Insomnia Treatment News
Treatment available for insomnia sufferers
Another sleepless night followed by a day where are you are too tired to get anything done.
This is the characteristic of insomnia, which hinders your ability to fall sleep or to stay asleep, which in turn affects your ability to function the next day.
Raed Hawa is a physician at Toronto Western Hospital who specializes in psychiatry and sleep medicine. He said what’s interesting about insomnia is it’s more a symptom of something else – sleep apnea or anxiety – rather than a standalone diagnosis.
Hawa said 90 per cent of people have this type of insomnia. However, the other 10 per cent of people have the pure form of insomnia called primary insomnia, which Hawa said is a true sleep disorder. Primary insomnia means all the other reasons you could be suffering from insomnia don’t exist.
“For example, if you’re not anxious or you’re not depressed and you don’t have apnea, leg restlessness or you’re not on medication or drugs, but you still have insomnia,” he said.
This means insomnia is bi-directional because it can cause symptoms such as apnea or anxiety or could occur as a result of those symptoms.
While there is no agreed upon definition of what insomnia is, Hawa said he defines it as a problem falling asleep, waking up frequently during the night and not being able to stay asleep (sleep fragmentation), waking up too early in the morning and an inability to fall back asleep or a combination of these symptoms.
“By the time people come to see me, they’ve had one, two or all three of these things throughout their life,” he said.
Besides sleep fragmentation, another consequence of insomnia is fatigue because people don’t get enough sleep or they have disruptive sleep. Hawa said this causes people to feel tired during the day and have low energy, which can be both detrimental and dangerous.
“People are falling asleep while driving, during a meeting or on the TTC. They are tired, feel depressed or sad, more irritable or cranky, anxiety, even physical symptoms like their stomach hurts. All this could be because of insomnia,” Hawa said.
Hawa explained there are three types of doctors who can look into sleep issues: a psychiatrist, to help with those thinking patterns and stressors that keep us awake; a respirologist or lung doctor, who deals with sleep apnea, a disorder that is brought on by breathing disruption; and a neurologist, as some sleep disorders are an indication of undiagnosed neurological issues.
Hawa said he sees people with all types of sleep issues because usually people who have one symptom or disorder also have another.
For example, people who have sleep apnea often also have insomnia and those with insomnia also have daytime sleepiness.
It’s a good idea to get treatment for insomnia, however, people must get the correct diagnosis in order to get the appropriate treatment.
The problem, Hawa said, is people rarely get treatment when they should and this could be because many people think insomnia is not harmful or that it’s just a part of getting older, because the older you get the more likely you are to suffer from insomnia, he said.
However, insomnia is classified in three ways: transient or temporary; short-term; and acute or chronic. If insomnia is chronic or persists more than a month, Hawa said it’s time to see your doctor.
“If there is no precipitant to it, stress, bad news, illness in the family, something happened that is stressful, you may not have a good sleep, but if the stress goes and the insomnia is still there this is a sign you need to get help,” he said.
Treatment options
Everyone’s insomnia is different so that means treatment also varies.
However, there are distinct approaches to treating insomnia – medication or cognitive behavioural therapy (CBT). The latter includes altering thoughts, sleep patterns and environments, and often times a combination of the two therapies are used.
When insomnia is due to anxiety or a particularly stressful time, Hawa said the mind has trouble shutting off and is constantly thinking about things that replace sleep.
“Cognitive therapy will help to attack these thoughts and make the person deal with these thoughts and cognitions,” Hawa said, adding CBT for insomnia has three main components:
1. Talking about and dealing with the thoughts that make the patient more aroused and unable to sleep. Hawa suggested having a diary or planner to document what thoughts you have before bed. They are then discussed with the patient to try to change their thinking patterns surrounding sleep or the lack of it.
2. Sleep hygiene means the person does things such as avoid smoking, caffeine, alcohol and bright lights in the hours before bed. Essentially, they are preparing themselves and their surrounding, including make sure a room is neither to warm nor too cold.
3. Stimulus control involves things like having the same wake and go-to-sleep schedule every day and only using the bed for sleeping. This means you should wake up, be still awake in 15 minutes and get up. “You want to train your brain that the bed is equal to sleep,” he said.
Also people should avoid napping and only go to bed when they are sleepy.
Hawa said there is no sleep treatment that shouldn’t involve sleep hygiene.
Many of his patients have suffered from insomnia for years and have tried these methods with no success.
In this case, Hawa suggests trying medicine.
Technically, there is only one type of sleeping pill called zopiclone. So many doctors prescribe things such as antidepressants for the sedative quality, which is particularly good for those also suffering from anxiety and depression as a result of insomnia.
“If it’s (insomnia) so severe and you’re so dysfunctional you might need medication because any behavioural or cognitive methods take months to work (but offer more long-term benefits), whereas a medication can have an immediate effect,” Hawa said.
Hawa said there isn’t one treatment approach that fits everyone and ultimately it’s about curing their insomnia.
Insomnia is one of those things that once someone is prone to it there is the possibility of it reoccurring. There isn’t really a cure, Hawa said, but it is manageable though the right treatment.
How to stop headache pain
More than 50 percent of all people experience some form of headache in their lifetimes, as the head is the only part of the body that can experience frequent and recurrent pain unrelated to tissue pathology, said AUB’s Dr. Samir Atweh, speaking at the meeting of the Lebanese Society for the Study of Pain’s (LSSP) Update on Treatment of Headaches, held at the Rafic Hariri School of Nursing’s (HSON) Hisham Jaroudi Auditorium on October 15, 2010.
All kinds of headaches, from migraines to tension to cluster to short-lasting unilateral headaches were discussed, as well as clinical and surgical treatments for pain. Many common causes can trigger different types of headaches that vary considerably in their clinical presentation and treatment. Most common headache triggers were identified: fatigue, insomnia, anxiety and depression, stress, irregular meals, high intake or withdrawal of caffeine intake, dehydration, and reduced physical exercise.
St. Joseph University’s Dr. Joseph Maarrawi illustrated the latest surgical procedures applied to eliminate severe cases of chronic headaches such as trigeminal and occipital neuralgia.
In his paper, “Tension Type Headaches,” Lebanese University’s Dr. Jose Chidiac pointed out that alternative methods of relieving pain such as acupuncture and yoga can supplement the standard medical treatment of headaches, but he also stressed the importance of the individual patient’s belief system.
According to the World Health Organization, “Health is not only the absence of infirmity and disease, but also a state of physical, mental, and social well-being.”
HSON Director Huda Abu-Saad Huijer, also the president elect of LSSP, said similar discussions on various types of pain will be held every three months.
LSSP, an associate chapter of the International Association for the Study of Pain, plans to launch a website to make the association’s plans and expertise more accessible to the public.