Insomnia

The quality of sleep is determined not only by its duration — healthy sleep is deep, undisturbed, and leaves a rejuvenated feeling in the morning. Insomnia manifests as a disruption of any of these components. While it can occur independently, it often accompanies organic pathologies, dementia, depression, anxiety disorders, bipolar disorders, and other psychotic or neurotic conditions. Insomnia may also present as a transient phenomenon in the context of stress or changes in flight and time zones. Over time, sleep disorder will result in numerous psychosomatic risks:

• Daytime fatigue.
• Impaired Cognitive function.
• Emotional distress.
• Reduced Productivity.
• Diabetes.
• Metabolic disorders.
• Weight gain.
• Cardiovascular diseases.
• Weakened Immune System.
• Increased risk of Substance abuse.

Approximately 30% of the adult population report sleep difficulties, and 10% suffer from chronic insomnia.

Sleep quality has a direct impact on mental health, cognitive functioning, the immune system, and overall quality of life. Chronic sleep deprivation increases the risk of depression, anxiety disorders, and other mental health conditions.

Types of sleep disorders

Difficulty falling asleep (initial insomnia) — it takes more than 30 minutes to fall asleep after going to bed. It is often associated with anxiety and overactive thinking.

Sleep fragmentation (middle insomnia) — waking up several times during the night and having difficulty falling back asleep.

Early awakening (terminal insomnia) — waking up at 3–5 a.m. and being unable to fall back asleep. It is often a symptom of depression.

Non-restorative sleep — despite adequate duration, the person wakes up feeling tired.

Causes:

• Stress.
• Flying and time zone changes.
• Neurological disorders.
• Dementia.
• Anxiety.
• Depression.
• Mania.
• Psychosis.
• Obsessive-Compulsive Disorder.
• Phobias.
• Withdrawal from marijuana or other drugs.
• Withdrawal from alcohol in alcoholism…

Mental health conditions

Depression — 75% of patients experience sleep problems

Anxiety disorder — hypervigilance makes it hard to fall asleep

PTSD — Nightmares and Waking Up at Night

Bipolar disorder — during a manic episode, the need for sleep decreases sharply

Insomnia treatment

CBT-I (cognitive-behavioral therapy for insomnia)

CBT-I is the first-line treatment for insomnia. Psychotherapists at GSMRC use:

Sleep restriction therapy — the time spent in bed is matched to the actual time spent sleeping

Stimulus control — using the bed only for sleep

Cognitive restructuring — changing negative beliefs and attitudes about sleep

Relaxation techniques — progressive muscle relaxation, mindfulness

Medication treatment

When CBT-I is not sufficient, a psychiatrist may prescribe:

Melatonin agonists

Orexin receptor antagonists

Low-dose antidepressants — trazodone, mirtazapine

Important: Long-term use of sleeping medications is not recommended. All medications should be taken only as prescribed by a psychiatrist!

Sleep hygiene includes the following behavioral measures:

• Comfortable, familiar environment.
• Darkness.
• Coolness.
• Silence.
• Sleep environment: a dark, quiet, cool room (18–20°C)
• Turn off screens: avoid blue light 1 hour before bedtime
• Consistent wake-up and bedtime.
• Limiting food and liquid intake in the evening.
• Caffeine: have your last cup no later than 14:00
• Minimizing prolonged time in bed while awake.
• Restricting physical activity a few hours before bedtime.
• Exercise: regular, but not within 3 hours before bedtime

When should we consult a specialist?

The sleep problem has lasted for more than 3 weeks

Insomnia significantly impairs daytime functioning

Sleep disturbances are often accompanied by depressive or anxiety symptoms

You are using sleeping medications without a doctor’s prescription

Any form of insomnia requires treatment.

Source: NHLBI — Insomnia.