The bad habits that cause sleepless nights

Excessive consumption of alcohol or coffee and the use of smartphones at all hours of the day and night are among the most common causes of insomnia.

Insomnia, bruxism, sleepwalking and apnea are just some of the disorders that agitate the sleep of many people, at all ages.

Among these, insomnia is probably the most common especially in its acute form, that is, when it occurs episodically, once in a while.

What is insomnia?

Insomnia is by definition “a condition of dissatisfaction with the quantity and quality of sleep, characterized both by difficulty in initiating sleep and maintaining it“.

It becomes a clinical problem if this situation is repeated for three or more nights a week over several months, compromising even daily activities.

A good quality sleep is important, in fact, not only to rest the body, but also to consolidate our memory, maintain the hormonal levels of the sleep-wake rhythm in the norm and an active metabolism.

Insomnia affects about 9-15% of the world’s population and can persist for a long time and become chronic.

Very often continuous insomnia, as well as other sleep disorders if prolonged for a long time, is associated with other chronic diseases, even non-psychiatric, such as diabetes or reduced glucose tolerance, hypertension, obesity in adults and children as well as cognitive deficits, alcohol abuse, anxiety or depression.

How do you recognize it?

Among the characteristic symptoms of insomnia we find:

– difficulty falling asleep

– frequent nocturnal awakenings

– early awakenings in the morning

– non-“restorative” sleep

– tiredness, drowsiness, anxiety, lack of concentration and irritability during the day.

There are also many causes, levels of severity and consequences of “blank nights”.

What are the most common causes?

Insomnia can be caused by countless factors: some pathologies, such as sleep apnea or the “restless legs syndrome“, the intake of certain drugs, a moment of strong stress, but also an incorrect lifestyle.

Often, in fact, some bad habits are enough to disturb or make it difficult to sleep at night. They range from using computers, tablets or smartphones just before bedtime, to excessive consumption of coffee, tea or alcohol during the evening hours.

Even practicing physical activity at the end of the day, perhaps with the aim of getting tired, can instead be counterproductive, as it makes us more alert and less likely to fall asleep.

Pay attention to the bedroom: the temperature must not be too high and there must be no television, computer, etc.

Another bad habit is to binge at dinner: it is in particular protein foods that make digestion difficult and therefore disadvantage a peaceful sleep.

Many types of insomnia

As the causes can be many, there are also various types of insomnia. The main ones are:

Adaptation insomnia. It is usually acute or short-term insomnia, determined by transient events or moments of stress. More common in women and the elderly.

Psychophysiological insomnia. It is characterized by anxiety about the feeling of not sleeping or resting and consequently not being active the next day.

Paradoxical insomnia. It is a rare form, but relatively serious as it overestimates the time of falling asleep and underestimates the total time of sleep. The main feature of this form is constant awareness of the surrounding environment and mental activity at night.

Insomnia from incorrect sleep hygiene. It mainly affects young adults and can be linked to daily behaviors or incorrect lifestyle that leads to sacrificing many hours of sleep for a continuous period.

Insomnia from drugs or substances of abuse. Among the drugs most blamed in causing insomnia we find:

• anti-hypertensives (alpha/beta blockers, ACE inhibitors, etc.)
• anti-inflammatories (corticosteroids)
• antihistamines (H1 antagonists)
• drugs for the treatment of dyslipidemias (statins).

Even the prolonged use of hypnotics can involve, after an initial period of relaxation and facilitation in falling asleep, an insomnia “return” or “rebound” for addiction to the drug.

Finally, stimulants such as caffeine, or the consumption of alcohol or certain foods can also cause insomnia.

Psychiatric insomnia. It is linked to mental disorders and is often referred to as “depression insomnia”. In this case it goes from being a symptom to becoming a pathology in all respects. In some cases it is insomnia itself that causes psychiatric pathologies such as anxiety and depression. This type of insomnia generally has a familial character.

Organic insomnia. This is defined as insomnia related to another pathological condition that does not allow a peaceful rest, such as back pain, asthma, continuous pain, but also depression and chronic anxiety.

Idiopathic insomnia. Insomnia is called idiopathic if the true cause is unknown.

How is insomnia diagnosed?

Mainly through the video recording of the subject during the night (videopoligraphy), the “actigraphic” examination to track movements or the monitoring of cardio-respiratory parameters.

Valid support to the doctor can also be the “sleep diary” by the patient himself. The validity of the latter, however, must be verified for a possible altered subjective perception of sleep.

Cognitive-behavioral therapy

First of all, it is essential to identify the cause of the disorder, and then go on to intervene on the behavior and habits of the patient, thus restoring a correct “sleep hygiene”.

The most widespread and applied tips to correct incorrect behaviors that cause or worsen insomnia are:

– learn to relax. Relaxation is especially helpful when the main cause of insomnia is stress or anxiety. It is also important before bedtime to take some time for relaxing activities such as reading a good book or listening to music, allowing our brain to “detoxify” from the frenzy of the day.

– go to bed only when you are sleepy

– get out of bed if you can’t sleep. Better, in these cases, to go to another room and dedicate yourself to something relaxing to promote sleep

– wake up at the same time in the morning, regardless of working days or holidays. This will be useful for regulating the internal biological clock.

– Reserve the bed and bedroom only for sleeping. So avoid reading, watching TV or snacking in bed in order to associate it more with sleep than wakefulness

– avoid taking daytime naps and falling asleep on the couch

– Eat light in the evening also avoiding alcohol, smoking and intense physical activity before bedtime.

Some people also find benefit from the use of herbal products, such as chamomile, valerian or hawthorn, also mixed together, or alternative medicine techniques that would seem to promote relaxation, such as acupuncture.

Drug therapy

If this first approach is not sufficient, the doctor may consider a drug therapy appropriate.

The drugs used in the treatment of insomnia are basically hypnotic, most of which are characterized by a marked anxiolytic, hypnotic-sedative, muscle relaxant and anticonvulsant activity.

What differentiates one hypnotic drug from another is its “half-life“, that is, the time necessary for it to be eliminated from the body. This peculiar aspect accordingly determines the duration of its effect.

The doctor will then prescribe sleeping pills:

• a short half-life, if the patient complains of difficulty falling asleep, but once asleep wakes up in the morning
• an intermediate half-life, if it is subject to frequent awakenings during the night and non-restorative sleep
• with a long half-life, if the problem is mainly in the morning with early awakenings.

Each insomnia therefore has its own type of drug, but it is still preferable to administer a drug with a short or intermediate half-life to reduce sedation time, since it can compromise daytime vigilance, and evaluate the most appropriate among the different pharmaceutical forms available orally (drops, tablets, capsules) depending on the patient and the speed with which the effect is to be obtained. The drop formulation, for example, is easier to swallow and is therefore used especially with the elderly.

These drugs should be used for short periods and with proper management of therapy to prevent the risk of addiction and/or dependence.

The necessary precautions for a correct, and therefore effective and safe, drug therapy are:

• discourage patient self-management
• attempt a non-daily use of the drug and for short periods
• Gradually stop taking it once the disorder has improved significantly and permanently
• If the disorder continues, avoid increasing the dosage excessively, considering a change of medication or a new diagnosis.

Particular attention should be paid with the elderly, since the sedative effects typical of these drugs can increase the risk of falls and therefore fractures.

The costs of insomnia

“Blank nights” not only have consequences on the individual’s productivity during the day, but also have broader social costs.

In addition to accidents caused by falling asleep while driving a vehicle or working in dangerous contexts, there are also huge expenses that health care has to face to cover medical visits and pharmacological, hospital and welfare interventions.

Given the fundamental importance of conducting good quality sleep, it is therefore important to extend a correct “sleep education” by informing not only people suffering from these disorders, but in general all citizens in order to anticipate.

In this regard, in our territory there are numerous associations active in this field, including AISM (Italian Association of Sleep Diseases).

Scientific research is also expanding to try to give an increasingly definitive answer to all this range of disorders. In addition to the classic studies to test the efficacy and safety of new drugs, more observational ones that monitor the hormonal or metabolic changes of the subjects enrolled as a result of more or less consistent changes in the duration and quality of sleep are gradually emerging.