Imagine a boy, not older than nine years and not heavier than thirty five kilograms of weight. He is playing yonder across with his toy car, specifically a police miniature sized car. He intermittently makes sounds mimicking siren sounds to make his experience more real than it actually is. He rides his miniature car ferociously exactly as he watched in a movie. His only worry in this world is his homework and not actually having enough playtime but we know that all this is bound to change as he grows older. One of the things that do not move him an inch is his ability to initiate or maintain sleep because he is always ready to lie down and sink into slumber without much hesitation or trouble.
A substantial number of people who relate to this story know it ends well except for the last statement. Most adults would trace exactly when they began having sleep problems as life’s responsibilities bundled up over the years. Insomnia or sleeplessness is the name given to that kind of condition.
Studies have shown that between 10% and 30% of adults has insomnia at any given point in time and up to half of people have insomnia in a given year. And that people over the age of 65 are more affected than younger people. It has been largely witnessed that the biggest draw-back to insomnia comes from the follow up state after the condition that includes low energy, day time sleepiness, irritability, depressed mood, increased motor vehicle collisions, problems focusing and learning all of which affect productivity and are detrimental to quality of life of an individual.
The causes of insomnia are mostly unknown but a considerable number of cases can be attributed to ,psychological stress, chronic pain, heart failure, hyperthyroidism, heart burn, restless leg syndrome. All of which can be ascertained with the help of a qualified health practitioner experienced in the field. Heritability as a predisposing factor has been seen to contribute to 38% of the cases in males and 59% of the cases in females. Females are more affected than men. Drugs such as alprazolam, diazepam, clonazepam, lorazepam which are used to treat insomnia in the short term can worsen sleep in the long run.
The principle most put forward in the management of insomnia calls for the ruling out of all medical or psychological causes before initiating medication. Among a plethora of these causes incudes depression, breathing problems and chronic pain. Non-medication effects may have long lasting effects and provide a more sustainable prognosis. The non-medical interventions include lifestyle changes such as consistent bed time, sufficient exposure to sun light, quiet and dark room and regular exercise.
As an alternative to taking prescription drugs, evidence shows that some over the counter drugs can help alleviate insomnia. These include Diphenhydramine (Piriton), Doxylamine. There are studies that have cited the importance of melatonin in improving the quality of sleep in older people and may be preferred due to its minimal side effects. Anti-depressant drugs such as mirtazapine, trazodone can have immediate sedative effect and are prescribed for insomnia.
While sleeping pill may be of help, it is seen that they are associated with injuries, dementia and addiction; they may not be recommended for more than four or five weeks.
1.”Dyssomnias” WHO pp 7-11
2. “Insomnia: Definition, prevalence, etiology, and consequences” Journal of clinical sleep medicine
3. Psychiatry, 2 Volume set John Wiley & Sons p4253
4.”In the clinic, insomnia” Annals of Internal Medicine. Wilson JF
5 “Management of chronic Insomnia Disorder in Adults: A clinical practice guideline from the American College of physicians” Annals of Internal medicine.