Insomnia: causes, diagnosis, treatment

Insomnia is a violation of the natural cycle of “wakefulness–sleep”, in which a person has difficulty in the process of onset and maintenance of sleep. Due to the lack of quantity and quality of a full night’s rest, the normal functioning of the body is disrupted. 30-45% of the world’s population complains about sleep disorders, but only 10-15% of them have a pathology that is a serious problem requiring medical treatment. It should be understood that the term “insomnia”, which is used by patients when contacting a doctor, is not entirely correct, since the disease is not always accompanied by complete loss of sleep.

Classification

Depending on the duration of symptoms, insomnia can be:

• transient – lasting no more than 2-3 days;
• short–term – such insomnia lasts no more than a week;
• chronic – persisting from 3 weeks to several months or more.

There is also a distinction between situational and permanent insomnia. The situational form is characterized by loss of sleep when the situation changes, for example, when a person makes a long flight with a change of time zones.

Depending on the severity of symptoms, the disease has 3 degrees:

• mild degree – episodes of insomnia are rare;
• average degree – a person faces violations on a weekly basis;
• severe degree – sleep disorders occur every night.

Severe insomnia significantly reduces the quality of life.

Causes of insomnia

The mechanism of the disease development remains unexplored. Scientific research in the field of neurology has shown that with insomnia, the brain does not rest during sleep, the level of its activity remains the same as when awake. High levels of beta waves, the stress hormone cortisol and adrenocorticotropic hormone remain.

Pathologies contributing to the development of insomnia:

• neuroses and neurosis-like states;
• clinical depression;
• panic disorder;
• post-traumatic stress disorder;
• dissociative disorder;
• arterial hypertension;
• schizophrenia;
• atherosclerosis;
• pleurisy;
• pneumonia;
• stroke;
• malignant and benign brain tumors;
• parkinsonism;
• epilepsy;
• pathology of the peripheral nervous system.

Predisposing factors include pregnancy, chronic stress, jet lag, taking psychotropic drugs. Residents of megacities, workers engaged in shift work often complain about insomnia.

Symptoms

The clinical symptoms of insomnia are divided into 3 groups:

1. Presomnic disorders. The patient has difficulty falling asleep. Normally, the stage of falling asleep lasts no more than 10 minutes, a person with insomnia takes from half an hour to 3 hours to fall asleep. This may be due to insufficient fatigue of the body, taking drugs that have an exciting effect on the central nervous system, increased anxiety. Lying in bed, the patient retains motor activity. He cannot take a comfortable position, in some cases there is itching, muscle cramps.
2. Intrasomnic disorders. The phase of deep sleep does not occur, the slightest stimuli lead to awakening and subsequent prolonged falling asleep. The patient is disturbed by ambient sounds, bright light. The cause of awakening may also be physiological factors: urge to urinate, attacks of palpitations. Intrasomnic disorders include restless legs syndrome. This is the appearance of unpleasant sensations in the legs, forcing the patient to make forced movements. A surge of motor activity leads to awakening. In some patients, sleep apnea syndrome is detected – a stop of nasal breathing, lasting at least 10 seconds. Apnea is often accompanied by snoring.
3. Postsomnia disorders. Manifestations of insomnia can haunt a person while awake. Waking up is very difficult, after sleep, weakness and weakness haunt. During the day, drowsiness is felt.

Due to lack of sleep, the following symptoms occur: impaired concentration, decreased ability to work, irritability, chronic fatigue, headaches, swelling, increased blood pressure. Complaints are more common in older people than in young people.

Diagnostics

The doctor diagnoses insomnia based on the patient’s complaints, while taking into account his physical condition. There are two diagnostic criteria:

• delay in falling asleep for more than half an hour;
• reduced efficiency of rest.

For example, if a person slept less than 4 hours every night for three days in a row, this is considered equivalent to one sleepless night.

A tendency to non-standard early or late ascent (the division of people into “owls” and “larks”) can also be considered a violation if a person is unable to follow his circadian rhythms. For example, the “owl” is forced to get up early in the morning, but this does not contribute to falling asleep earlier.

The patient is recommended to consult a somnologist. The doctor may recommend keeping a diary where the periods of wakefulness and sleep will be recorded. Polysomnography may be prescribed – a study conducted to assess the functioning of the body during sleep. Before going to bed, numerous electrodes are attached to the patient’s body. It is necessary to record the results of EEG, ECG, eyeball movements, the level of muscle tension. According to the data obtained, sleep phases and their duration are determined.

Treatment

Transient and short-term insomnia often pass on their own, after the elimination of stressful factors. Drug treatment usually requires chronic insomnia. It is necessary not only to ensure a healthy deep sleep with the help of drugs, but also to eliminate the root cause of violations.

First of all, it is necessary to observe sleep hygiene:

• ventilate the room;
• ensure a normal level of physical activity during the day;
• give up daytime sleep;
• does not go to bed hungry;
• avoid exposure to bright light;
• develop peculiar rituals that will help you tune in to rest.

Sometimes compliance with these rules helps to solve the problem without the use of medications. If the cause of insomnia lies in neurosis-like states, it is necessary to consult a psychotherapist. Cognitive behavioral therapy is the most effective. This technique has no contraindications, helps to cope with fear and anxious thoughts that prevent you from falling asleep.

The use of sleeping pills in a short time solves the problem, but their long-term use is addictive, followed by withdrawal syndrome. Therefore, the doctor always prescribes mild drugs first, for example, sedatives based on herbal components. Melatonin–containing products are also shown – this is the main hormone of the pineal gland, a natural sleep regulator. Neuroleptics and antihistamines are used to reduce motor activity.

The recommended duration of medication lasts from 2 weeks to 1 month. When selecting medicines, it is necessary to take into account their compatibility, as well as the presence of contraindications and concomitant diseases. Strong sleeping pills reduce the reaction rate of the body, impose restrictions on certain types of professional activity and driving a car.

The use of sleeping pills is only symptomatic treatment. It is necessary to work on eliminating the root causes of insomnia, whether it is somatic or neurological diseases.

Prevention

To minimize episodes of insomnia, you need to follow the following rules:

• if complaints appear, do not delay contacting a somnolu or neurologist;
• to establish and observe the daily routine;
• ensure an adequate level of physical activity (for example, WHO recommends doing about 10,000 steps a day).

If the doctor has prescribed tranquilizers, antidepressants, sleeping pills or sedatives, it is necessary to strictly observe the dosage and not exceed it.

In acute insomnia, the prognosis is favorable. The chronic form of the disease requires long-term therapy.