Difficulty falling asleep can be short term (acute) or long term (chronic). Some common problems that cause difficulty falling asleep are as follows:
Short-term causes:
- New environment and unfamiliarity
- Stress
- Excessive noise or light
- Extremes of temperature
- Uncomfortable bed or mattress
- New job or school
- Relocation to a new place
- Jet lag
- Work deadlines or examinations
- Death of a relative or close friend
- Difficulties in a relationship
- Physical discomfort such as pain
- Certain medications
- Acute illness and allergies
Chronic causes:
- Chronic medical conditions such as acid reflux disease, thyroid disease, diabetes, sleep apnea, neurological conditions such as Parkinson’s disease, and chronic pain
- Psychological conditions such as depression, anxiety, and bipolar disorder
- Medications such as anti-hypertensives (blood pressure [BP] medication), respiratory medications, anti-histamines, hormonal medication, seizure medication, anti-depressants, and chemotherapy
- The central nervous system (CNS) or brain stimulants, nicotine, or excessive caffeine
- Lifestyle factors such as frequent travel causing jet lag, constantly rotating shift work, irregular naps, and sleep timings
- Nasal block and sinus issues
- Age (insomnia becomes more common with age)
- Onset insomnia (difficulty initiating sleep; this type of insomnia may be short term or chronic)
Behavioral insomnia of childhood (BIC):
BIC can usually be managed with appropriate behavioral therapy. BIC has three subtypes:
- BIC sleep-onset: It can usually be resolved with a few behavioral changes such as creating a healthy sleep routine or learning self-soothing or relaxation techniques. It occurs due to negative associations with sleep such as needing to go to sleep by being rocked or nursed or watching TV while going to bed.
- BIC limit-setting: This occurs due to the child’s refusal to go to bed.
- BIC combined type: This is a combination of both BIC subtypes.
How to fall asleep
The treatment usually includes a combination of more than one treatment modality and uses a multidisciplinary approach. Treatment options include the following:
Cognitive-behavioral therapy:
- Sleep hygiene education: This addresses behavior that is incompatible with sleep such as caffeine or alcohol, environmental noise, inappropriate room temperature, and watching TV in bed.
- Cognitive therapy and relaxation therapy: This involves inculcating correct sleep beliefs, reducing stress and anxiety, performing relaxation exercises, and meditating.
- Acupressure and massage therapies: These can help relax and reduce chronic pain.
- Stimulus-control therapy: This works by associating the bed with only sleepiness and when it is time to sleep.
- Sleep-restriction therapy: This is based on the fact that excessive time in bed can lead to insomnia. Hence, it is advised for adults to limit their sleep time to around 5-7 hours.
Medication to treat insomnia:
The physician may prescribe sedative-hypnotic drugs, sedating antidepressants, antihistamines, and other drugs.
Devices:
Patients with insomnia can use U.S. Food and Drug Administration (FDA)-approved prescription devices.
Patients are advised
- To avoid caffeinated drinks in the late afternoon or evening.
- To avoid alcohol in the evening.
- To avoid large meals right before bedtime.
- To exercise in the late afternoon or early evening (6 hours before bedtime) that can promote sleep.
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References
https://www.sleepfoundation.org/insomnia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
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