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INSOMNIA (Disorder of Sleep)
Dr. Rukhshanda Alam, Riyadh KSA

It comes from a Latin word, which means ‘no sleep’. In general practice, it is quite a common complaint of sleep. Either there is no sleep at all or there is disturbed or inadequate sleep. Females are affected more than males. The problem is more common in aged persons, rising to 1:2 amongst the over 65 years old.

CAUSES:
There are many. Most common ones are
• Minor: They are self-limiting and are due to circumstances like travel, shift work, small children.
• Psychological: Alcoholism, Anxiety, Depression and Grief.
• Physical: Pain, Pruritis (itching), Tinnitis (ear ringing), Nocturia, Asthma, Drugs (steroids), Night time sweats (meno pause)

WHAT IS A GOOD NIGHT’S SLEEP?
When a person takes less than 30 minutes to fall asleep, sleep is maintained for 6-8 hrs, there are less than three brief awakening and person feels well rested on getting up.

COMPLICATIONS:
Decreased quality of life, Decreased concentration and Memory, Effect on daytime tasks, Risk of accidents-------10% motor accidents are related to tiredness.

HOW TO MANAGE:
• Person should be carefully evaluated.
• Cause should be eliminated e.g. Pain should be relieved with long acting painkillers, treat asthma, and try hormonal therapy for menopausal sweating etc.
• Treat the psychological causes.
• Use relaxation techniques. Calm, quiet dark room, audiotapes or techniques taught by Psychotherapists.
• Drug treatment: It should be considered as the last resort, only when insomnia is severe, disabling and leading the person to extreme distress. Benzodiazepines should be prescribed first but patient should be warned about their sleepy (drowsy) effect, so should not do any technical work after taking those pills. Be aware of the side effects of these drugs like dependence and abuse
• Follow sleep hygiene.

WHAT IS SLEEP HYGIENE:
• Do not go to bed until you feel sleepy.
• Do not stay in bed if you are not asleep.
• Avoid daytime naps.
• Make regular bedtime routine.
• Do not eat, read, work or watch TV in your bed.
• Your bed and bedroom should be comfortable, neither too cold, nor too hot.
• Avoid strong tea, coffee and alcohol at sleep time
• Have warm bath and warm glass of milk before going to bed
• Rise at the same time in the morning regardless of how long you slept.


REMEMBER:
Sleeplessness may no be a disease itself, but it may be an indication of ‘something wrong’ going on. So always consult your doctor if there is any change in your sleeping pattern.

 

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