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The insomnia nightmare: Brief notes about its causes and treatment



Sleep is a vital physiological process essential for brain function. During sleep, the brain processes and consolidates information acquired during wakefulness, facilitating better memory retention, emotion regulation, and generally contributing to a physical and psychological well-being. The sleep-wake cycle is regulated by intricate neural networks and hormonal signals, and disruptions to this cycle can lead to sleep disorders such as insomnia.

Insomnia is a sleep disorder, that can have profound effects on an individual's physical and mental health. It is defined as a subjective experience of inadequate sleep or sleep of limited quality, despite adequate opportunity and conditions for sleep, with impairment of social, occupational, and other daytime functioning. It can be characterized as difficulty initiating sleep (initial insomnia), difficulty maintaining it (intermediate insomnia), waking up too early (terminal insomnia) or, although less frequently, by a complaint of non-restorative or poor-quality sleep. It can be acute (lasting less than four weeks) or chronic (lasting more than four weeks) with symptoms occurring on at least three nights a week.


Causes of insomnia

In terms of causes, it can be divided into primary (not caused by a known physical or mental condition) or secondary (caused by another medical or psychiatric illness, medication, among others). The prevalence of secondary is much higher than primary and seems to be increasing.

Several factors are involved in the development of insomnia, such as: i) genetic, since sleep traits and conditions, including insomnia, seem to run in families; ii) brain activity differences - people with insomnia may have more active brains or brain chemistry differences that affect their ability to sleep; iii) medical conditions that affect your circadian rhythm, your body’s natural sleep/wake clock, such as temporary illnesses like minor infections or injuries, or chronic conditions like acid reflux or Parkinson’s disease; iv) mental health conditions, such as anxiety or depression; v) life circumstances, several stressful or difficult life circumstances may contribute to insomnia; vi) habits and routine, that includes naps, when people go to sleep, if and when they consume caffeine or alcohol, and the use of electronic devices before bedtime.

There are several risk factors associated with insomnia such as increasing age, female gender, poor social relationships, low socioeconomic status, marital or partner separation, and unemployment.

It's important to recognize that insomnia can result from a combination of these factors. For instance, psychological stress may trigger insomnia in someone predisposed to sleep difficulties due to poor sleep habits. Additionally, chronic insomnia can create a vicious cycle, where the fear of not sleeping well can further exacerbate sleep difficulties.


Intervention and treatment

Treating insomnia involves a multidisciplinary approach, considering both psychological and physiological factors.

Psychological treatment of insomnia primarily involves Cognitive Behavioral Therapy for Insomnia (CBT-I), which is a well-established and effective therapeutic approach. CBT-I targets the behavioral and cognitive factors that contribute to sleep disturbances, aiming to improve sleep quality and address the underlying psychological issues. The treatment is typically administered by trained mental health professionals, such as psychologists or sleep specialists. Additionally, pharmacological treatments, when appropriate, can be used on a short-term basis to alleviate symptoms and improve sleep quality.

If you are experiencing persistent sleep disturbances or insomnia, it's crucial to consult a healthcare professional or sleep specialist to identify the specific causes and develop an appropriate treatment plan. Addressing the underlying causes is essential for effectively managing insomnia and improving overall sleep quality and quality of life.


References

Alimoradi, Z., Jafari, E., Broström, A., Ohayon, M. M., Lin, C. Y., Griffiths, M. D., ... & Pakpour, A. H. (2022). Effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep Medicine Reviews, 64. https://doi.org/10.1016/j.smrv.2022.101646

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-013-0418-8

Rossman J. (2019). Cognitive-Behavioral Therapy for Insomnia: An effective and underutilized treatment for insomnia. American Journal of Lifestyle Medicine, 13(6), 544–547. 10.1177/1559827619867677

Van Someren, E. J. (2021). Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiological Reviews, 101(3), 995-1046. https://doi.org/10.1152/physrev.00046.2019

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