Insomnia : Treatment

Chronic sleep deprivation results in memory and concentration problems. There may be excessive daytime sleepiness and fatigue, which in turn may lead to occupational stress and marital disharmony.

Based on the duration of symptoms, insomnia is classified as: Transient Insomnia (When symptoms last for less than two weeks it is transient insomnia), Intermittent Insomnia (Insomnia is intermittent when repetitive episodes of transient insomnia occur) and Chronic Insomnia (When symptoms last for at least a month, it is known as chronic insomnia)

Therapy for insomnia is usually carried out with hypnotics and behavioral therapy.

Hypnotics:
These are sedatives that are given to induce sleep. The ideal dose is the lowest dose that adequately induces and maintains sleep. To prevent rebound insomnia, longer acting hypnotics are used.

Commonly used Hypnotics are: (a )Benzodiazepines like Furazepam
and Triazolam, (b.) Imidazopyridine medication; Zolpidem, which is currently widely used due to its rapid onset of action, limited abuse potential and low incidence of side effects, and (c )Cyclopyrrolone medication like Zopiclone, which is a relatively safe drug to be used for the elderly.

Adverse effects of hypnotics occur more commonly in patients above 55 years of age in whom there can be increased daytime sleepiness and cognitive impairment.

Behavioral therapy
The basis of behavioral therapy is to help overcome phobias related to sleep, and to achieve ideal sleeping habits. Based on the type of insomnia and the associated history the appropriate therapy is chosen. The techniques employed are:

(1) Relaxation therapy effectively reduces mental or muscular tension in a person who has difficulty in initiating and maintaining sleep. Relaxation techniques like meditation help to relax the mind, and physical exercises help to relax the muscles.

(2) Sleep restriction therapy This therapy imposes strict limits on the time of getting into bed and arising from the bed. This helps the person to tune his internal clock so that he can easily fall asleep and maintain good sleep.

(3) Stimulus control therapy is based upon the fact that the time spent in bed worrying about sleep is counterproductive to initiating sleep. The patient is advised to go to bed only when sleepy, and to associate bed with falling asleep quickly.

(4) Cognitive therapy This therapy seeks to alter the negative emotions like fear and anxiety that are associated with sleep.

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