Understanding Insomnia and How to Prevent It

The causes of insomnia can vary, depending on the type. Here are the various causes of insomnia based on the type:

Primary Insomnia

Primary insomnia can be caused by many things. One cause of primary insomnia is things that trigger stress, such as problems at work or finances. Stress can also be caused by a sad event, such as the loss of a loved one.
Other factors that can cause primary insomnia include:

• Bad habits before bed, such as eating too much, using a computer or smartphone, and watching television.
• Environmental factors, such as loud noises, bright lights, temperatures that are too cold or too hot.
• Irregular sleep schedules, such as due to changing work hours or having a long afternoon or afternoon nap.
• Jet lag.

Secondary Insomnia

A number of diseases or medical conditions that can cause secondary insomnia include:

• Mental disorders, such as:
• • • Anxiety disorders.
    • Post-traumatic stress disorder (PTSD).
    • Bipolar disorder.
    • Depression.
• Conditions that cause pain or discomfort at night include:
• • • Hormonal disorders, such as hyperthyroidism, which causes heart palpitations even at rest, or postmenopausal women who experience hot flashes at night.
    • Muscle and joint disorders, such as arthritis and fibromyalgia, which cause pain.
    • Urinary disorders, due to an enlarged prostate or diabetes, which cause frequent trips to the bathroom at night.
    • Digestive disorders, such as GERD, which causes a burning, full feeling in the stomach when lying down.
    • Respiratory disorders, such as asthma and chronic obstructive pulmonary disease, which can cause anxiety because it is difficult to breathe.
• Other health problems include:
• • • Neurological disorders, such as Parkinson’s disease or Alzheimer’s disease, which disrupt the brain chemicals that control sleep and drowsiness.
    • Sleep disorders, such as restless leg syndrome and sleep apnea, which cause sufferers to wake up repeatedly during the night.
• Unhealthy patient lifestyle, such as:
• • • Smoking.
    • Abusing drugs.
    • Consuming excessive amounts of alcohol or caffeine.
• Consumption of medicines that can cause sleep disorders, for example:
• • • Antidepressants, such as fluoxetine and protriptyline.
    • Asthma medications, such as theophylline.
    • Decongestants.
    • High blood pressure medications, such as beta blockers.
    • Medications containing caffeine, such as allergy medications and pain relievers.
    • Stimulant medications, such as methylphenidate for attention deficit hyperactivity disorder (ADHD) or modafinil for narcolepsy.

Risk Factors for Insomnia

Insomnia can happen to anyone, but there are factors that can increase the risk of this condition, namely:

• Female gender
  Hormonal changes during menstruation and menopause can disrupt sleep patterns. Insomnia is also common during pregnancy.
• Age over 60 years
  Health conditions and sleep patterns can change with age, increasing the risk of insomnia.
• Medical conditions
  The risk of insomnia is higher in people who suffer from health problems, both physical and mental, especially those that have been going on for a long time (chronic).
• Changes in activity schedule
  A changing activity schedule can disrupt sleep patterns, for example due to changes in work schedules.
• Stress
  Mild stress can cause temporary insomnia. The more severe and prolonged the stress, the higher the risk of chronic insomnia. For example, many people are experiencing stress due to the COVID-19 pandemic and the changes that have occurred because of this condition.

Insomnia symptoms vary widely and can be influenced by the physical and mental condition of the sufferer. However, the most common complaints in insomnia sufferers are:

• Difficulty falling asleep at night.
• Waking up frequently during the night and having difficulty falling back asleep.
• Waking up too early in the morning.
• Always feeling like you haven’t had enough sleep.

Apart from the symptoms above, there are also symptoms that often accompany insomnia, including:

• Headache.
• Tired, weak, and sleepy during the day.
• Easily irritated and depressed.
• Not able to focus, concentrate, and remember.

In secondary insomnia, other symptoms that appear can include disturbing pain at night, shortness of breath, and frequent trips to the bathroom.

See a doctor if your lack of sleep causes negative impacts, such as difficulty concentrating and irritability, high blood pressure, and disrupts your quality of life. An examination is important, especially if insomnia has been going on for months. Through an examination, a doctor can find out the cause of insomnia and plan the right treatment method.

Diagnosis of insomnia is done by asking questions about the insomnia symptoms experienced by the patient.

Doctors can diagnose insomnia if the following criteria are met:

• Sleep disorders that cause problems in various aspects of the sufferer’s life.
• The sufferer has difficulty sleeping at least 3 nights a week and has been going on for at least 3 months.
• The sufferer still has difficulty sleeping even though there is enough time to sleep.

In addition, doctors need more information to find out the cause of insomnia. Therefore, doctors will also ask several questions related to the following:

• Medical conditions experienced.
• Environmental conditions around the residence.
• Emotional and psychological conditions.
• Daily habits or activities.
• Sleep schedule and room conditions or patient habits before going to bed.

Information related to the above can help the doctor determine the underlying cause of insomnia. The patient will also be asked to record the time of going to bed and waking up for several weeks so that the doctor can understand the patient’s sleep pattern.

If necessary, the doctor will perform supporting examinations to determine health disorders that can cause insomnia. The type of examination performed will be adjusted to the symptoms and additional information obtained from the patient.

Some of these supporting examinations are:

• Blood tests, to detect blood sugar levels or thyroid hormone levels.
• Polysomnography or sleep study, to determine the patient’s brain activity and body condition while sleeping.
• Ultrasound or CT scans, to check for abnormalities in the prostate, heart, or respiratory system.

In a polysomnography test, the doctor will attach electrodes to the patient’s crown, temples, and chest. A machine connected to the electrodes will record the patient’s body activities while sleeping, including body movements, brain waves, breathing rate, heart rate, and blood pressure.

The first step to treating insomnia is to find out and treat the cause of the insomnia. If insomnia is caused by a certain disease, the doctor will work with other specialists who can treat the disease. In addition to treating the cause, the doctor will also advise the patient to live a healthy lifestyle and practice good sleep habits (sleep hygiene).

Some of the ways to practice sleep hygiene are:

• Make a sleep schedule and wake up at the same time every day so that the body gets used to a regular sleep time.
• Prioritize sleep over other activities when it is time to sleep.
• Avoid sleeping during the day or limit it so that it does not interfere with sleep at night.
• Create a routine schedule before bedtime to relax your body, such as installing dim lighting, listening to slow music or white noise, and not watching television or playing with gadgets, such as cellphones or laptops.
• Adopt healthy habits, such as exercising regularly, not smoking and not consuming alcoholic beverages, not consuming caffeinated beverages in the afternoon and evening, and not eating too late at night.
• Do not do any physical activity or strenuous exercise close to bedtime.
• Use eye masks and ear plugs if necessary.
• Choosing a comfortable bed, pillow, and blanket if possible.
• Setting the right room temperature as needed.
• Using aromatherapy from lavender flowers.
• Using sleeping pills, such as melatonin, with a mild effect (temporarily).

If the patient continues to experience insomnia, the doctor will add counseling in the form of cognitive behavioral therapy for insomnia (CBT-I), medication, or a combination of the two.

The following is an explanation of each insomnia treatment method:

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I aims to help insomniacs change negative thoughts and behaviors that make it difficult for them to sleep. This insomnia therapy is the primary treatment option for insomnia because it is more effective than medication.
Some of the methods in CBT-I include:

• Relaxation techniques
  Relaxation techniques are done by regulating breathing to be more relaxed. Through this therapy, patients will be trained to reduce feelings of anxiety or manage stress that can interfere with sleep.
• Stimulus control therapy
  This therapy trains patients to only use the bedroom for sleeping or having sex. Patients are also advised to leave the bedroom if they cannot fall asleep within 20 minutes and only return to the room when they are sleepy.
• Paradoxical intention
  Paradoxical intention gets patients used to not thinking and hoping to fall asleep quickly while in bed. This therapy aims to reduce anxiety and worry about not being able to sleep which will actually make it harder to sleep.
• Phototherapy
  Phototherapy aims to normalize sleep hours in patients who go to bed too early at night and wake up too early in the morning. In phototherapy, patients will be exposed to UV light for 30–40 minutes after waking up.

Mediciness

Another method to treat insomnia is with medication, such as estazolam. Generally, doctors do not recommend using sleeping pills for more than a few weeks. Some sleeping pills, such as nimetazepam, should only be used as temporary relief for severe insomnia. However, there are several types of medicines that doctors can prescribe for long-term use, such as:

• Zolpidem.
• Zaleplon.
• Ramelteon.

It should be noted that the use of sleeping pills can cause side effects such as dizziness and increase the risk of fainting. Therefore, consult a doctor first before using sleeping pills for insomnia. It is important to remember not to use over-the-counter medications containing antihistamines or motion sickness medications to help you sleep. Long-term use of these medications can cause side effects, such as dizziness, difficulty urinating, and decreased cognitive function.

Poor quality and quantity of sleep can affect the quality of daily life. Some complications that can arise from insomnia are:

• Slow reactions when driving, increasing the risk of accidents.
• Difficulty achieving success, both at school and at work.
• Decreased endurance.
• Increased risk of long-term illnesses, such as asthma, high blood pressure, diabetes, or heart disease.
• Mental disorders, such as depression, anxiety disorders, and drug abuse or alcohol addiction.
• Decreased sexual desire, and the ability to concentrate or remember.

There are several sleep hygiene steps that can be taken to prevent insomnia, including:

• Implement a regular sleep and wake-up schedule every day, including on weekends.
• Maintain a regular meal schedule and increase consumption of healthy foods, including vegetables and fruits.
• Exercise regularly, but not close to bedtime.
• Limit nap time.
• Maintain comfort and temperature in the bedroom, and try to only enter the room when you want to sleep.
• Make your body feel relaxed before going to bed, for example by taking a warm bath or reading a book.
• Check your health regularly with a doctor, especially if you have a chronic disease that requires regular check-ups.