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Insomnia and Sleeping Better

Overview of Insomnia

Insomnia is a rather common sleep disorder. It is a disorder characterized by a difficulty to fall asleep or to stay asleep, or both. People with insomnia usually wake up feeling unrested and unrefreshed, which should not be the case if a person has had a good night’s sleep. This is why insomnia causes a person to be devoid of energy, resulting in decreased work performance and quality of life. The mood of the person may even be affected as the person may be grouchy and moody due to feeling tired all the time. In other words, insomnia is a sleep disorder that takes a toll on a person’ ability to function well during the day. Everyone requires different amounts of sleep. For instance, infants sleep a lot, but adults only require about seven to eight hours of sleep every night. This amount also various from person to person. As mentioned earlier, insomnia is a rather common sleep disorder.

A large percentage of adults will experience insomnia at some point in their lives, but other may have chronic insomnia (i.e. long term insomnia). Hence it is important for you to understand what insomnia is, and know how to identify if you are suffering from it and whether you need to seek professional help.

Types of Insomnia

There are two ways to classify insomnia – type and duration.

Insomnia can be classified into two different types of insomnia – primary insomnia and secondary insomnia. Primary insomnia means that the person is experiencing a sleep disorder that is not directly associated with any other existing health conditions or problems. Secondary insomnia, on the other hand, means that the person is experiencing a sleep disorder that is caused by something else. This could be a health condition, medication, etc.

Insomnia can be long term, or short term.

Long term insomnia is referred to as chronic insomnia, whereas short term, or temporary, insomnia is referred to as acute insomnia. Chronic insomnia is defined as insomnia that lasts for at least three nights a week for a month or longer. Acute insomnia, on the other hand, is defined as insomnia that lasts from just one night to a length of a few weeks. Even in the case of chronic insomniacs, there could be temporary periods where the insomnia seems to simply disappear, and the person enjoys high quality sleep for a period of time before the insomnia sets in once again.

There is one other type of insomnia. Termed ‘learned’ insomnia, it can be either chronic or acute, depending on intensity, but either way, it is caused by an individually worrying excessively about being unable to sleep well. The person tries too hard to fall asleep, such that he or she ends up making his or her brain too busy to be able to fall asleep.

Causes of Insomnia

Insomnia can be due to many different reasons. In addition, acute insomnia and chronic insomnia may also be due to differing causes. Acute insomnia is usually caused by milder reasons, such as significant life changes (such as job loss, death of a loved one, divorce et cetera), illness, environmental factors (such as noise, bright lights, extreme temperatures – both hot and cold), medications (such as depression medication, high blood pressure medication etc), interference with normal sleep schedule (such as switching from a day work shift to a night work shift, jet lag etc) or emotional or physical discomfort.

Chronic insomnia, on the other hand, may be caused by more serious and long lasting reasons such as depression and/or anxiety, pain or discomfort at night due to possible physical conditions and chronic stress.

Factors that may contribute to Insomnia

The following is a generic list of factors that may cause an individual to develop insomnia (either type, depending on severity and duration of effects of these events), and a brief explanation of why that factor can cause insomnia:

  • Anxiety – Anxiety may affect a person’s quality of sleep since the person is preoccupied with whatever he or she is feeling anxious about, being unable to relax the mind, and hence is unable to have a good night’s sleep.
  • Depression – An individual with depression, similar to an individual with anxiety, may be unable to have a good night’s sleep due to he or she being preoccupied being certain issues, being unable to relax the mind to have a good night’s sleep. Depression can also cause insomnia because it causes chemical imbalances in the brain, which may affect sleep quality as well.
  • Caffeine – This addictive substance which occurs in beverages such as coffee and cola is a stimulant. If a person consumes such substances, especially if it is consumed in the late afternoon or later in the day, he or she may be unable to fall asleep at night due to their brain still being stimulated and hence unable to relax enough for the person to fall asleep.
  • Alcohol – Although alcohol can function as a sedative, helping a person to fall asleep, it prevents deeper stages of sleep, hence preventing a person from having a good night’s rest. Also, the consumption of alcohol often causes a person to awaken in the middle of the night, hence causing sleep to be disrupted.
  • Medication – Some medications and prescription drugs have the potential to cause insomnia. They interfere with a person’s sleep in various different ways. Prescription drugs that may cause insomnia include, but are not limited to, allergy medications, corticosteroids, blood pressure medications, antidepressants (as aforementioned) and heart medications. Many over the counter (OTC) medications may interfere with sleep and cause insomnia as well. Over the counter medications that may cause insomnia include, but are not limited to, decongestants, weight loss products and certain pain killing medications. Some of these medications cause insomnia in an ‘indirect’ way. For instance, antihistamines, like alcohol, initially cause one to become groggy, hence allowing him or her to fall asleep easily. However, it causes one to have to urinate more often. Hence, even though antihistamines allow one to fall asleep easily, it also causes the person to have to wake up multiple times throughout the night to urinate, hence eventually disrupting sleep.
  • Stress – When an individual is overly stressed about different things, be it school, work, family, health or relationships, his or her mind may be overly active at night, making him or her unable to fall asleep. When we say ‘stress’, we also refer to stressful life events and changes, such as death of a loved one, illness of a loved one, loss of job, change of job, divorce, or moving house. All these cause a person to be unable to relax fully either by affecting the body’s circadian rhythms or otherwise, hence affecting his or her sleep quality.
  • Medical conditions – Persons with medical conditions that affect sleep quality directly, or indirectly, may have insomnia. For instance, if a person has a medical condition that causes him or her to have chronic pain, or to have to urinate frequently, his sleep will be disrupted. Also, individuals suffering from breathing difficulties (chronic illnesses or even persons who have the flu) may face difficulties getting a good night’s sleep. Other medical conditions that have been found to be connected to insomnia include, but are not limited to, cancer, heart failure, lung disease, stroke, arthritis, Alzheimer’s disease, an overactive thyroid, Parkinson’s disease and gastrointestinal reflux disease, also known as, GERD.
  • Over eating in the evening and/or before bedtime – Some people like to have a light snack before bed as they are unable to sleep on an empty stomach. That is actually fine. However, if a person eats too much before bed, he or she will feel physical discomfort when he or she lies down on the bed. This causes him or her to experience difficulty falling asleep. Over eating before going to bed may also cause heartburn, further contributing to insomnia, as heartburn is a back flow of acid and flood from the person’s stomach back up into the esophagus, which creates an uncomfortable feeling.
  • Poor sleep habits – If a person practices bad sleep hygiene, he or she will develop insomnia. Examples of poor sleep hygiene includes engaging in stimulating activities before bed, using the bed for activities other than sleep or sex, having an unfavorable sleep environment (e.g. bright lights, loud noises), or having an irregular sleep schedule.

Aging

Aging is also a common cause of insomnia. Many individuals find that they develop insomnia as they age. The following is a list of age-related factors that contribute to insomnia:

  • A change in sleep pattern – As a person ages, he or she will find that his or her sleep patterns will change. For example, he or she will be more likely to be awoken by noises or a change in temperature in the middle of the night. Also, aging often causes a person’s internal clock to shift forward, meaning that the person gets tired earlier in the evening and wakes up earlier in the morning the following day.
  • A change in health – With age comes a wide array of age-related medical conditions. Such conditions include arthritis or back problems. These problems cause chronic pain for aged individuals, hence causing them to experience physical discomfort, which in turn prevents these aged individuals from easily falling asleep at night. In the case of older or elderly men, a large percentage of them contract benign prostatic hyperplasia, a non-cancerous enlargement of the prostate gland. This causes them to have to urinate frequently, hence requiring them to have to wake up frequently to make trips to the toilet during the night. This disrupts the person’s sleep. In the case of older or elderly women, they may experience hot flashes, also known as hot flushes or night sweats, which are associated with menopause. These also cause physical discomfort, hence causing aged females to have disrupted sleep. Some other age related medical conditions that affect sleep, but are not gender specific include, but are not limited to, sleep apnea (causes one to stop breathing periodically during the night time) and restless legs syndrome (causes one to have an uncomfortable sensation in the legs at night, resulting in the person having to constantly move the leg to alleviate the unpleasant sensation, hence causing the person to be unable to fall asleep).
  • A change in daily activities – As people age, they tend to change the activities they engage in daily. For instance, elderly persons tend to be less physically or socially active as compared to younger persons. As a result of the loss of activity, older or elderly persons will be less able to fall asleep or to maintain sleep at night. In addition, this lack of activities to engage in during the day may spur some older or elderly persons, especially those who are retired and have nothing to occupy their time, to take afternoon naps. These naps also have detrimental effect on the ability of a person to fall asleep at night, or to maintain sleep.
  • Increased use of medications – As a person ages, he or she is likely to develop an array of age related medical conditions. As a result, elderly individuals use more prescription drugs and over the counter drugs than young individuals do. As such, elderly individuals face an increased risk of developing insomnia caused by a medication.

Symptoms of Insomnia

As insomnia is a condition that can have great detrimental effect on a person’s quality of life and ability to function, it is important to be able to recognize the symptoms of insomnia and to be able to determine if your condition requires a professional’s help.

Symptoms of insomnia

  • Tiredness during the day
  • Irritability (due to lack of sleep)
  • Problems concentrating or remembering things
  • Difficulty falling asleep at night
  • Awakening during the night
  • Awakening too early in the morning
  • General tiredness
  • Not feeling refreshed and well rested after waking up in the morning
  • Increased carelessness due to a decreased ability to focus
  • Tension headaches
  • Feeling as if you have not slept at all for the entire night
  • Gastrointestinal symptoms

As mentioned before, it is important to know if your condition warrants a trip to the doctor. If your insomnia is mild, you can probably afford to wait a few days or for a week to monitor your condition and see if it improves. If it worsens or does not improve, it is advisable to schedule an appointment to consult your doctor. Also, if your insomnia causes you to have decreased ability to function well during the day, you should also schedule an appointment to consult your doctor.

Diagnosis of Insomnia

Doctors have several different methods of determining if you have insomnia, or to determine the seriousness of your condition. To evaluate your condition, a doctor may conduct a physical exam to look for signs of other problems that may be causing your insomnia, and ask questions about your medical history and sleep history. He or she may ask you to monitor your sleep for a week or two by keeping a sleep diary, taking note of your sleep patterns during the night and the condition of your mind during the day. Blood tests may also be done to check for underlying medical conditions that could have caused your insomnia. In some, more serious, cases or if your doctor is unable to find the cause of your insomnia, your doctor may refer you to a sleep centre, where you will undergo special sleep tests and observations.

The following is a list of questions that your doctor may ask you. To better prepare yourself for the visit to your doctor’s clinic, do think through these questions in advance so as to allow the doctor to be able to give a more accurate evaluation.

  • Do you often worry about being unable to sleep?
  • Do you experience tiredness during the day?
  • What time do you usually go to bed at night?
  • What time do you usually wake up in the morning?
  • What are some of the activities you usually do before going to bed?
  • Do you eat before going to bed?
  • Are you particularly stressed out recently?
  • Do you suffer from depression?
  • Do you have any underlying medical conditions?
  • Are you currently taking any medications?
  • Do you drink caffeinated beverages such as coffee or cola in the late afternoon or later in the day?
  • Do you drink alcohol?
  • Do you smoke cigarettes?
  • Do you experience chronic pain at night?
  • Do you experience difficulty breathing at night?
  • Do you experience restlessness or an unpleasant sensation in the legs at night?
  • Have you noticed any changes in your sleep patterns recently?
  • Do you wake up frequently at night? For what reason?
  • How long do you usually take to fall asleep at night?
  • Do you feel tired and unrefreshed upon waking up in the morning?

Treatments of Insomnia

Different types of insomnia require different types of treatment. In fact, if your insomnia is mild and acute (short term) you may not require treatment at all. Instead, you can try to practice good sleep hygiene to cure the mild and acute insomnia. A guide to practicing good sleep hygiene will be provided later on in this article. As for chronic insomnia, your doctor will first have to find any underlying medical conditions that could be causing the insomnia. Once this underlying medical condition has been treated, the insomnia, in most cases, will naturally cease. Next, we will move on to discuss some common treatments for insomnia and their effectiveness.

Behavioral Therapy – Behavioral therapy is usually the first course of treatment provided for people with insomnia. Behavioral treatments aims to teach people with insomnia new sleep behaviors, kicking any old behavior that may contribute to insomnia (e.g. consuming caffeinated beverages before going to bed). It also aims to teach these people ways to improve their sleeping environment. Behavioral therapy is rather effective, and has been proven to work as well, or in some cases even better, than sleep medications.

Behavioral therapy also includes teaching the person some relaxation techniques that he or she can apply to help himself or herself relax when going to bed, so as to be able to fall asleep easily. Some relaxation techniques include breathing exercises and progressive muscle relaxation. Another component of behavioral therapy is sleep restriction. It entails limiting the time the person spends in bed. As a result, the person will be partially deprived from sleep (not to an extent that it becomes dangerous), which makes him or her more tired the next night, hence being able to fall asleep and to maintain sleep. As the treatment progresses, the person becomes more able to fall asleep each night, and will slowly be able to fall asleep normally even without being deprived of sleep. The next component of behavioral therapy is cognitive behavioral therapy. This is more of a counseling session. It involves replacing the person’s worries about being unable to sleep with other, more positive, thoughts through counseling. Light therapy is another form of behavioral therapy. Professionals will use the control of light to manipulate the person’s internal clock. For instance, if the person is used to sleeping too early at night and then waking up too early the next day, doctors will use light to push back the person’s internal alarm clock so that the body can slowly adjust its internal clock to a more ‘normal’ or desired pattern. The last component of behavioral therapy is stimulus control. This means that through actions, the brain is reprogrammed to classify the bed as a place to rest, not for stimulating activities. This means that the person should stop, or at the very least limit, carrying out any stimulating activities in his or her bed, only using the bed for sleep and sex.

Prescription Medications – Some doctors may prescribe sleeping pills to patients suffering from insomnia. Such prescription sleeping pills include Xanex, Halcion, Ramelteon, Eszopiclone, Zaleplon and Zolpidem. Although these prescription sleeping pills help people with insomnia to fall asleep, they also pose a small risk. Although the cases are rare and few, these prescription sleeping pills may trigger severe allergic reactions in some people.

Allergic reactions include the usual reactions such as facial swelling, but the real danger lies in the reaction of unusual behaviors. If a person has an allergic reaction from the above prescription sleeping medications, he or she may do certain unusual things in his or her sleep. For example, he or she may prepare food while asleep, eat food while asleep, or even drive while asleep, which is extremely dangerous. Also, prescription medications often have numerous side effects such as excessive drowsiness, agitation and impaired thinking. These side effects are often more pronounced in older individuals. As above mentioned, these prescription sleeping pills help a person with insomnia fall asleep easily, but it is not advisable for people with insomnia to rely on prescription sleeping pills indefinitely as some of them may be habit-forming. In other words, the person could become addicted to the drug.

Also, it is always better to have a regular sleep pattern naturally instead of having to rely on drugs. Over the counter Sleeping Medication – There are certain sleep medications available over the counter as well. Many of these contain the same chemical – antihistamines. Antihistamines make a person drowsy, hence allowing the person to fall asleep easily. However, they may also cause reduced quality of sleep, and also have several side effects that the person may experience during the day, such as dry mouth, blurred vision and day time sleepiness. As with prescription sleeping medication, these side effects may be more pronounced in the elderly.

Some Alternative Methods and Tips to Overcome Insomnia

If you are not willing or not able to consult a professional physician, or if your insomnia is mild and you feel it does not warrant a trip to the doctor’s, there are some alternative methods and tips that you can consider trying. Maintaining good sleep hygiene – Also known as good sleep habits, good sleeping hygiene can help people to beat insomnia. The following list contains some examples of good sleep hygiene and other tips to help you beat insomnia:

  • Going to sleep at the same time every night, and waking up at the same time every morning.
  • Avoid taking afternoon naps.
  • Avoid the consumption of caffeinated beverages late in the day.
  • Avoid the consumption of alcoholic beverages late in the day.
  • Don’t eat too much late in the day, especially before sleeping (a light snack is acceptable and may even help you to sleep better, but don’t overdo it).
  • Exercising regularly, but not too close to bedtime either, as that may stimulate you and make you unable to fall asleep (experts recommend having your exercise sessions at least three to four hours before the time you plan to go to bed).
  • Make your bedroom a more conducive sleeping environment (e.g. make sure that it is dark, quiet, and has a comfortable temperature). If you are unable to make your bedroom a more conducive sleeping environment, try the following: use a sleeping mask to block out light from your eyes, use earplugs or a white noise machine to block out noise.
  • Don’t try too hard to fall asleep; if you are unable to fall asleep, don’t force yourself but rather, get up and do something that is not overly stimulating (such as reading a book) until you feel sleepy. Trying too hard to fall asleep will result in anxiety, which in turn actually prevents you from being able to fall asleep.
  • Make a to-do list before you go to bed, so that you don’t have to keep worrying about these things when trying to fall asleep. Avoid using the bed, or even the bedroom if possible, for anything other than sleep and sex. Follow a fixed routine to help you fine tune your internal clock (e.g. always do the same things before going to bed, so that your brain will be programmed to prepare itself for sleep when you do these things).
  • Find ways to relax before bedtime. For instance, you can take a relaxing warm bath or have a massage. Some people also choose to do relaxing things such as yoga or meditation, or to do breathing exercises or to listen to relaxing music.
  • Be more aware of your own health. If you experience chronic pain, schedule an appointment for a consultation with your doctor immediately.
  • Hide your bedroom clock. As strange as this may sound, seeing the glowing numbers and arms at night actually put pressure on you to fall asleep. For example, you may be unable to fall asleep, and when you look at the clock and see that it is already 2am, you may get frustrated and anxious, asking yourself “It’s already 2am, why can’t I fall asleep?” This anxiety and frustration actually worsens your insomnia, making it even more difficult for you to fall asleep.
  • Drink a glass of warm milk before going to bed. Calcium, a component of milk, helps jagged nerves to relax, hence helping you to fall asleep easily.
  • Drink a glass of herb tea before going to bed. Possible teas include camomile tea, catnip tea, anise tea or fennel tea. These are organic teas that help to soothe you, hence helping you to fall asleep more easily.

The following are some alternative tips on beating insomnia. They are in no way a doctor’s prescribed course of treatment, but some people who have had insomnia in the past have claimed that these methods have helped them beat insomnia in some way or another:

  • Sleep on a good quality bed
  • Sleep in a well ventilated room
  • Sleep on your back
  • Sleep with your head facing north
  • Don’t watch TV or read before going to bed
  • Wiggle your toes
  • Rub your stomach
  • Visualize something peaceful
  • Visualize something boring
  • Imagine that it is time to wake up
  • Stop thinking about anything. Try to empty your mind
  • Smoke yourself to sleep
  • Yawn
  • Sex
  • Count backwards
  • Sleep in a secure place
  • Use a hot water bottle
  • Take a short walk before going to bed
  • Acupuncture

Disclaimer: This article was not written by a physician, and does not claim to be able to identify or treat insomnia; it is merely an informative guide to insomnia. If you suspect that you are suffering from insomnia, please consult your doctor.

References


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