Insomnia is the most common sleep disorder. In the Sleep Unit of the University Hospital of San Vicente Foundation, we recently conducted a study in Sabaneta – Antioquia and found that 1 in 5 people had chronic insomnia. It is a problem that can have several causes but sometimes has so much impact on the lives of people that their presence requires a care aimed at improving it, regardless of its cause.
Insomnia is the perception that each person has of not sleeping well, which can have several manifestations: difficulty falling asleep, frequent awaken with difficulty falling asleep, wake up earlier than desired, or the feeling of not sleeping well Made all night long. These symptoms that occur at night should be accompanied by fatigue, fatigue, lack of energy or problems of concentration during the day, which decrease performance at work and study. When these problems do not occur during the day, there is probably no insomnia, but a false belief about sleep needs. For example, it is common for people over 65 to wake up early, at 2 or 3 in the morning, but do it rested and during the day feel good, this case is not considered insomnia and what is recommended is Get up and do some activity at this time of the morning.
The most common causes of insomnia are depression, anxiety, psychophysiological insomnia, sleep apnea, restless legs syndrome, medications, poor health and sleep habits. In the first two cases, it is best to consult the psychiatrist to start the recommended treatment.
There are several types of insomnia:
- Transient insomnia: Is insomnia that lasts 1-2 weeks. Most people have ever had a night when we can not sleep for some reason: stress, anxiety or changes due to the loss of a loved one or a job; Health, work or personal problems; A special or tragic event, etc. However, most of the time insomnia goes away and we continue with a normal dream.
- Chronic Insomnia: Is insomnia lasting more than 1 month. Some people who are anxious or have other personality traits persist with insomnia because they acquire bad habits, false beliefs, behaviors and thoughts that are incompatible with sleep, have difficulty relaxing, and begin to unconsciously associate bedtime and Bedroom with different aspects when sleeping.
These people with insomnia usually underestimate what they sleep, that is, they think that they sleep less than they actually sleep. It is common for these people after the sleep study (polysomnogram) to believe that they slept less than what the test reports and often this erroneous belief is reinforced by doctors. This has to be taken into account as it is the reason for patients to only improve their fear of not sleeping well, and without increasing the actual sleep time, feel that they obtained a noticeable improvement of their problem.
Untreated insomnia can lead to sleepiness during the day, depression, memory difficulties, poor performance, accidents, illness, and inability to enjoy life.
The polysomnogram, or sleep study, is the recommended examination for many sleep disorders and requires that the patient go to sleep all night to the hospital sleep laboratory, where several electrodes are connected to the head, sensors in the nose, mouth, Thorax, abdomen and legs, to evaluate different variables that allow the medical specialist to determine what type of sleep problem each person has. The usefulness of this test in the case of insomnia is to rule out the presence of periodic leg movements and sleep apnea. For other causes, it is of little use, but it is indicated when insomnia does not respond to the appropriate treatment and when it is accompanied by drowsiness in the day.
Tips for Preventing and Improving Insomnia
- Do not drink alcohol for at least two hours before going to bed. Although alcohol is a central nervous system depressant, your bedtime intake results in poor quality, fragmented sleep.
- Do not consume caffeine or any other type of stimulant for at least six hours before going to bed. To know the foods, drinks, and medicines that contain stimulants (tea, coffee, energizing drinks, some analgesics, theophylline, salbutamol, anti-grip, etc.) Contrary to popular belief,
- Effects of caffeine may be present up to 20 hours after ingestion. Avoid tea.
- Do not smoke for several hours before going to bed, because nicotine is a stimulant.
- Exercise regularly. Avoid physical exercise after 4 pm
- Arrange the bedroom so that it favors the dream. Set a pleasant temperature (on average 23 ° C) and minimum levels of light and noise.
- Do not eat chocolate.
- Avoid excess fluid. If you wake up at night, do not eat, otherwise, you can get used to waking up whenever you are hungry.
- Short naps of 10-25 minutes are recommended to improve performance at work and in the study. However, in people with insomnia should be avoided because they are often associated with a night with poor sleep quality.
- Meals must be scheduled at regular times. At night reduce fats and protein (meat, egg etc.) and consume the highest percentage of flour or sugar of the day. The latter favor sleeps and is recommended at this time.
- Avoid looking at the clock.
Sleep hygiene alone is not usually enough for chronic insomnia, so this strategy is often part of larger programs where different techniques, among which is the integrated control therapy stimulus, which aims To reestablish the room as a discriminative stimulus to sleep, that is, to eliminate from that site all the behaviors incompatible with sleeping. This therapy is performed with the following recommendations:
- To lie down only when he is sleepy.
- Do not use the bed for activities other than sleeping (except sexual activity). Do not eat, read or watch TV in the bedroom (except when reading or watching TV to sleep). When going to bed, turn off the lights with the intention of falling asleep right away.
- Establish a set of habits that indicate the closeness of bedtime. Close the door, turn off the gas, brush your teeth, etc. Do these activities every night and in the same order.
- If you are unable to sleep (normally in 10 minutes), get up and go to another room, stay as long as you want (doing, if you want, some quiet activity, until you start falling asleep again) and then return to the bedroom to sleep.
- If the person still can not fall asleep, repeat the previous step – doing it as many times as necessary throughout the night.
- Do not nap and get up at the same time each morning (no matter how long you’ve slept).
There are other techniques such as paradoxical intention, progressive relaxation therapy and sleep restriction therapy, which is effective in 80% of people with insomnia when properly performed by trained personnel, in fact, these therapies are the most effective Long-term treatment of chronic insomnia.
Frequently, some people with insomnia also require hypnotic medication to improve the problem, which must be formulated by the doctor. Very safe drugs are now available for the treatment of insomnia without generating addiction and with few side effects.
There are so-called “natural medicines” that are obtained mainly in health food stores, among them valerian, passiflora, ginseng, melatonin etc. Valerian is a drug in the benzodiazepine family to which valium, Ativan, Xanax, Rivotril, etc. therefore, be used for insomnia but has the same problems as these drugs: addiction, causing falls in people Over 65 and others. Melatonin is also a drug that is indicated in certain sleep problems and that should be formulated by the doctor, the same is true with passiflora and ginseng.
It is therefore, wrong to believe that these “naturist” medicines can be consumed without the doctor’s permission, as they can produce side effects and may not be as effective or safe as they do not undergo the same rigorous tests That are made to the medicines with formula.
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