Insomnia can interfere with daily life and must be treated before it becomes chronic.
Insomnia is a disease characterized by a combination of symptoms such as difficulty falling asleep, waking up frequently even when falling asleep, or waking up early in the morning and being unable to sleep. Although insomnia is not fatal, it can interfere with daily life during the day, so caution is required.
Professor Ji-eun Yoon of the Department of Neurology at Soonchunhyang University Bucheon Hospital said, “Acute insomnia is caused by daytime fatigue, lethargy, attention/concentration/memory disorders, living and learning disorders, mood disorders, daytime sleepiness, behavioral disorders, decreased vitality and motivation, frequent mistakes, sleep dissatisfaction, Worries about sleep may appear. “If left untreated, it can develop into chronic disease, so it is better to treat it,” he advised.
The main causes of acute insomnia are having something to worry about, such as an important exam the next day, stress, depression, anxiety, pain, caffeine, alcohol, illness, or the environment, but it can also appear without any triggering factors. If the cause is removed, it can naturally improve.
Cognitive behavioral therapy, which maintains good sleep hygiene and mediates psychological, cognitive, and behavioral factors that worsen insomnia, can be helpful. Cognitive behavioral therapy is a method of breaking the conditioning between the environmental stimulus of sleep and inappropriate cognitions and behaviors regarding sleep, a method of reducing the time spent in bed closer to the actual sleep time, and a method of reducing physical arousal by relaxing stress and tension. etc. are included.
Professor Ji-eun Yoon said, “If you can’t sleep well even with these methods, sleeping pills may help in the short term. “If you can’t sleep any longer and become anxious about sleep, insomnia can get worse, so taking sleeping pills for a short period of time is a good treatment option,” he said.
Anyone can experience insomnia at least once, but if it occurs more than three times a week and lasts for more than three months, it is classified as chronic insomnia. In the case of chronic insomnia, other sleep disorders may be present in addition to insomnia, or other sleep disorders may appear like insomnia. These include sleep apnea, restless legs syndrome, periodic limb movement disorder, REM sleep behavior disorder, and circadian rhythm sleep disorder.
These diseases have different treatment methods from simple insomnia, so it is important to differentiate them well and treat them together. In addition to sleeping disorders, you should also check for other chronic diseases. These mainly include pain such as arthritis and musculoskeletal diseases, gastrointestinal diseases, cardiovascular diseases such as heart failure and arrhythmia, and mental diseases such as depression and anxiety.
Professor Ji-eun Yoon said, “If you have chronic insomnia, it is important to check whether you are engaging in any behavior that goes against ‘sleep hygiene,’ such as excessive napping, early bedtime, inappropriate sleeping environment, or excessive drinking or caffeine consumption.”
To diagnose chronic insomnia, the patient’s sleep history must be checked. Patients and guardians should check when they go to sleep, how many times they wake up, and how long the symptoms last. In addition, we ask a detailed questionnaire about how drowsy and tired you are the next day, how much your quality of life has declined, and check whether there are other diseases that affect insomnia.
Another diagnostic method is a sleep diary. The goal is to subjectively keep a diary about your total sleep time and sleep efficiency for 1 to 2 weeks. In addition, it displays factors that affect sleep, such as naps, drugs, caffeine, alcohol, and antidepressants, to determine what kind of insomnia it is and whether there is a circadian rhythm similar to insomnia.
Actigraphy, which objectively detects movement, can also be performed. It determines your sleep pattern, such as whether you are actually sleeping when lying down or whether you are active.
Professor Ji-eun Yoon said, “Polysomnography can be performed when other sleep disorders appear to be present, when other sleep disorders appear to resemble insomnia, or when chronic insomnia has been treated but is not well treated.”
There are non-pharmacological and pharmacological treatments for chronic insomnia, and non-pharmacological treatment called ‘cognitive behavioral therapy’ is recommended first. Cognitive behavioral therapy includes stimulus control therapy, sleep restriction therapy, and relaxation training.
Stimulus control therapy involves going to bed only when you feel sleepy and getting out of bed when you can’t sleep. If you can’t fall asleep even though you try, you may become fearful of the act of trying to sleep, and insomnia tends to get worse by engaging in sleep-inappropriate behavior, such as watching TV or worrying in bed. Stimulus control is a treatment that breaks the link between sleeping and sleep-disrupting behaviors.
Sleep restriction therapy is a method of reducing the time spent in bed closer to the actual sleeping time, and is mainly a method of increasing sleep efficiency by adjusting the bedtime time later.
As your sleep efficiency increases, you become more confident, and by fixing your sleep schedule regularly, you can gradually overcome insomnia. Muscle relaxation therapy includes abdominal breathing and progressive relaxation therapy and helps reduce muscle tension and mental alertness.
Professor Ji-eun Yoon said, “The Ministry of Food and Drug Safety recommends that drug therapy should be used within 4 weeks for acute insomnia rather than chronic insomnia. However, it should be taken even for chronic insomnia if necessary. “You can control sleep by using medication along with cognitive behavioral therapy, and treat it by reducing the amount of medication,” he said.
He continued, “If you want to overcome chronic insomnia on your own, it is a good idea to keep a sleep diary. Exercise regularly, but avoid it 1-2 hours before bed. It is best to see a lot of sunlight during the day, avoid lying down as much as possible, and avoid things that contain caffeine such as cigarettes, coffee, black tea, cola, and alcohol. “Bright light delays your biological clock, causing you to wake up late and go to bed late, so it’s best to sleep with the lights off,” he said.