Insominia : Causes, Diagnosis, Treatment

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Postsomnic Disturbances

Insomnia manifests even during wakefulness after awakening. It is difficult for the individual to wake up early, and they feel lethargic throughout their body. Sleepiness and reduced productivity may accompany the individual throughout the day. Often, non-imperative daytime sleepiness is observed: even with all conditions conducive to good sleep, the person cannot fall asleep.

There are noticeable mood swings, which adversely affect interactions with others, often exacerbating psychological discomfort. For some time after waking up, individuals may experience headaches, and an increase in blood pressure (hypertension) is possible. It is characterized by a more pronounced increase in diastolic blood pressure.

Diagnosis

Insomnia is diagnosed based on the patient’s complaints and their physical condition. The actual duration of sleep is not crucial; the 5-hour threshold is a sort of minimum: having less sleep for three consecutive days is equivalent to one night without sleep.

There are two clear diagnostic criteria for insomnia: delayed sleep onset of more than 30 minutes and sleep efficiency reduced to 85% or less (the ratio of actual sleep time to the time spent in bed).

Disruption of the circadian rhythm (early sleep onset and early awakening – “lark” person, or late sleep onset and late awakening – “owl” person) is diagnosed as a pathology if the individual experiences postsomnic disturbances and does not have the opportunity to sleep longer or fall asleep earlier.

Sometimes, individuals with chronic insomnia are advised to keep a diary for a month, recording periods of wakefulness and sleep. In cases where insomnia is accompanied by breathing disorders (obstructive sleep apnea) and motor activity disturbances, as well as in cases of ineffectiveness of medication therapy, a consultation with a sleep specialist and polysomnography are prescribed. Computerized analysis provides a complete picture of sleep, determines the duration of its phases, and assesses the body’s functioning during sleep.

Diagnosing insomnia does not pose difficulties; it is often more challenging to determine the true cause or combination of factors that caused insomnia. Consultations with specialists may be required to identify somatic pathology.

Treatment of Insomnia

Transient insomnia usually resolves on its own or after addressing the underlying causes. Subacute and especially chronic insomnia require a more attentive approach, although treating the root cause is fundamental.

Successful elimination of insomnia involves adhering to sleep hygiene. Daily sleep at the same time, avoiding daytime naps, and maintaining daytime activity can completely eliminate insomnia in elderly individuals without the use of medication.

Psychotherapy can help alleviate psychological discomfort and restore sleep. Acupuncture and phototherapy (treatment with high-intensity white light) have shown good results in treating insomnia.

The use of hypnotic drugs promotes rapid onset of sleep and prevents frequent awakenings. However, hypnotics have a number of adverse effects, ranging from habituation to dependence and rebound effect. That is why pharmacological treatment of insomnia begins with herbal remedies (valerian, mint, thyme, peony, etc., medicinal herbs with a sedative effect) and preparations containing melatonin. Drugs with a sedative effect (neuroleptics, antidepressants, antihistamines) are prescribed to increase sleep duration and reduce motor activity.

Medication for Insomnia

Imidazopyridine and cyclopyrrolone drugs have a short duration of action and do not induce post-insomnia disturbances, making them among the safest chemical hypnotics. Tranquilizers – benzodiazepines – predominantly inhibit brain processes, thereby reducing anxiety and increasing sleep latency. These drugs can lead to dependence, significantly affect reaction time, and enhance the effects of barbiturates and analgesics.

Guidelines for taking medications for insomnia include: adherence to the duration of hypnotic treatment – typically 10-14 days (no more than 1 month); medications may be prescribed in combination, considering their compatibility; the choice of a specific medication depends on concomitant somatic pathology and the minimal set of side effects. For preventive purposes, hypnotics are prescribed 1-2 times a week. It is important to understand that the use of hypnotics is purely symptomatic treatment. This fact, along with the multitude of undesirable consequences, necessitates limiting their use as much as possible.

Prognosis and Prevention

To completely eliminate insomnia, it is important to adhere to the following rules: do not delay visiting a neurologist when obvious signs of insomnia appear; do not take medications without a doctor’s prescription. It is essential to strictly follow a daily routine (balanced activities, walks, and sufficient sleep time) and develop personal stress resilience; emphasis should be placed on psychological techniques and minimal use of medications.

The prognosis for acute and subacute insomnia is favorable; in most cases, treatment does not require the use of hypnotics and tranquilizers. Treating advanced chronic insomnia is a lengthy process; only close collaboration between the patient and the doctor will allow for the selection of an effective treatment regimen and achieving positive results.

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