INSOMNIA

Insomnia is the inability to sleep during a period in which sleep should normally occur. Sufficient and restful sleep is a human necessity. The average adult needs slightly more than eight hours of sleep per day.

People with insomnia tend to experience one or more of the following sleep disturbances:

• Difficulty falling asleep at night


• Waking too early in the morning


• Waking frequently throughout the night

TYPES OF INSOMNIA

• Transient insomnia is the inability to sleep well over a period, lasting fewer than four weeks. Usually brought on by excitement or stress. Children, for example, may toss and turn just before school starts in the fall, or before an important exam or sporting event. Adults might sleep poorly before an important business meeting or after an argument with a family member or close friend. People are more likely to have trouble sleeping when they are away from home, especially if they have traveled across time zones. Physical activity close to bedtime (within four hours) and illness can also cause this type of insomnia


• Short-term insomnia is the inability to sleep well for a period of four weeks to six months. Periods of ongoing stress at work or at home, medical conditions, psychiatric illness or other persistent factors can result in short-term insomnia. As the cause resolves or the sleeper adjusts to it, sleep will usually return to normal


• Chronic insomnia is defined as poor sleep every night or most nights for more than six months. Physical ailments - such as disorders of breathing or abnormal muscle activity - are often the cause of sleep disruption and may account for a large number of self-diagnosed cases of insomnia.

While occasional restless nights are often normal, prolonged insomnia can interfere with daytime function, and may impair concentration, diminish memory, and increase the risk of substance abuse, motor vehicle accidents, headaches, and depression

SIGNS AND SYMPTOMS

• Not feeling refreshed after sleep


• Inability to sleep despite being tired


• Daytime drowsiness, fatigue, irritability, difficulty concentrating, and impaired ability to perform normal activities


• Anxiety as bedtime approaches

CAUSES

Insomnia is occasionally a symptom of an underlying medical or psychological condition, but it may also be caused by stress (from work, school, or family) or lifestyle choices, such as excessive coffee and alcohol consumption. About 50% of insomnia cases have no identifiable cause. Some conditions or situations that commonly lead to insomnia include:

• Substance abuse - consuming excessive amounts of caffeine, alcohol, recreational drugs, or certain prescription medications; smoking can cause restlessness and smoking cessation may also result in temporary insomnia


• Disruption of circadian rhythms - shift work, travel across time zones, or vision loss; circadian rhythms are regulated, in part, by release of melatonin from the brain


• Menopause - between 30% and 40% of menopausal women experience insomnia; this may be due to hot flashes, night sweats, anxiety, and / or fluctuations in hormones


• Hormonal changes during menstrual cycle - insomnia may occur during menstruation; sleep improves mid-cycle with ovulation


• Pregnancy - Insomnia usually occurs in the later months of pregnancy when the mother's size and need to urinate disrupt sleep


• Advanced age - biological changes associated with aging, underlying medical conditions, and side effects from medications all contribute to insomnia


• Medical conditions - acid reflux (return of stomach contents into the oesophagus; frequently causes heartburn), Fibromyalgia or other chronic pain syndromes, heart disease, arthritis, attention deficit hyperactivity disorder, and obstructive sleep-apnoea (difficulty breathing during sleep)


• Psychiatric and neurological conditions - anxiety, depression, manic-depressive disorder, dementia, Parkinson's disease, restless leg syndrome (a sense of indescribable uneasiness, twitching, or restlessness that occurs in the legs after going to bed), post-traumatic stress disorder


• Certain medications - antidepressants, decongestants, bronchodilators, and beta-blockers


• Excessive computer work


• Partners who snore

RISK FACTORS

The following factors may increase an individual's risk for insomnia:

• Age - the elderly are more prone to insomnia
• Stressful or traumatic event
• Night shift or changing work schedule
• Travel across time zones
• Substance abuse
• Asthma - bronchodilators occasionally cause insomnia
• Excessive computer work

DIAGNOSIS AT OUR CLINIC REGARDING INSOMNIA / SLEEPING DISORDERS

Our assessments for insomnia are oriented towards determining what is impeding your body's ability to function normally and how this is affecting your sleep, and then establishing a treatment strategy specific to your health needs. This assessment includes:

• A comprehensive symptom intake including lifestyle, dietary and environmental factors with questions about your sleep patterns and quality


• Questions to determine whether you snore, have any underlying medical conditions, take medications, or have recently undergone any significant life changes


• Keeping a sleep diary (recording all sleep-related information) in order to determine the type of insomnia and how best to treat it. We may recommend a sleep specialist or a sleep disorders center where brain waves, body movements, breathing, and heartbeats may be electronically monitored during sleep


• Specific testing - to check hormones, melatonin levels, cortisol levels and other parameters to determine physiologic aspects that may be affecting your sleep

THE NATUROPATHIC TREATMENT APPROACH FOR INSOMNIA

Naturopathic treatments* are based on correcting the root cause of the problem rather than justfixing the problem with a band aid solution. Insomnia, as mentioned earlier, may be caused by various lifestyle factors and hence treatment should be based on correcting behaviours, patterns or factors that are causing the sleeping disorder so that sleep maybe restored naturally without the use and dependency of addictive sleeping pills. Once we determine what exactly caused insomnia, we treat and prevent it with various natural modalities such as:

• Acupuncture and traditional Chinese medicine


• Behavioural techniques


• Diet


• Herbs


• Homeopathy


• Hypnosis


• Life style changes


• Relaxation techniques


• Supplements

MIND / BODY MEDICINE

A variety of behavioural techniques have proved helpful in treating insomnia. These include:

Relaxation Training Techniques

Progressive relaxation, meditation, yoga, guided imagery, hypnosis, or biofeedback can break the vicious cycle of sleeplessness by decreasing feelings of anxiety about not being asleep. Studies indicate that these therapies significantly reduce the amount of time it takes to fall asleep, increase total sleep time, and decrease the number of nightly awakenings.

Cognitive-Behavioural Therapy

This therapy is intended to re-establish healthy sleep patterns by helping an individual cope with his or her sleep problem. One cognitive-behavioural approach, called paradoxical intention, helps to retrain an individual's fears of sleep by doing the opposite of what is causing the anxiety. For example, a person with insomnia worries long before going to bed about not being able to sleep and the difficulty he or she will have at bedtime. Rather than preparing to go to sleep, therefore, the person prepares to stay awake.

Another cognitive-behavioural technique, called thought stopping, allows a person with insomnia a certain period of time to repeatedly and continuously think about going to bed. This technique helps "wear out" the anxiety associated with going to bed, and decreases the likelihood that he or she will obsess about falling asleep at other times.

Sleep Diary

Keeping a daily/nightly record of sleep habits (including the amount of sleep, how long it takes to fall asleep, the quality of sleep, the number of awakenings throughout the night, any disruption of daytime behaviours, attempted treatments and how well they worked, mood, and stress level) can help a person understand and, consequently overcome his or her insomnia.

Lifestyle

Studies reveal that healthy sleep habits are essential for treating insomnia. The following healthy sleep habits may help treat the condition:

• Maintaining a consistent bed and wake time


• Establishing the bedroom as a place for sleep and sexual activity only, not for reading, watching television, or working


• Avoiding naps, especially in the evening


• Taking a hot bath about two hours before bedtime


• Keeping the bedroom cool, well-ventilated, quiet, and dark


• Avoiding looking at the clock; this promotes anxiety and obsession about time


• Avoiding fluids just before bedtime


• Avoiding television just before bedtime


• If sleep does not occur within 15 to 20 minutes in bed, moving to another room with dim lighting

Nutrition

Quite often an inadequate intake / deficiency of certain nutrients and proteins may affect the quality of sleep. A carbohydrate snack of cereal or crackers with milk before bed may help because foods rich in carbohydrates and low in protein and fat may boost the production of serotonin and melatonin, brain chemicals thought to promote sleep. Intake of alcohol and coffee a few hours before bedtime may significantly impact the quality of sleep as well.

Dietary Supplements, herbs and homeopathic medicines

Various dietary supplements, herbs, herbal teas and homeopathic medicines are used short term to treat insomnia. Once the cause of insomnia is determined, your health care provider / naturopath may decide to use certain dietary supplements in conjunction with other therapies. In my naturopathic experience, in treating patients with insomnia and sleeping issues, I have found that dietary supplements, herbs and homeopathic medicines usually help with sleep temporarily, but do not necessarily treat the underlying cause of insomnia. Its is pertinent to establish the root cause of the insomnia before treating it.

Traditional Chinese Medicine and acupuncture

Many methods have been used historically in Traditional Chinese Medicine to treat insomnia including herbal remedies, acupuncture, Chinese massage, and qi gong. Acupuncture has been shown to be quite effective in treating insomnia as well as stress related sleeping issues such as difficulty falling asleep, unable to stay asleep for prolonged periods of time and having an overactive mind during the night. Through a complex series of signals to the brain, acupuncture increases the amount of certain substances in the brain, such as serotonin, which promote relaxation and sleep. Our naturopathic doctor may recommend acupuncture in conjunction with other therapies once she completes your assessment and if it is indicated for you.

Warnings and Precautions with regards to substance use and insomnia

Alcohol should be avoided in those who are taking prescription medications or OTC sleeping pills. Discontinuing prescription medications or OTC sleeping pills can lead to rebound insomnia.

Prognosis and Complications

Most people who have insomnia with no underlying medical conditions tend to recover within a few weeks. For those who develop insomnia from a traumatic event (such as those with post traumatic stress disorder), sleep disruptions can continue indefinitely. People who become dependent on sleeping pills and prescription medication for sleep often have the most difficulty overcoming insomnia.

Please ask your doctor or naturopath before starting on any supplements. Its is better to first identify the cause and then treat it with the right remedies, even though those mentioned above have minimal side effects.

For any questions, or concerns, or to schedule an initial naturopathic appointment, please contact us at 416 913 4325 (HEAL) or email us at [email protected]

* DISCLAIMER: The information on this article is the property of Dr. Sushma Shah, Naturopathic Doctor, and is not intended to treat, diagnose or cure any diseases or promote any services or products mentioned on the website.