Insomnia / Sleeplessness

Sleep Disorders

- Dr. Rehana Khan

What do you mean by insomnia?

Difficulty in sleeping or inability to fall asleep or to remain asleep long enough to feel rested, especially when this is a problem that continues over time.

It is also explained as:

· Inability to sleep,

· Over a period of time;

· Difficulty initiating sleep;

· Difficulty maintaining sleep;

· Early morning awakening;

· Non Restorative sleep.

Types of Insomnia:

1. Transient Insomnia (short term),
2. Intermittent Insomnia (on and off),
3. Chronic  Insomnia (constant).

Transient Insomnia-

Insomnia lasting from a single night to a few weeks is referred to as transient. Temporary insomnia (transient insomnia) usually is due to situational changes, such as travel and stressful events. It lasts for less than a week or until the stressful event is resolved. Short-term insomnia lasts for 1-3 weeks,

Intermittent Insomnia-

If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent.

Chronic  Insomnia-

Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more. Chronic insomnia continues for more than 3 weeks.

Insomnia may also be classified into:

• Primary insomnia-

It occurs in the absence of other medical problems

• Secondary insomnia

It occurs as a result of a medical condition such as heart disease, arthritis, cancer, or heartburn, etc. causing wakefulness.

Who suffer from Insomnia?

Insomnia is found in males and females of all age groups, although it seems to be more common in females (especially after menopause) and in the elderly. The ability to sleep, rather than the need for sleep, appears to decrease with advancing age.

What are the causes of Insomnia?

• Advanced age (insomnia occurs more frequently in those over age 60); the melatonin - a chemical that is needed in order to induce sleep, decreases and, at the age of sixty, very little is produced by our bodies. Without the presence of this chemical, the amount of sleep that the body receives diminishes. This may either mean rising earlier in the morning or the inability to sleep at night.
• Female gender affected most; Women tend to be the victims of insomnia more often than their male counterparts. This is partially due to the fact that hormonal changes which are intrinsic to females can bring about this particular condition. These changes may include PMS, menstruation, pregnancy and menopause. Any number of things can happen when an influx or decrease of hormones takes place in the body, and insomnia is one of the more common side effects
• A history of depression.
• Stress, anxiety.
• A medical problem or the use of certain medications occur along with the above conditions, insomnia is more likely.
• Various medical conditions such as high blood pressure, heart disease, asthma, arthritis, allergies, hyperthyroidism and Parkinson’s disease.
• Physical disorder- congestive cardiac failure, pregnancy, hyperthyroidism, nocturnal asthma and nocturnal seizures.
• Painful or uncomfortable syndromes- toothache, arthritis and restless legs syndrome.

• Difficulty in initiating sleep may be due to psychiatric illness such as; anxiety, phobia, schizophrenia and depression.
• Drugs withdrawals such as caffeine, antidepressant, beta blockers, alcohol, sympathomimetics and hypnotics.  
• Reversal of sleep rhythm, seen in jet-lag, head injury, encephalitis, sedative misuse, irregular night shift work.
• Nocturnal enuresis [bed wetting in the children], sleep walking, taking while asleep and night terrors can cause sleep disturbance in children.
• Sleep apnea is a disorder characterized by a reduction or cessation (pause of breathing, airflow) during sleep and may cause sleeplessness.
• The predisposition to insomnia tends to run in family lines. It is believed that genetics play some role in whether or not a person will suffer from this illness; which is unknown to the medical community
• Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following- stress, environmental noise, extreme temperatures, a change in the surrounding environment, sleep/wake schedule problems such as those due to jet lag, or medication side effects.

What are symptoms of insomnia?

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Insomnia patients generally complain of:

• Inadequate or poor-quality sleep. 
• Difficulty falling asleep; early wakening, waking frequently during the night, un-refreshing sleep, or a combination of these.
• Waking up frequently during the night with difficulty returning to sleep.
• Waking up too early in the morning.
• Persons without adequate sleep can experience tiredness, lack of energy, and concentration problems.

How insomnia is diagnosed?

Patients with insomnia are evaluated with the help of a medical history and a sleep history. Specialized sleep studies may be recommended in Secondary insomnia, to find the medical condition.

Conventional treatment:

Transient insomnia can be treated by altering some changes in the lifestyle, or counseling may help. The treatment of chronic insomnia consists of:

• First, diagnosing and treating underlying medical or psychological problems.
• Identifying behaviors that may worsen insomnia and stopping them.
• Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.
• Sleeping pills are often antihistamines. Antihistamines are generally taken for allergies, but also make you feel very sleepy. Sedatives like, Barbiturates, Benzodiazepines, Imidazopyridine, and Antihistamines.

Side Effects of Sleeping Pills:

• They impair our consciousness, judgment, memory and intelligence.
• Almost everyone has some risk of becoming dependant on sleep medication.
• Those who use sleeping pills have significantly higher mortality rates than those who do not.
• Sleeping pills do little or nothing to improve chronic insomnia and cause long-term chemical dependency.
• Sleeping pills reduce brain cell activity during the day, affecting short-term memory as well as causing a hangover effect.
• Sleeping pills accentuate the GABA neurotransmitter, which keeps the nerve cells in the lung tissue from firing. This is why an overdose of sleeping pills will cause asphyxiation and over 1000 overdose related deaths each year.
• GABA actuation is also responsible for impaired physical ability. Each year, thousands of traffic deaths, accidents and falls (especially in the elderly) are attributed to sleeping pills.
• Sleep Apnea Patients should never take sleeping pills. Sleeping pills increase the pauses and length of pause in breathing. Someone with sleep apnea could suffer brain or ocular damage from the lack of oxygen or even death.
• Anyone over the age of 40 should be cautioned against sleeping pills, and anyone over the age of 65 should never take sleeping pills. Studies show that almost all people over 40 have some symptoms of sleep apnea, and anyone over 65 would be clinically diagnosed with sleep apnea.
• Sleeping pills create a hypnotic dependency similar to alcohol and lower inhibitions and fear of pain or consequences. This is one reason why sleeping pills contribute to accidents and why chronic sleeping pill users are less likely to worry or take care of themselves.
• Sleeping pills are highly addictive. Sleeping pills are similar to barbiturates and are extremely difficult to stop using.
• Although sleeping pills do not improve daytime functioning, people still prefer taking them because of the barbiturate feel-good effect they produce. As with many addictive drugs, they may not be helpful, but we feel good when we take them.

In general, over-the-counter sleep medications are not a good choice because they:

• Are not intended for long-term use.
• Interfere with mental alertness during the day, so you should avoid driving and other similar tasks. You may also be at risk for falling.
• Reduce the quality of your sleep by reducing time you spend in deep sleep.
• Commonly seen side effects of sleeping pills are, drowsiness the next day, dizziness, lack of coordination , forgetfulness, constipation, urinary retention, blurred vision, and dry mouth and throat.

Homeopathy Treatment & Homeopathic Remedies for Insomnia or Sleep Disorders:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. The medicines given below indicate the therapeutic affinity but this is not a complete and definite guide to the treatment of this condition. The symptoms listed against each medicine may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy. To study any of the following remedies in more detail, please visit our Materia Medica section. None of these medicines should be taken without professional advice.

Homeopathic Treatment

Reportorial rubric

[Kent] Sleep, Sleeplessness

[Murphy] Sleep, Insomnia

[Boericke] Nervous system, Sleep, Insomnia (Sleeplessness)

[Boenninghausen’s] Sleep, Sleeplessness

Homeopathy Remedies:

Homeopathic medicines are selected on the basis of symptoms, cause, family history and constitution of the person affected. Considering all these factors any of the below listed (or some other) homeopathic medicine may be indicated and helpful in this condition.

Nux vomica, Opium, Coffea cruda, Ambra grisea, Hyoscyamus niger, Sulphur, Belladonna, Chamomilla, Arsenic album, Argenticum nitricum;

Gelsemium, Ignatia amara, Magnesium  carbonica, Cocculus indica,  Aconitum  napellus, Arnica Montana, Causticum,  Ferrum metallicum, Muriaticum acidum, Tabacum, Senecio jacobaea; Cannabis indica, Kalium phosphoricum

MATERIA MEDICA:

Nux vomica

Sleepless from rush of ideas. Cannot sleep after 3a.m. until towards morning, falls asleep when it is time to rise and feels heavy and unrefreshed. It is especially the remedy for those who drink too much, those who abuse coffee and tea, those who are subject to abdominal disorders and a sluggish portal circulation. It is curative in cases where sleep is unattainable except from a stimulant. The symptoms of Nux vomica are better after undisturbed sleep, worse when sleep is disturbed. Sleeplessness from mental overwork, from too close study, especially at night. Dreams full of bustle and worry.

Opium

Stupefying and unrefreshing sleep. Sleepy, but cannot sleep. Sleeplessness with acuteness of hearing, clock striking and cocks crowing at great distance keep her awake. Loss of breath on falling asleep. Bed feels so hot she cannot lie on it; moves often in search of a cool place; must be uncovered. Sleepy but cannot sleep with great drowsiness. Dreams of cat, dog and black forms. Pleasant, fantastic, amorous dream. Suffocative attacks during sleep like nightmare.

Coffea cruda

Nervous sleeplessness from rush of ideas, mental activity, awakes at or hears every sound after pleasurable excitement. In cases where there is excessive agitation of body and mind, and where ideas force themselves on the mind. The patient is wide awake, without the slightest inclination to sleep, and all the senses are extremely acute. It is the remedy when excitement or good news, joys or night watching causes the insomnia. It is well suited to sleeplessness in teething children, Sleeplessness from the bad effects of too good news. Is indicated in wide-awake condition; impossible to close the eyes; physical excitement through mental exaltation. Sleeplessness, on account of excessive mental and bodily activity. The greatest mental and physical exhaustion; great restlessness lying awake most of the night. Sensitiveness of vision, of hearing, of smell, of touch; sensitiveness to pain; it is most astonishing sometimes about this great sensitiveness. Wakeful, on a constant move. Sleeps until 3 a.m. after which only dozing. Sleep disturbed by dreams or by itching of anus.

Ambra Grisea

Sleeplessness arising from worriment of mind as from business trouble. The patient retires to bed feeling tolerably tired, yet as soon as the head touches the pillow he becomes wakeful. Before midnight sleeplessness. He cannot sleep at night, he knows not why. For several nights sleeplessness , and in the morning slumber full of fantastical dreams. Frequent waking at night. Frequent waking, and at 2 a.m. long uneasiness in the whole body, especially in the occiput. Uneasiness in the occiput after midnight. At night he wakes up with headache , which goes off on rising.  Very early waking; followed by frequently interrupted, but very profound sleep, with eyes fast closed. In the morning, in bed, weariness, with feeling in the eyes as if they were too firmly closed. Sleep restless, with anxious dreams. Retires tired, wakeful as soon as touches the pillow. Coldness of body and twitching of limbs during sleep.

Hyoscyamus niger

Sleeplessness from nervous excitement; the brain is full of bewildering ideas and images. After long illnesses and the brain cells are poorly nourished. Sleeplessness in children, who twitch, cry out frightened and tremble. Sleeplessness from overworked minds and without apparent cause may be benefited by Hyoscyamus. Hyoscyamus paints the mental town of its victim a brilliant and luminous red. The patient is jolly and wakeful. Sleeplessness from nervous excitement. Starts out of sleep, frightened.  Brain full of bewildering ideas and images. Sleeplessness in children who twitch, cry out, frightened and tremble. Irritable and easily excited individuals. Sleeplessness from anxiety or over - excitement.

Sulphur

Sleeplessness from nervous excitement, cutaneous irritations and external heat. The patient is drowsy all day and sleepless at night. Sleeps in "cat naps", wakes frequently. Restlessness of anaemic irritability. Long but unrefreshing sleep, in morning. Nightly jerking and twitching in body during. Nightmare. Sings during sleep and wakes up with singing. Cannot sleep during 2 and 5 a.m. 

Belladonna

The sleepless conditions calling for Belladonna are due to congestion; sleep is extremely restless, as a rule it is interrupted by talking, starting, muscular jerkings and spasmodic motions; frightful images appear on closing the eyes and the patient therefore dreads sleep. Children awake from sleep frightened. Oftentimes there is a violent throbbing in the brain which prevents sleep. Frightful dreams, they constantly awaken the patient. Insomnia due to cerebral hyperaemia. Restless sleep during dentition; sleeps with eyes partially open; sudden starting, twitching, hot head and dilated pupils will indicate it. Sleep is extremely restless due to congestion in the head. Cannot close the eyes, as he sees dreadful images on doing so. Children wake from sleep frightened.

Chamomilla

For sleeplessness in children due to severe pain. It quiets the irritability and the emotional excitement and the patient sleeps. It is also adapted to weak, nervous women. The sleep is tormented by dreams which are fanciful, vivid and anxious; the patient is hot and thirsty. Moaning in sleep. Great drowsiness is characteristic of the remedy, but cannot sleep. Sleepless due to pain. Nightly sleeplessness with visions and anxiety. Crying out, starting up, tossing about and weeping during sleep. Yawning and stretching.

Arsenic album.

Patient is disturbed, anxious and restless. Awakened by pains. Sleeplessness due to fear of air raids etc. Frequent starting up and twitching in. Somnolency in evening. Sleeplessness with constant restlessness and tossing about. Inability to fall asleep after once awaking at night. Anxious dreams.

Argenticum nitricum

Sleepless from fancies. Dreams of serpents, with horror. thoughts activity of mind, from : midnight, before.

Gelsemium

It is suited for the insomnia of brain workers. It is indicated in business men who pass restless nights, awaken early in the morning and worry over their business affairs. It also is most useful in a state of alternate excitement and depression. Gelsemium has also sleeplessness from emotional disturbances, and after evening company. The patient goes to bed tired, but immediately becomes wakeful. It is especially suited to thin, spare men who are nervous and subject to nervous chills. Yawning, with stupor and inability to keep eyes open; with general numbness. Late falling to sleep, the nightmare. Insomnia from exhaustion and irritation.

Ignatia amara

Sleeps so light that he hears everything in it. Dreams all night of the same subject. Insomnia due to grief, anxious thoughts, sadness or any depressing emotions. Deep, stupefying. Sleep after the cough paroxysms. Restless sleep and great restlessness at night with a tremor passing through the body. Fixed ideas in his dreams which continue after waking. Child awakes from sleep with piercing cries and trembles all over.

Magnesium  carbonica

Sleeplessness from oppression in abdomen or from anxious uneasiness and internal fear, with a great dread of being uncovered. Sleeplessness from flatus, cutting wisdom- teeth, exhaustion. Unrefreshing sleep and feels tired in the morning. Dreams of fire, food, robbers, quarrels, money, pleasures, misfortune and dead persons.

Cocculus indicus

It is especially suited to light haired, timid, nervous and bookworms persons.  Sleeplessness due to night watching, nursing with worry and anxiety. Thinking of the business of the day prevents sleep. Spasmodic yawning. Sleepless from mental or physical exhaustion.

Aconitum  napellus

Sleeplessness from anxiety, restlessness, anguish and fear; child tosses about feverishly. Starting up in after midnight during sleeplessness, with constant tossing about from anxiety, and flightiness with closed eyes. Drowsiness, with inability to sleep. Disturbed sleep. Anxious dreams. Insomnia of the elderly.

Arnica montana

Arnica is particularly adapted to sanguine, plethoric persons, disposed to cerebral congestion, persons easily made train-sick or sea-sick. Sleeplessness caused by over-exertion and weariness of mind and body. Day sleepiness, with inability to sleep. Dreams of death, anxious and terrible, awakes in terror, then sleepless.

Causticum

Sleeplessness at night on account of dry heat cannot rest in any posture. He cannot get quiet position. Nightly sleeplessness with anxiety, dry heat and frequent starting up. Anxious dreams. Wakes with slightest noise.

Ferrum metallicum.

It is adapted to young, anemic, pseudo- plethoric persons who look strong but are very weak physically. Restless, with anxious tossing. Great drowsiness and fatigue, with inability to sleep at night. Falls to sleep late in evening. Can lie on back only.

Muriaticum acidum

Sleepy, but unable to sleep; tosses about; dreamy and restless all through the night. Irritable. Continual snoring, groaning, tossing about and talking, with sliding down in bed, especially before . Frequently wakened by a chill early in morning in bed.

Tabacum

Sleeplessness or insomnia due to nervous break down. Stupefying, with profuse sweat. Insomnia with dilated heart, with cold, clammy skin and anxiety.

Senecio jacobaea

For sleeplessness from prolapsus of uterus. Uterine irritation during climacteric.

Cannabis indica

In obstinate and intractable forms of insomnia. An irregular sleep is more of an indication than absolute insomnia. Unconquerable day sleepiness; Unrefreshing night sleep. Sleepless at night because of anxiety and heat as though dashed with hot water.

Kalium phosphoricum

Sleeplessness, especially during the latter part of the night. The patient is a nervous due to business worries and excessive mental exertion.

What can be done for preventing insomnia?

• Avoid watching TV, eating, and discussing emotional issues in bed.
• Don’t use bright light in your bedroom.
• Avoid, caffine and smoking.
• Get a massage on your scalp.
• A light snack may be sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep. So milk and cookies or crackers (without chocolate) may be useful and taste good as well.
• Do not exercise vigorously just before bed.
• Take a warm bath. This often helps.
• Listen light music. Actually, any soothing noise (played softly) in the background may help.
• Sleep with your head facing north (magnetic) and feet facing south.
• Relaxation techniques like yoga and meditation.

HEALTH CALCULATORS