Sunday, May 5, 2013


What is sleep? Sleep is a natural phenomenon in which the brain takes a rest with diminished awareness about surroundings. Sleep is an essential element in daily life of person. On an average a person sleeps for one third of their life. Denied of sleep, a person will soon die.  
The sleep can be affected in many ways. It may be increased or decreased or there may be other problems during sleep. Here we are discussing only decrease in sleep called insomnia. The problem might be associated with going to sleep or frequent awakenings.
Causes of insomnia
Causes of difficulty going to sleep are-
     1.      Central nervous system lesions
     2.      Pain
     3.      Anxiety
     4.      Tension
     5.      environmental changes
Causes of difficulty maintaining sleep or frequent awakenings are-
    1.      aging
    2.      sleep apnea syndromes
    3.      dietary factors
    4.      alcohol
    5.      substance abuse withdrawals
    6.      Parasomnias
    7.      depression
    8.      PTSD
    9.      Schizophrenia
Dyssomnias- These are sleep disorders which are not due to above mentioned conditions
    1.      Primary insomnia- True insomnia without any physical or mental conditions
    2.      Psychophysiological insomnia-objects associated with sleep example bed cause the patient to remain awake due to conditioning. These people sleep well in sleep lab.
    3.      Sleep state misperception- patient feels that he has not gone to sleep but objective polysomnographic evidence says opposite.

Treatment of insomnia

If there is a specific cause of insomnia physical or mental it should be treated. If there is no other cause following methods may be helpful
Sleep hygiene
     1.      Arise at same time daily
     2.      Limit day time bad presence
     3.      Do not take tea coffee alcohol colas two hours before going to bed
     4.      Avoid sleeping in daytime
     5.      Do regular exercises
     6.      Avoid television or radio near bedtime
     7.      Eat at regular intervals
     8.      In evening do relaxation exercises like JPMR
     9.      Maintain comfortable sleeping conditions
    10.  Take a relaxing hot bath in evening
Medications like benzodiazepine, zolpidem and zolpiclone are useful but may cause dependence if used continuously for long duration. Melatonin may be useful.
Dietary supplements containing L-tryptophan also induce sleep.
* Adequate duration of sleep 6-8 hours
Wishing you a long and healthy life
Dr Hitesh Sharma
MBBS, MD (Psychiatry)

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