Insomnia | lack of sleep

Definition;

What is insomnia?

Insomnia refers to difficulty in either falling asleep, remaining asleep or feeling refreshed from sleep.

Insomnia increases with increase in age and is twice as common in women as in men.

It(insomnia) results from disturbances in the sleep/wake chemicals in the brain thought it might be caused by other underlying conditions like pain.

Sleep.

Normal sleep has two distinct cycles.

Orthodox sleep which normally takes about 75% of the total sleep. It is also known as Non-Rapid Eye Movement Sleep.

It is made up of four stages. The stages are beyond the scope of this discussion and we will therefore not cover it.

Paradoxical sleep(Rapid Eye Movement Sleep)

This sleep takes about 25% of the total sleep. It is characterized by rapid eye movement

It is called paradoxical sleep because one seems half asleep yet very hard to awaken.

This is the deepest part of the sleep and occurs near morning.

This is the dreaming part of of sleep and the eye movement is actually due to the person eyes chasing things in the dreamland.

During this sleep the brain metabolism icreases by about 30% the normal to facilitate the dreaming..

Causes and signs of insomnia.

What causes lack of sleep?

Insomnia may result from increased activity of arousal system of the brain or decreased activity of the sleep system.

The imbalance is caused by;

  • chronic pain
  • uncontrolled asthma
  • Gastric reflux,
  • some drugs like caffeine(from coffee) and nicotine(from tea leaves) stimulate the brain and make it hard to fall asleep.
  • Some medications like thyroxine, theophylline, 
  • some ilicit drugs like cocaine, amphetamine, miraa,
  • withrawal from drug use like alcohol and other drugs.
  • Difficulty in staying asleep may be due to depression and sleep record usually show frequent wakings during the sleep.
  • Post traumatic stress disorder also causes insomnia
  • sleep apnea(blocking of the airways during sleep)

Investigations

Most people require 7-8hours of sleep daily though some subjects require as lowas three hours.

Always investigate the underlying cause of insomnia eg pain, drug use, depression, anxiety or any sickness.

Treatment

Non drug therapy(what are the natural treament options for lack of sleep?)

Sleep hygiene

sleep hygieine

Exersice has proved to be very effective in management of insomnia. 

If non drug therapy fails to work then drugs can be used.(what are the drugs used to treat lack of sleep?)

Benzodiazepines-these should only should not be used for a long time as they cause addiction beyond three days.

Z-Hypnotics– these are Zaleplon, zolpidem, zopiclone. They are better than benzodiazepines as they have short duration of action and therefore do not cause hangover.

Some antihistamines like chlorpheniramine(piriton) and promethazine also cause sleep.

Some antiepilepsy drugs like carbamazepine and valproic acid may be used to manage insomnia.

Undesired effects of using drugs for sleep.

Tolerance and dependence
Tolerance to the hypnotic effects of benzodiazepines and probably z-hypnotics develops rapidly and may lead to dosage escalation.

Nevertheless, poor sleepers may report continued efficacy and the drugs are often used long-term because of difficulties on withdrawal.

What happens when one stops using sleeping pills?

Rebound insomnia.

This is insomnia that occur when one stops using the sleep drugs. It is usually more severe than the original insomnia.

Hangover. This mostly results from use of benzodiazepines.

 

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Dr Mathu

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