How to achieve better sleep? – treatment of insomnia

Sleep is a basic physiological need, very important for normal daily functioning. Insomnia is defined as a sleep disorder in which there are difficulties in falling asleep, maintaining sleep and/or insufficient sleep, and feelings of fatigue and sleepiness despite an adequate length of sleep.

Causes of insomnia

Insomnia can be the result of several factors: biological, physiological, psychological and environmental. Research has shown that some of the most common causes are the following:

Stress and anxiety. Constant worry and anxiety can disrupt sleep patterns, making it difficult to relax and fall asleep.

Poor sleep hygiene. Bad habits, irregular sleep schedules, excessive daytime napping, and engaging in stimulating activities before bed can disrupt the body’s natural sleep-wake cycle.

Medical conditions. Underlying health problems such as chronic pain, asthma, allergies and gastrointestinal problems can contribute to insomnia.

Mental disorders. Conditions such as depression, bipolar disorder and post-traumatic stress disorder (PTSD) are often associated with sleep disorders.

Substance abuse. Consumption of stimulants such as caffeine, nicotine, and certain medications, as well as excessive alcohol or drug use, can disrupt sleep patterns.

Effects of insomnia

Daily fatigue and impairment of cognitive function. Insomnia can lead to excessive daytime sleepiness, reduced concentration, memory problems and impaired decision-making ability.

Mood disorders. Chronic lack of sleep is closely related to mood disorders such as irritability, anxiety and depression, and can worsen pre-existing mental disorders.

Reduced quality of life. The constant fatigue and irritability that often accompany insomnia can interfere with social functioning, strain relationships and reduce the overall quality of life.

Increased risk of health issues: Long-term and chronic sleep disturbances are associated with a higher risk of developing chronic health problems such as obesity, diabetes, cardiovascular disease and weakened immunological function.

Treatment options

1. Sleep hygiene

Sleep hygiene refers to a series of habits that need to be established for better and higher quality sleep.

A regular sleep schedule. Going to bed around the same time every day can greatly help with sleep.

A suitable sleeping environment. It is necessary to darken the sleeping area and remove noise and other possible disturbances. Before going to bed, it is advisable to ventilate the room well. During the day, it is advised to separate the sleeping area from the working area and avoid studying or working on the bed.

A relaxing routine. By introducing a relaxing routine before bed, such as reading or taking a warm bath, we signal to our body that it is time to relax. It is recommended to avoid looking at mobile phones and other screens at least 30 minutes before going to bed, because blue light creates the illusion that it is still daytime and prevents the release of the sleep hormone – melatonin.

Food and drink. It is recommended to avoid coffee and caffeinated drinks in the afternoon, as well as heavy food and large meals before going to bed. Also, it is advised to reduce or avoid smoking and alcohol consumption.

Physical activity. Moderate exercise during the day helps to restore balance in the body, leads to better sleep, but is also generally beneficial for overall health.

2. Cognitive-behavioral therapy

Cognitive-behavioral therapy aims to change the patient’s opinion and view of the world by acting on negative thoughts, emotions and behavior patterns in order to bring about long-term emotional and behavioral changes. This type of therapy includes: sleep hygiene education, cognitive therapy, relaxation therapy, stimulus control and sleep restriction. It is carried out by a psychologist or psychiatrist as part of individual or group therapy. Cognitive-behavioral therapy proved to be successful in the treatment of primary insomnia and led to better sleep in as many as 64% of people.

3. Pharmacotherapy

Benzodiazepines

Benzodiazepines are a group of drugs with a wide spectrum of activity. By binding to GABA-A receptors in neuron synapses, they have an anxiolytic, sedative, anticonvulsant and muscle relaxant effect. Use in insomnia is based on their sedative and hypnotic effect. They are indicated for the treatment of insomnia that leads to exhaustion and affects the performance of daily activities. Short-acting benzodiazepines are used, and their use should be short-term – up to 4 weeks, due to the possible development of addiction and tolerance. Such drugs disrupt the natural structure of sleep and reduce its quality. Some of the side effects include fatigue, drowsiness and impaired psychomotor abilities. Abrupt discontinuation of therapy leads to withdrawal symptoms and rebound symptoms, which is why it is necessary to discontinue therapy gradually.

“Z” drugs

Benzodiazepine-like drugs or “Z”-drugs bind to the same binding site as benzodiazepines, but their effect is only sedative and hypnotic. They are indicated for the short-term treatment of insomnia in severe sleep disorders. They are used for up to 4 weeks, and the side effects are similar to those of benzodiazepines. Their advantage compared to benzodiazepines is the short duration of the effect of “Z” drugs and less severe side effects.

Melatonin

Melatonin is a key hormone in regulating the cycle of wakefulness and sleep, and it is released more during the night. After the age of 55, the production of melatonin decreases and therefore it is used as monotherapy for the treatment of primary insomnia in people over 55. It is also indicated for the treatment of insomnia caused by time zone changes, the so-called “jet lag”. Treatment with melatonin lasts up to 13 weeks, the advantage compared to previous drugs is a minimal withdrawal syndrome after stopping therapy, and they do not affect the structure of sleep.

4. Phytotherapy

In insomnia therapy, it is possible to use some traditional herbal medicines or dietary supplements. The herbal extracts used are those from the root of common valerian, the flower of cultivated hops, lemon balm leaves and peppermint leaves. Also, passion flower, chamomile and lavender are used, which have a relaxing and anxiolytic effect. By alleviating the signs of mild and transient nervousness, herbal preparations can help with transient insomnia.

What to choose?

Proper and quality sleep is essential for the overall well-being of the organism. In the treatment of insomnia, there are several approaches and therapeutic options. It is necessary to adjust the therapy to the individual and to solve the underlying problems, if they exist. It is always advisable to start with non-pharmacological measures, and only if they do not prove to be effective, to try pharmacotherapy. Pharmacotherapy, although very effective, can lead to side effects and new problems and cannot be used as a long-term solution. Patients with insomnia often misuse and irrationally use drugs, which must be prevented by adequate education and presentation of other options.