Life Style

Haunting Nights

Haunting Nights
By Nagaland Post | Publish Date: 2/11/2019 5:45:54 AM IST

 “The worst thing in the world is to try to sleep and not to” (F. Scott Fitzgerald).  There are too many of us that take sleep for granted. To the extent that we find it difficult to understand the plight of someone who doesn’t sleep well. If you think about it, our entire day leads up to this one eventuality- falling into the arms of sweet liberating sleep. 

What would it be like if this eventuality kept evading you? You wake up like the rest, you work like the rest and your bones feel fatigue like the rest. Yet, you cannot sleep like the rest. As evening sets in, a familiar fear creeps into your mind; today will also be like the other days and you will be lying on your bed, wide awake. 

Insomnia is as real as any other physical or mental condition. Insomnia is characterized by inability to sleep/total lack of sleep. The difficulty can be of varying types- difficulty initiating sleep, difficulty maintaining sleep, early awakening or poor quality of sleep. This condition is not only under recognized but also under diagnosed and under treated. 

Age and gender have been identified as demographic risk factors with increased prevalence noted in women and older adults. In women, insomnia is much more likely at the onset of menses and menopause. For the elderly population, it has been hypothesized that decline in the functionality of sleep control system may be responsible. 

During old age, there is also likelihood of co-morbid medical conditions that may increase the risk for insomnia. Other risk factors include co-morbid psychiatric disorders/medical disorders and working late nights/changing work shifts. 

As a result of its chronic nature, insomnia can lead to substantial deterioration in one’s quality of life. 

Findings from numerable studies have indicated impairment in major domains such as physical health, social functioning and mental health. Sleep has restorative properties. When you go to sleep, your body has the time to rest and recover, ensuring that you wake up feeling refreshed. 

This does not take place when there is insomnia. As a result, individuals have lowered productivity at work (decreased concentration, fatigue, unable to perform duties). Individuals experiencing insomnia are also more likely to have accidents (road traffic accidents/accidents at workplace such as industries). 

An association has been found between insomnia and depression, though the relationship is yet unclear. 

Some studies have found insomnia to be a risk factor in the development of depression while other studies found insomnia to be a part of the symptom complex of depression. 

It is likely that sleep and mood share common pathophysiology. Insomnia has been associated with stress, the neuroendocrine system and adverse life events. 

The cognitive model of insomnia offers an understanding of the maintaining factors. Often, it may not be possible to find the cause for insomnia and finding it may not be relevant for the treatment process. Maintaining factors, on the other hand, lead to the insomnia persisting. It has been conceptualized that insomnia is maintained by a host of cognitive processes that operate during the night and day. 

This includes worry (usually accompanied by arousal), dysfunctional beliefs, overestimation of sleep disturbance and counterproductive safety behaviours. Individuals with insomnia tend to lie on the bed and worry about various topics including sleep. When you worry, this activates the sympathetic nervous system. 

This is the system responsible for the “fight or flight” response. In other words, you are in bed (because you want to sleep) but your body and mind are in a state of alertness. Thus, insomnia then continues through a cycle of thoughts and sensations.

Individuals may also engage in certain “safety behaviours” as a way of managing the insomnia. For example- drinking alcohol to diminish anxiety and promote the onset of sleep. Drinking alcohol may lead to onset of sleep but is also more likely to cause frequent awakening and disturbing the overall quality of sleep. 

There are various channels of treatment available for insomnia. Pharmacological treatment is one option available. However, the problem with medication is that it is recommended for short term use. On ceasing the use of medicines, the problem often returns. Non pharmacological options are also available such as relaxation training, stimulus control, sleep hygiene and cognitive behaviour therapy for insomnia (CBT-I). 

Few changes such as modification in lifestyle (part of sleep hygiene) can be initiated by the person themselves. This includes restricting intake of caffeine and nicotine, decreasing daytime napping and including physical activity in the daily routine. Techniques such as relaxation training and CBT-I will require the involvement of a professional. 

Research conducted on the efficacy of such methods has shown promising results. As distressing and frustrating the experience of insomnia can be, there is something concrete that can be done to overcome it. Insomnia does not have to be a death sentence hanging over your head for the rest of your life. 

Parvathy Nair, Clinical Psychologist,

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