Insomnia

A great part of the world’s population complains of problems and difficulties sleeping. Epidemiological surveys of more than a decade ago show that there is a prevalence of insomnia in about 10% of the general population of the world [1]. However, this percentage varies from place to place, and in some studies, this percentage has reached 40%.

A great part of the world’s population complains of problems and difficulties sleeping. Epidemiological surveys of more than a decade ago show that there is a prevalence of insomnia in about 10% of the general population of the world [1]. However, this percentage varies from place to place, and in some studies, this percentage has reached 40%.

But after all, what is insomnia?

Generally, everyone has some preconceived definition, which is related to sleeping problems. Which is not wrong!

According to the International Classification of Sleep Disorders (ICDS [2]), insomnia is defined as difficulty in initiating or maintaining sleep, or even the perception of non-restorative sleep, combined with adverse consequences on the day, such as excessive fatigue, drop in performance or change in mood. As a result, it is common to report greater fatigue and drowsiness, which can be associated with other symptoms such as irritability, anxiety, lack of attention and memory.

There are some specific criteria for the accurate diagnosis of insomnia: 1) difficulty falling asleep and staying asleep, or poor quality of sleep 2) frequency of insomnia, which is related to how many days of the week the individual has trouble sleeping 3) concern about lack of sleep, and how it can affect the performance of their daily routine 4) the sleep routine directly affects the social and occupational functioning of the individual.

Thus, for a careful identification of insomnia, it is always necessary to seek a health professional capable of assessing your problem.

In addition to the diagnosis, there are several factors that cause insomnia that are related to different types of insomnia, which have different severity and prevalence in the population.

According to the International Classification of Sleep Disorders (ICDS [2]), insomnia can be broadly classified into two major groups: acute and chronic. However, in addition to this initial division, it is possible to further differentiate the causes and consequences in order to generate different groups – which we will address below.

• Adaptive insomnia: also known as acute insomnia or short-term insomnia. It is usually caused by mental stress and tends to last only a few days or weeks. Epidemiological studies indicate that the prevalence of this category of insomnia in adults is probably in the range of 15-20%. This problem can occur at any age. Adaptive insomnia is more common in women than men, as well as in older adults than younger adults and children
• Childhood behavioral insomnia: occurs when a child associates falling asleep with an action (being held), some object (bottle) or sleeping place (parents’ bed), in order to be unable to fall asleep if separated from this association. About 10-30% of children are affected by this insomnia condition.
• Idiopathic insomnia: an insomnia that begins in childhood and lasts a lifetime, cannot be explained by other causes. The information suggests that this condition is present in approximately 0.7% of adolescents and 1.0% of very young adults.
• Inadequate sleep hygiene: this form of insomnia is caused by poor sleep habits that keep you awake or cause disorder in your sleep schedule. Studies report that this condition is present in about 1 to 2% of adolescents and young adults
• Insomnia due to drug or substance abuse, medical condition or mental disorder: insomnia symptoms usually result from one of these causes. Insomnia is more often associated with a psychiatric disorder, such as depression, than with any other medical condition. Research suggests that about 3% of the population has symptoms of insomnia caused by a medical or psychiatric condition. Among adolescents and young adults, the prevalence of this form of insomnia is slightly lower. 2% of the general population is affected by this type of insomnia. Approximately 3.5% of all sleep center patients are affected by this condition.
• Paradoxical insomnia: a complaint of severe insomnia occurs even though there is no objective evidence of a sleep disorder assessed in specialized clinics. The prevalence in the general population is not known. Among clinical populations, this condition is usually found in less than 5% of patients with insomnia. It is believed to be more common in young and middle-aged adults.
• Psychophysiological insomnia: a complaint of insomnia occurs with an excessive amount of anxiety and concern about sleep and insomnia. This condition is found in 1-2% of the general population and 12-15% of all patients seen in sleep centers. It is more frequent in women than in men. It rarely occurs in children, but it is more common in adolescents and in all groups of adulthood.

A specific analysis protocol is used in order to identify each category of insomnia. In an article by researchers at the American Association of Sleep Medicine (AASM) [3], a survey of the categorization of each of the types of insomnia was carried out and described which criteria are used to identify insomnia and in which spectrum the patient is inserted.

In a recent article, the authors proposed an update on the criteria for identifying insomnia. The aspects that must be observed are:

• Main complaint: the individual complains about lack of sleep
• Sleep / wake rhythm routine: identify the daily pattern of bedtime and waking times, as well as the identification of latency at bedtime and daytime naps.
• Routine at bedtime: environments without noise / light pollution are not the causes of sleep problems
• Nighttime behavior: incidence of other problems such as snoring and nighttime movement can be the cause or a complementary diagnosis of the problem.
• Daytime dysfunction: decreased quality of life, memory problems, tiredness and mood swings are directly associated with insomnia.
• Daytime dysfunction: decreased quality of life, memory problems, tiredness and mood swings are directly associated with insomnia.
• Medicines: the use of medications directly affects sleep. The use of psychiatric drugs, as well as some remedies for chronic lung and heart disease can affect your sleep routine.
• Social history: work hours and daily tasks also affect sleep. Trans-regional travel, night work, as well as the consumption of nicotine, coffee and alcohol can directly affect the worsening of insomnia problems.

One aspect that should be kept in mind is that many people sleep little, and that it has no negative consequences on their tasks, nor on their quality of life. However, they are concerned that they are sleeping too little at night. If you are one of them, don’t worry, you probably don’t suffer from insomnia! A portion of the population does not need to sleep many hours a night to have a completely restorative sleep!

In addition to the information that provides a diagnosis of insomnia, there are tools that are used in order to complement, or even identify sleep problems more objectively. The use of sleep diaries – which consists of documentation of the daily routine of sleeping and waking hours of individuals – is very common in this type of analysis.

In a more robust investigation, it is possible to carry out a follow-up using actimeters, which provide more accurate assessments of sleeping and waking hours for a long period of time with the individual in their usual routine, as well as sleep latency and episodes of movement and night awakening. If necessary, it is possible to perform a polysomnography, an even more specific examination in a laboratory setting. These methods of analysis have been addressed previously in other texts.

For the treatment of insomnia, the best treatment will be that recommended by a health professional, preferably a sleep doctor. In general, it is possible to divide treatment into two large groups: drug treatment and cognitive behavioral therapy for insomnia. Often the approaches are carried out together, supporting one another. It is worth remembering that insomnia treatments are a serious process that must be strictly followed as long as necessary.

Thus, it is possible to notice that insomnia is a very common disorder that generates negative consequences for people, directly affecting the quality of life and the daily performance of tasks. Therefore, it is necessary to maintain healthy lifestyle habits, and to maintain a dark and peaceful environment, to facilitate a better quality sleep!