Insomnia, how to treat it before it becomes chronic?

Insomnia, should be treated before it becomes chronic... How? © Provided by Financial News

Financial News

Insomnia is a condition characterized by difficulty falling asleep, frequent awakenings during sleep, or waking up early in the morning and being unable to fall back asleep. While insomnia is not fatal, it can interfere with daily activities, so caution is necessary. Professor Yoon Ji-eun of the Department of Neurology at Soonchunhyang University Bucheon Hospital stated on the 5th, "Acute insomnia can manifest as fatigue, lethargy, attention, concentration, and memory impairments, difficulties in daily life and learning, mood disorders, daytime sleepiness, behavioral issues, decreased vitality and motivation, frequent mistakes, dissatisfaction with sleep, and worries about sleep," and added, "If left untreated, it can develop into chronic insomnia, so treatment is recommended."

Acute insomnia is primarily caused by stress, depression, anxiety, pain, caffeine, alcohol, illness, or environmental factors, especially when there are important events like exams the next day, but it can also occur without any identifiable trigger.

Removing the cause can naturally lead to improvement. Maintaining good sleep hygiene and using cognitive-behavioral therapy to address psychological, cognitive, and behavioral factors that worsen insomnia can be helpful.

Cognitive-behavioral therapy includes methods such as breaking the conditioning between environmental stimuli like bedtime and inappropriate thoughts and behaviors related to sleep, reducing the time spent in bed to be closer to actual sleep duration, and relaxing stress and tension to decrease physical arousal.

Professor Yoon said, "If these methods do not help you fall asleep, short-term use of sleeping pills can be helpful," and added, "If you cannot sleep better and develop anxiety about sleep, insomnia can worsen, so short-term use of sleeping pills is a good treatment option."

Insomnia can be experienced by anyone at least once, but if it persists for more than three times a week for over three months, it is classified as chronic insomnia.

In cases of chronic insomnia, other sleep disorders may be present alongside insomnia, or other sleep disorders may appear similar to insomnia. These include sleep apnea, restless legs syndrome, periodic limb movement disorder, REM sleep behavior disorder, and circadian rhythm sleep disorder.

These conditions require different treatment methods from simple insomnia, so it is important to distinguish them carefully and treat them together. In addition to sleep disorders, other chronic illnesses should also be checked. These mainly include pain conditions such as arthritis and musculoskeletal disorders, gastrointestinal diseases, cardiovascular diseases such as heart failure and arrhythmia, and mental health conditions like depression and anxiety.

Professor Yoon said, "If you have chronic insomnia, it is important to check for behaviors that violate 'sleep hygiene,' such as excessive daytime napping, early bedtime, inappropriate sleeping environment, excessive alcohol or caffeine intake."

To diagnose chronic insomnia, it is necessary to review the patient's sleep history. This includes confirming when they go to bed and wake up, how many times they wake up during the night, and how long these symptoms have persisted. It also involves detailed questionnaires about how sleepy and tired they feel the next day, and how much their quality of life has declined. Additionally, it is important to check for other conditions that may affect insomnia.

Another diagnostic method is a sleep diary. It involves subjectively recording total sleep time and sleep efficiency over 1 to 2 weeks. Additionally, factors that affect sleep such as naps, medications, caffeine, alcohol, and antidepressants are noted to identify the type of insomnia and to check for circadian rhythms similar to insomnia. An objective assessment called actigraphy, which detects movement, can also be performed. It helps determine whether the person is truly sleeping while lying down or engaged in activity, providing insight into sleep patterns.

Professor Yoon said, "Polysomnography can be performed when other sleep disorders appear to be present, when other sleep disorders resemble insomnia, or when chronic insomnia has been treated but does not improve well."

Chronic insomnia can be treated with both non-pharmacological and pharmacological methods, with non-pharmacological treatment called "cognitive-behavioral therapy" being recommended first. Cognitive-behavioral therapy includes stimulus control therapy, sleep restriction therapy, and relaxation training.

Stimulus control therapy involves only going to bed when feeling sleepy and getting out of bed when unable to sleep. If you try to sleep but cannot, you may develop a fear of the act of trying to sleep itself, and engaging in behaviors unsuitable for sleep, such as watching TV in bed or worrying, can worsen insomnia. Stimulus control is a treatment that breaks the link between the bed and behaviors that interfere with sleep.

Sleep restriction therapy involves reducing the time spent in bed to closely match actual sleep time, primarily by delaying bedtime to improve sleep efficiency. As sleep efficiency increases, individuals gain confidence, and by establishing a regular sleep schedule, they can gradually overcome insomnia. Muscle relaxation techniques include diaphragmatic breathing and progressive relaxation, which help reduce muscle tension and mental alertness.

Medication therapy is recommended by the Korea Food and Drug Administration to be used within 4 weeks for acute insomnia rather than chronic insomnia. However, it should also be taken if necessary for chronic insomnia. Combining medication with cognitive-behavioral therapy can help regulate sleep, and the medication can be gradually reduced as part of the treatment.

Professor Yoon explained, "If you want to overcome chronic insomnia on your own, it is good to keep a sleep diary."

Exercise regularly again and avoid it 1 to 2 hours before sleeping. During the day, get plenty of sunlight and try not to lie down too much. It is advisable to avoid caffeine-containing items such as cigarettes, coffee, black tea, cola, and alcohol. Bright light delays the biological clock, causing you to wake up late and go to bed late, so it is best to turn off the lights and sleep.

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Sleep diary ~

Diet diaries and workout journals are something I've heard a lot about.

I've never heard of a sleep diary before.

Is this also part of a regular routine or management?

I also have trouble sleeping, so I'm thinking of trying treatment starting in September.

I hope it helps with your sleep diary.