A widespread disorder, but few choose to resort to specialized centers, which with a correct diagnosis can help solve the problem.
About 10% of the world’s population suffers from it: the most affected are women, along with the elderly, those who work night shifts and people with medical or psychological disorders, such as anxiety and depression. Let’s talk about chronic insomnia: a problem that can negatively affect the activities of our day.
What is it?
Insomnia is a condition of dissatisfaction with the duration or quality of night’s rest, characterized by difficulty both falling asleep and maintaining it. This leads to a clinically significant condition of stress or a reduction in one’s functionality in different areas of life, such as social, occupational or behavioral.
It is not a disorder that causes physical pain, but, if it persists over time, it can still represent a disabling problem.
Restless nights because…
Difficulty falling asleep, frequent awakenings in the night, or waking up early in the morning, without being able to fall asleep again: these are the main manifestations of poor quality sleep.
Each form of insomnia can be caused or influenced by different factors and it is important to explain your problem in detail to your doctor, to get a correct diagnosis and to understand the cause of the disorder in each individual case.
«If there is a problem of falling asleep – explains Luigi Ferini Strambi, neurologist, director of the San Raffaele Sleep Medicine Center in Milan, President of the World Association of Sleep Medicine – the cause may be an anxiety disorder or restless legs syndrome. If there are several awakenings during sleep, it could instead be a nocturnal myoclonus (short leg shots every 30-40 seconds) or a breathing problem, such as apnea. The fragmentation of sleep could also be linked to external noises, while those who wake up very early, without falling back asleep, could suffer from depression.
Insomnia isn’t just about sleep
Despite being classified as one of the sleep disorders, insomnia has repercussions that go beyond the period of night rest and that can have an important impact on our physical and mental well-being.
In fact, in those suffering from insomnia are more frequent symptoms such as:
– tiredness or daytime drowsiness
-anxiety
– mood disorders.
Insomnia is often accompanied by depression, of which it can be a cause or a consequence. The lack of rest during the night has in fact effects on the nervous system, and trying to recover sleep with daytime naps is not enough. In particular, in those suffering from insomnia an imbalance can be observed in the concentration of a brain neurotransmitter, serotonin, also responsible for regulating mood.
Insomnia and sleep disorders: the long-term consequences
“The consequences of not sleeping – explains Ferini Strambi – go far beyond the pale complexion and obvious dark circles that can appear after a night in white. Those who cannot sleep well for a long time feel confused, have concentration problems and memory lapses. The fault is the continuous lack of REM sleep phases, during which the brain stores the information learned during the day and stimulates memory circuits.
And that’s not all: those who sleep little and badly put their health at risk. “During the deep sleep phase, the body releases cytokines, substances that modulate the immune response to diseases,” explains the neurologist.
And what about overweight? Insomniacs are more susceptible to it than those who rest well. Recent studies say that in the presence of good sleep, leptin is produced, a hormone that regulates the feeling of satiety. In case of reduced or fragmented rest, however, the body produces ghrelin, a substance that increases the sensation of appetite, thus stimulating our desire to eat.
There is insomnia and insomnia
A blank night can happen to everyone, and it is not always the case to be alarmed. A moment of stress or too many worries can prevent us from sleeping as we should. “But when this situation is repeated more than three times a week, for a period of about three months, then we can actually talk about chronic insomnia,” says the expert.
Of course, there are different types of insomnia. The chronic one, which does not respond to the classic therapies with hypnotic drugs, must be addressed with the help of an expert in sleep disorders, after the execution of a specialist visit and specific examinations.
Owls or larks: everyone has their own rhythm
«The need to sleep well is common to everyone – explains Ferini Strambi – even if it varies according to age and individual needs. There are those who feel comfortable with five or six hours of rest, those who have to sleep nine hours to fuel in the morning. All of us, however, need to complete some cycles of full sleep, consisting of phases of orthodox, or non-REM, sleep and paradoxical sleep, or REM. All stages are important to regenerate body and mind.”
In addition, it is important to understand if you are “larks”, that is, you tend to go to bed early and wake up earlier, or “owls”, who make the small hours more willingly.
The “do it yourself” to avoid
Although insomnia is a widespread disorder, there are still few people who turn to specialized centers, preferring DIY.
Many rely on dubious natural remedies, which rarely have an effect. In some cases this type of treatment offers a moment of relief, but does not give results that can be maintained over time.
“A counterproductive attitude – comments Ferini Strambi – as insomnia not treated promptly, of whatever nature it is, can lead to a vicious circle. A week without closing a blind eye is enough to lead to negative conditioning and the risk of this disorder becoming chronic: once lying in bed, the thought and fear of not falling asleep will almost certainly lead to another night in white».
Sleep loss is not a passing disorder that sooner or later will go away on its own: it is therefore better to consult a specialist. In Italy there are about thirty sleep centers, where it is possible to find experts who, with a series of questions and outpatient tests, can help the patient to define the type of problem. And, therefore, to find the right cure.
The sleep visit
60% of insomnia cases are resolved with an outpatient visit that investigates:
- Habits and lifestyle
- type of insomnia
- level of vigilance in the morning
- any state of stress, anxiety or depression.
“In some cases – explains the neurologist – the actigraph is used, a device equipped with a motion sensor, to be kept on the wrist for several days, which serves to monitor the moments of wakefulness and sleep”.
For 30% of patients who go to a sleep therapy center, another type of instrumental examination may be necessary: polysomnography, a test that can be carried out in the hospital or at home. It is a kind of recorder equipped with sensors that detect the behavior of the heart, brain, muscles and more during sleep.
«In 10% of cases – continues the expert – the patient is chosen to keep the patient in the hospital for a few nights because he needs a series of tests that go beyond polysomnography. For example, continuous observation for a few days, with progressive modifications of therapy. We also often admit patients who need to be detoxified from prolonged treatment with drugs at massive doses that inevitably lead to addiction ».
White night or sleeping pill? Drug therapy
In cases of chronic insomnia, drug treatment may be necessary. There are several medications that the specialist may prescribe.
«Some molecules are better tolerated and cause fewer side effects such as drowsiness, dizziness, nausea. In general, sleeping pills should be taken only in the doses indicated by the specialist – warns the expert – and possibly associated with non-pharmacological therapies, such as cognitive-behavioral therapy».
In the treatment of insomnia we do not always proceed with pharmacological treatment, but one thing is certain, as Ferini Strambi points out: “It is much worse to spend the night blank than to take a sleeping pill, even if not all sleeping pills create a sleep perfectly superimposable to the physiological one”.
An alternative or support to medication is cognitive-behavioral therapy, which teaches you to avoid wrong attitudes towards sleep. This therapy in some cases has proven to be more valid than pharmacology, also having the advantage of maintaining the effect in the long term.
“It often happens, in fact, that insomniacs have distorted perceptions and thoughts about not getting enough sleep and the side effects that derive from it. To this negative thought are added a whole series of other wrong attitudes that only worsen the situation» explains Ferini Strambi.
Sleep hygiene: goodnight and sweet dreams
When we talk about sleep hygiene, we refer to those few and simple rules to be adopted to guarantee us a better night’s rest.
Let’s see some good habits that can help us sleep better:
– always go to bed at the same time
– pay attention to nutrition, avoid a heavy dinner, preferably based on carbohydrates that contain tryptophan, a precursor of serotonin
– Ban stimulants, such as coffee, tea and alcohol after 17pm
– during the evening, engage in relaxing activities
– Do not spend more time in bed than necessary.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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