sleep

There are also some medications that will make you sleep. However, it is appropriate to take measures to ensure sleep hygiene first, and if necessary, drug treatment may be recommended by your doctor.

SOURCE:
Bonnet M.H, Arand L.D. Insomnia. Up to date 2020
Tepper D. Sleep disorders and headache. Headache 2015

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