What is insomnia like?
Based on duration, insomnia is divided into acute (up to three months, usually associated with specific stress) and chronic. It is during the transition to a chronic form that the self-maintenance mechanism is activated, and it is no longer only the original cause that needs to be treated.
- Difficulty falling asleep - a person lies down for more than 30 minutes, thoughts are spinning
- Frequent awakenings at night with difficulty falling back asleep
- Early morning awakenings - woke up at 4 am and never went back to sleep; characteristic of depression
- Sleep without a feeling of rest - slept enough, but woke up exhausted
Reasons
- Stress, anxiety disorder, depression are the most common group of reasons
- Sleep apnea: snoring with pauses in breathing; a person does not remember awakenings, but sleep does not restore strength
- Restless legs syndrome: discomfort in the legs in the evening, desire to move them
- Pain of any origin, urge to urinate at night
- Hyperthyroidism, menopause, neurological diseases
- Caffeine, alcohol, nicotine; a number of medications
- Shift schedule, flights, late night screens
Алкоголь — самое частое самолечение бессонницы и одна of главных причин её хронизации. Он ускоряет засыпание, но разрушает структуру сна во второй половине ночи и провоцирует ранние пробуждения.
Survey
- Дневник сна в течение 2 недель: время отхода ко сну, засыпания, пробуждений, дневная активность, кофеин и алкоголь.
- Опрос о храпе и остановках дыхания — обязательно с расспросом близких.
- Анализы: гормоны щитовидной железы, ферритин (при синдроме беспокойных ног), глюкоза.
- Оценка тревоги и депрессии.
- Полисомнография — при подозрении на апноэ сна, необычном поведении во сне, дневных засыпаниях.
Treatment: why not sleeping pills
Cognitive behavioral therapy for insomnia (CBT-I) is considered the first choice treatment for chronic insomnia. It eliminates the self-maintenance mechanism and gives a result that persists after the end of treatment, whereas sleeping pills work only while they are taken, and with long-term use they lose their effect and become addictive.
- Limiting time in bed: do not lie awake, get up if it is impossible to fall asleep in 20 minutes
- Constant rise time - seven days a week, no matter how the night went
- Dealing with anxious thoughts about sleep and the “fear of not falling asleep”
- Avoidance of daytime naps during treatment
- Sleeping pills - for a short course and as prescribed by a doctor, as temporary support, not a basis
- Treatment of the underlying cause: apnea, depression, restless legs syndrome, pain
Sleep hygiene: what really works
- Getting up at the same time, including weekends, has a stronger effect on sleep than going to bed
- Bed is for sleeping only: do not work, do not eat or watch TV series lying down
- Cool, dark and quiet bedroom
- Avoid caffeine after lunch and avoid alcohol 3–4 hours before bedtime
- Physical activity during the day, but not intense exercise before bed
- Bright daylight in the morning - it adjusts the biological clock
- Avoid looking at the clock at night: it increases anxiety and makes it difficult to sleep
Если не спится — встаньте, перейдите в другую комнату, займитесь чем-то спокойным при неярком свете и вернитесь в постель, когда появится сонливость. Лежать и «заставлять себя уснуть» — прямой путь к хронической бессоннице.