อาการ สาเหตุ การตรวจวินิจฉัยและการรักษาโรคนอนไม่หลับ (Insomnia)- Symptoms, Causes, Diagnose, treatment of insomnia

Insomnia

When you have difficulty falling asleep and staying asleep through the night or you wake up too early and cannot return to sleep, you may suffer from a sleep disorder or insomnia. After waking up,

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Insomnia

When you have difficulty falling asleep and staying asleep through the night or you wake up too early and cannot return to sleep, you may suffer from a sleep disorder or insomnia. After waking up, you may not feel energized. The lack of a restful slumber can deplete your energy, make you feel grumpy, and interfere with your work, well-being, and lifestyle.  

An adult usually needs 7-8 hours of sleep, but this may vary individually.

It is common for adults to have a short-term sleep problem or acute insomnia for several days or weeks. The problem may stem from stress or an upsetting incident. Some may suffer long-term sleep trouble or chronic insomnia for a month or longer. The condition can be a primary problem or a result of medications or diseases.

The sleepless condition is something you do not have to endure. By modifying your lifestyle, your condition can improve. 

What are the symptoms of insomnia?

  • You cannot fall asleep easily.
  • You wake up during the night.
  • You become awake earlier than desired.
  • You do not feel energized after waking up.
  • You feel sleepy or tired during the day.
  • You feel anxious, depressed, or irritated.
  • You cannot concentrate or remember things well.
  • You make more mistakes or are prone to a higher risk of accidents.
  • You constantly feel worried about not falling asleep.

When to see a doctor?

When you cannot properly carry on your daily tasks as usual, please seek medical attention to find the cause and treatment. You may need a sleep test if you are diagnosed with a sleep disorder.

What are the causes of insomnia?

Insomnia can be the primary problem or related with other health problems.

Stress, painful life events, and habits can cause chronic insomnia. Sleep problems can be treated once an underlying cause is found; however, this may take years.

  • What can cause long-term insomnia:
    • Stress
      Having worries over your health, work, school and family, or financial burden may keep you ruminating and make it hard for you to fall asleep. Traumatic events like death, divorce, unemployment, or illness of a loved one can cause insomnia.
    • Change of your biological clock
      Everyone has a biological clock governing your sleep-wake cycle, metabolism, and body temperature. If your internal clock is disrupted by traveling, and change of working shift hours, these may cause sleep disorder.
    • Bad sleep habits
      Follow an inconsistent bedtime routine, engage in vigorous activities before bedtime, stay in an uninviting sleep atmosphere or use your bed for eating, working, or watching television are considered bad sleep habits. Having a screentime before your bedtime may upset your natural sleep pattern.
    • Big dinner or late-night snack
      Before going to bed, please avoid a heavy meal or late-night snack. It can make you uncomfortable and wake you up during the night because of acid reflux symptoms like heartburn and esophagitis.

Certain medications or medical conditions can cause chronic insomnia. Treatments of the medical conditions may improve your sleep.

  • Other causes of insomnia are:
    • Mental health problems
      If you suffer from anxiety disorders, your sleep routine may be disturbed. Waking up too early may be a hint of depression. Sleep disorders can also be related to mental health conditions.
      Medications
      Medications for asthma and blood pressure as well as antidepressants can cause sleep disturbances. Medications for colds, pain, and allergies or weight-loss pills contain stimulants including caffeine which can interfere with your sleep.
    • Health problems
      Some diseases are associated with insomnia. These are cancer, diabetes, chronic pain, heart problems, asthma, gastroesophageal reflux disease (GERD), hyperthyroid, Alzheimer's disease and Parkinson's disease.
    • Sleep-related problems
      Sleep apnea can disrupt your sleep when your breathing stops momentarily during sleeps. Restless legs syndrome keep you awake because you feel so uncomfortable that you have an overpowering urge to move your legs.
    • Consumptions of stimulants
      Caffeine in tea, coffee, soft drinks can stimulate your body at night if you drink them in the late afternoon or evening. Nicotine in cigarettes or other tobacco products can disrupt your sleep. Alcohol may decrease sleep onset latency early in the night. But it keeps you from falling into a deep sleep and you may wake up frequently during the night.
  • Insomnia and age
    Insomnia increases with age. The older you become, the higher the possibility of insomnia.
    • Sleep habits
      When you get older, it is harder to get a relaxed slumber. Any sound or changes in your surroundings may disturb your sleep.  Your biological clock is also likely to shift. You feel exhausted easily during the day and wake up earlier than usual. However, the same hours of sleep are still needed by both older and younger people.
    • Lifestyle change
      A good deal of daytime activities can contribute to a good night sleep. But when you get older, you tend to participate in fewer physical and social activities. With fewer activities, you may nap more often during the day. This can make it more difficult for you to fall asleep at night.
    • Health conditions
      The quality of sleep becomes worse when you have chronic physical pain from conditions like joint and back pain or mental problems like anxiety or depression. Prostate or bladder problems can constantly wake you up to urinate during the night. Some conditions like sleep apnea and restless legs syndrome also increase with age.
    • Medications
      Because older people tend to use more medications, the chance of medication-related insomnia increases.
  • Insomnia in youth
    Children and adolescents can also face with insomnia. They may have problem falling asleep or simply do not want to go to bed because of the change of their circadian rhythm; making them want to stay up and sleep late.

ปัจจัยเสี่ยงของภาวะนอนไม่หลับ- Risk factors of insomniaปัจจัยเสี่ยงของภาวะนอนไม่หลับ- Risk factors of insomnia

Risk factors

A sleepless night is something almost everyone has experienced. But there are certain factors contributing to insomnia.

  • Your gender Women may suffer from insomnia during menstruation, menopause, and pregnancy due to hormonal influence. Menopause symptoms like hot flashes and night sweat can wake you up at night.
  • Your age If you are over 60 years old, your health and sleep habits change over time, leading to insomnia.
  • Physical and mental conditions Issues which are disturbing your mind and health can also affect your sleep.
  • Stress If you are under a lot of pressure, you may face a short-term sleep problem. Persistent stress can eventually cause long-term insomnia.
  • Irregular daily routine If you change your working hours or travel over the time zones, your sleep schedule may be disturbed.

What are the complications of insomnia?

A restful and adequate sleep can contribute to a healthy lifestyle. Sleep loss can damage both mental and physical well-being. People who suffer from insomnia are susceptible to a lower life quality compared to people who do not have a sleep problem.

Complications of Insomnia:

  • Poor performance at work or school
  • Slow response time during driving and prone to be in an accident
  • Mental health problems including drug dependency, depression, and anxiety disorders
  • Higher risk and severity of long-term health threats such as high blood pressure and heart disease

How to prevent insomnia?

A healthy sleep habit can foster quality sleep and prevent sleep deprivation.

  • Stick to the same sleep schedule every day.
  • Stay active during the day for a restful slumber at night.
  • Check if you are taking any medications which affect your sleep.
  • Limit or refrain from taking daytime naps.
  • Limit or refrain from drinking caffeine, alcohol, or using nicotine.
  • Do not eat or drink a large amount of food before going to bed.
  • Create a calm and relaxing bedroom ambiance for a good night's sleep or sex.
  • Soak in a warm bath, reading, and listening to soothing music are nighttime rituals that can help you wind down before bedtime.

How is imsomnia diagnosed?

The insomnia diagnostic study varies and depends on each patient’s condition.

  • Physical exam
    Physical examination is to check if any underlying causes or problems are contributing to your lack of sleep. A blood test may be done to check if your condition is related to thyroid issues or other conditions.
  • Sleep habits review
    You will be questioned about your sleeping habits and will need to fill out a questionnaire to review your sleep pattern and daytime drowsiness. You will be encouraged to write down a diary to record your sleep habits for a few weeks.
  • Sleep study
    You may be required to spend a night at a sleep center to uncover other underlying causes like sleep apnea or restless legs syndrome. While sleeping, tests will be conducted to monitor and review your breathing, heart rate, brain waves as well as eye and body movements.

    How is insomnia treated?

    Many can have a well-rested slumber once again after they modify their sleep routine and clear underlying causes such as anxiety, sickness, or medicines. For those who still suffer from insomnia, medications, cognitive behavioral therapy, or both, may be prescribed to restore a good night's sleep.

    • Cognitive behavioral therapy for insomnia
      Cognitive behavioral therapy for insomnia (CBT-I) is an approach to rid thoughts and actions that keep your mind restless. It is the initial and most important method to treat people with sleep problems. It is usually equally or more successful than using a sleeping pill, especially for the long-term solution.
      The cognitive part of CBT-I allows you to realize and alter your sleep habits. It helps you to be in control and free from worries and negative thoughts. It helps diminish your habit of worrying too much about not being able to fall asleep at bedtime. The behavioral part of CBT-I can promote your sleep health and eliminate poor sleep habits. Those methods are:
      • Stimulus control therapy
        It eliminates factors that keep your mind from quietening down. You will learn how to stick to your sleep-wake routine, avoid napping during the day, and use the bed for sex and sleep only. If you cannot fall asleep within 20 minutes, you should get out of bed and go back to sleep only when you feel sleepy.
      • Relaxation techniques.
        You will learn how to relax your mind and body before bedtime through techniques such as breathing exercises, biofeedback, and progressive muscle relaxation. You will control your breath and heart rate as well as relax your mood and muscles.
      • Sleep restriction
        Your time in bed will be restricted and you must refrain from daytime napping which can lead to insufficient night sleep and increasing fatigue. When you have better sleep quality, you will be allowed to spend more time in bed little by little.
      • Remaining passively awake.
        This is a paradoxical method. You will learn how to become less preoccupied about falling asleep during bedtime. You will lie in bed awake without trying to fall asleep.
      • Light therapy.
        This method uses light to alter your circadian rhythm particularly when you sleep earlier and wake up earlier than usual. A lightbox will be used, or you will need to go out and be exposed to evening light. Please ask your doctor for medical advice.

    Other methods may be recommended to fit your way of living and create a soothing sleep environment. They are to create a sound sleep habit that keeps you alert during the daytime.

    Prescription medications

    Doctors may prescribe sleeping pills to improve your sleep pattern. It is usually not healthy to rely on the pills for longer than a couple of weeks. The pills usually completely lose their effectiveness after a few years of continuous use.

    The side effects may make you feel dazed and tipsy during the day, and you may become dependent on the pill for sleep. Please consult your doctor before using these sleeping pills.


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    Published: 07 Apr 2022

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