Insomnia
Insomnia refers to a difficulty getting enough sleep. It is characterized by trouble falling or staying asleep (frequent arousals in the night or early morning arousals). About one third of adults and a quarter to a third of children suffer from insomnia. These sleep problems can have repercussions on daytime functioning (fatigue, irritability, cognitive disorders, deteriorated mood and motivation) and interpersonal relations (family tension, physical abuse in children).
What causes insomnia?
The causes of insomnia are diverse: lifestyle (stimulants, alcohol, snacking, work schedule, exercise, etc.), environmental factors (light, noise), psychological factors (stress, anxiety, depression, bipolar disorder, etc.) or other medical conditions (sleep-related movement disorders, sleep apnea, dementia, asthma, chronic respiratory failure, gastroesophageal reflux, migraines, pain and menopause). In this case, the insomnia represents the symptom of another condition and is referred to as secondary insomnia. Sometimes, insomnia occurs without any identifiable cause, and is therefore called primary insomnia.
1. Acute insomnia: This type of insomnia lasts a few days and disappears in less than three months. This problem is usually quickly resolved once the trauma or the factors involved have disappeared. Sometimes, in more vulnerable people, insomnia persists and becomes chronic.
2. Chronic insomnia: This type of insomnia persists for weeks, months, even years. For example, idiopathic insomnia is a stable and chronic condition that appears without any precipitating factor. This sleep disorder seems to run in families, is seen in approximately 0.7-1% of teens and adults, and is rare in young children. Another chronic type of insomnia is psychophysiological insomnia. This condition is characterized by cognitive hypervigilance, intellectual or physical hyperactivity during the day, and negative sleep conditions. It is usually caused by factors such as depression, pain, disturbed sleep environment or shift work and is found in 1-2% of the general population.
How is insomnia treated in adult?
1. Identifying the cause: Treating insomnia requires taking the cause of the problem into consideration. Often, insomnia is triggered by a combination of factors, be they environmental (noise, light), physical (chronic pain), psychological (depression) or medical (gastroesophageal reflux, sleep apnea, and sleep-related movement disorders).
2. Medication: The right medication may relieve insomnia caused by acute stress, shift work, travel across time zones, or chronic insomnia. However, this medication should ideally be taken for a short period since it can have side effects (drowsiness, cognitive disorders), be habit-forming, or lose its effectiveness in the long term. There are natural supplements, but they can have negative effects when used in conjunction with allopathic medication. Moreover, it must be controlled by Health
3. Cognitive Behavioural Therapy (CBT): This method is based on relaxation (to reduce tension at bedtime), stimulus control (to establish a positive association between the bedroom and bedtime), sleep restriction (to limit the time spent in bed to real sleep time), and cognitive restructuring (to erase the belief that we must sleep eight hours a night). Between 70 and 80% of people with insomnia can benefit from cognitive-behavioural therapy. The success of this method primarily depends on whether or not the advice is taken. In certain cases, medication may also be used along with the therapy, or the help of a therapist may be recommended.
4. Sleep hygiene helps the individual adapt habits that can make sleep as good as possible. Maintaining good sleep hygiene helps prevent or minimize sleep disorders.
Consult your physician to find the right treatment for your condition.
How is insomnia treated in children?
Advice for parents
1. Establish a comforting, warm and safe sleep routine while still encouraging the child to be
2. Identify the cause of the insomnia: environmental (recurring noise) or biological (colic).
3. Consult a health professional before the sleep problem becomes chronic.
Signs of insomnia
Resistance at bedtime (in children)
Unrestful sleep
Fatigue
Cognitive disorders (reduced alertness and attention)
Mood disorders
References:
Ohayon, MM. Epidemiology of Insomnia: What We Know and What We Still Need to Learn. Sleep Medicine Reviews, 6 (2002): 97-111.
Morin, CM, et al. Nonpharmacological Treatment of Chronic Insomnia. Sleep, 22 (1999): 1156-1234.
Morin CM. Vaincre les ennemis du sommeil. Montréal, Éditions de l’Homme; 1997.
Touchette, E., et al. Factors Associated with Fragmented Sleep at Night Across Early Childhood. Arch Pediatr Adolesc Med, 159, 3 (2005): 242-9.
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