Insomnia - Causes and Treatment. What to do if I cant sleep?

Insomnia, also known as sleeplessness, is difficulty in either initiating sleep, maintaining sleep continuity, or poor sleep quality.
These symptoms occur despite the presence of adequate opportunity and circumstance for sleep.
Insomnia adversely affect the health, quality of life, academic performance, increase the risk of motor vehicle accidents, decrease the productivity at work, irritability and increase daytime sleepiness.
Chronic Insomnia is called when sleep disturbances occur at least three times a week and have been present for the last 3 months.
There is no one factor can could cause insomnia, but there is associated conditions, when risk of insomnia is high.
Such conditions include:
Depression, Anxiety, and Post-traumatic stress disorder.
Comorbid medical issues also are associated with insomnia: like restless legs syndrome, chronic pain, gastroesophageal reflux disease, respiratory issues, and immobility are associated with risk of chronic insomnia.
People with certain personality traits like perfectionism, ambitiousness, neuroticism, low extraversion, are more likely to develop insomnia over time.
Other Risk Factors for Insomnia include:
Individuals older than 60,
Emotional stress,
Working late night shifts,
Traveling through different time zones,
Alcohol or drug use disorders,
Gastrointestinal reflux disease,
Heavy smoking,
Work stress.
Management of insomnia consist of several steps:
Sleep hygiene:
Limiting the daytime naps,
Avoiding late night dinner or evening intake of alcohol,
Avoiding Caffeine, or smoking.
Adopt a healthy diet, exercise.
Regular sleep and wake time schedules.
Sleep hygiene alone is ineffective in managing the patients with chronic insomnia and should be used with other aspects of cognitive behavior therapy.
Sleep Restriction Therapy
This therapy depends on limiting the number of sleep hours with the idea that a reduced sleep time might improve the sleep drive and result in a consolidated sleep.
Relaxation Therapy
It means, Regular practice of breathing exercise, meditation and yoga.
The benzodiazepines and benzodiazepine receptor agonists. Both of them have sedative, anxiolytic, muscle relaxant, and hypnotic effects.
For example, zolpidem, zopiclone, eszopiclone and zaleplon.
benzodiazepines have high risk of rapid development of tolerance, the risk of abuse or dependence.
Melatonin is available over the counter and is approved by Food and Drug Administration (FDA) for treatment of insomnia, especially in older adults. A dose range of 2 to 8 mg is effective in treating circadian rhythm sleep-wake disorders.
food can delay the absorption of melatonin. and a gap should be maintained between the last meal and intake of melatonin.
Doxepin is a tricyclic antidepressant, but at a low dose of 3 mg and 6 mg, it is effective in the management of sleep maintenance insomnia.
Trazodone, mirtazapine, and amitriptyline are most commonly used antidepressants for the management of insomnia at low doses mainly because of their antihistaminic effect.
Histamine type 1 receptor blockers: due to their sedative effects, these drugs can be helpful in patients with sleep disorders. However, due to their anticholinergic effect, these drugs should be avoided in the elderly. Examples include chlorpheniramine and diphenhydramine.
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