Hypertension, mental illness, others trigger insomnia –Expert

Consultant cardiologist with interest in sleep disorders, Dr Folasade Alli, discusses insomnia and its treatments with SIMON UTEBOR

What is insomnia?

Insomnia is a serious debilitating condition. It is defined as difficulty in initiating or maintaining sleep, waking earlier than desired and/or resistance to going to bed on an appropriate schedule. It is either one wakes up earlier than one desired or there is a resistance in going to bed at an appropriate schedule.

Is it true that insomnia cannot be cured?

Insomnia can be cured. It can be cured by appropriate measures.

What are the appropriate measures?

There are two main management modalities for insomnia. The first, which is the main one, is cognitive behavioural therapy, that is, there are some things that we do that make sleep not to come. CBT is a structured programme that helps one to identify and replace thoughts and behaviours that cause or worsen sleep problems with habits that promote sound sleep. Therefore, there are undertones of cognitive/behavioural issues.

The second is pharmacological intervention – the process of taking care of other medical conditions that can result in making sleep not to come such as hypertension, diabetes, obesity, etc. If they are not managed to optimal goal, one can have insomnia.

What are the causes of insomnia?

The main causes of insomnia are multi-factorial. It ranges from diseases that are not well managed or covered. We have the issues of apnoea, if it is there and it is not properly evaluated and managed, then the individual will end up having sleep disorders.

How can one prevent or stop insomnia?

Early and proper diagnosis of insomnia is mandatory. Diagnosis of insomnia is based on the sleep disturbance for at least three days of the seven days a week for three consecutive months.

Once that has developed, then one will need to look at the person to know if there are behavioural issues; whether there is stress keeping one’s mind awake. The second is whether there are underlying medical conditions that make sleep not to come. Have they been diagnosed and appropriately managed? These are two key points that need to be evaluated before a person can be said to have insomnia.

Are there food types that cause insomnia?

Yes, of course. Food items, the timing and the types of food can actually cause insomnia. Consuming heavy meals or food that have slow digestion, late at night, for example after 8pm, can result in insomnia. This will be elaborated by Gastroesophageal Reflux Diseases etc.

Is insomnia a sign of cancer?

Insomnia is not a sign of cancer. As I said, disease conditions, which have not been well evaluated and managed, can result in insomnia.

For example, if someone has cancer but it has not been diagnosed, the natural body environment is already being disturbed. Therefore, things cannot go accordingly. So, with cancer, individual can experience serious wakefulness when they are supposed to be sleeping. Therefore, diseases not properly attended to can precipitate and perpetuate insomnia.

What are the commonly associated symptoms of insomnia?

The symptoms may include difficulty falling or staying asleep and not feeling well rested after sleeping at night. Other symptoms are forgetfulness, memory lapses, daytime sleepiness, headaches, lack of concentration or slowness in performing activities, as well as irritability, mood swings, anxiety, panic attacks, decreased work productivity, driving accident (sleeping off while driving), impotence, among others.

 What are the medical treatments for insomnia?

The medical treatments for insomnia are behavioural therapy, pharmacologic agents, ranging from sleep inducers, sleep enhancers and optimal treatment of the underlying medical conditions.

However, certain medications and stimulants may cause chronic insomnia. They include alcohol, antihypertensive agents like beta blocker, illicit drugs such as cocaine and other stimulants. Obese people are prone to sleep disorders. The treatment requires a personalised evaluation of formulation of specific plan supervised by the specialists. Sometimes, with the support of mental health specialists (psychiatrist, psychologist).

How is it diagnosed?

As I said earlier, three nights out of seven nights a week, an individual does not fall asleep or wake up early, and if the situation should continue for the next three months, you will know that there is something happening. There are usually predisposing, precipitating and perpetuating factors that must be assessed and addressed if present. Finally, sleep study is an investigation to perform in order to evaluate the type of sleep disorder.

Is it true that sex improves sleep?

Exercises are good for human beings and sex is an exercise. So, sexual activity as a form of exercise improves sleep.

What are the risk factors for insomnia?

The risk factors of insomnia include obesity, heart disease, diabetes, asthma, hyperthyroidism, hypertension, depression that have not been diagnosed.

They are usually predisposing, precipitating and perpetuating factors. These mixed factors include medical conditions that are in the individual that have not been diagnosed, or have been diagnosed but not well managed. Heart conditions such as hypertension, abnormal cholesterol, depression, mental illness – all these are conditions that can predispose one to having insomnia. They can precipitate insomnia and can also perpetuate the condition when they are not properly attended to.

What is the difference between insomnia and sleep apnea?

Insomnia is a situation whereby there is difficulty initiating sleep, waking earlier than desired, while sleep apnoea is a disorder that forces the body to stop breathing when one is sleeping. In sleep apnoea, there is breathing difficulty – there is a period where breathing becomes disturbed during sleep. In insomnia, there is no issue with stopping breathing; it is just that you cannot sleep, but in sleep apnoea, you have added condition whereby the person stops breathing momentarily. Therefore, it is the momentary stopping of breathing that now causes arousal just enough to gasp and start breathing again. During the period of apnoea, there is an accummulation of carbon dioxide which the brain senses, with activation of alert centre that actually makes the individual to wake up and sleep resumes and the cycle begins again.

Can insomnia lead to death?

Of course, it can if there are underlying conditions that have not been properly evaluated. For instance, somebody has a high blood pressure that is not well managed; the blood pressure can suddenly rise up during the night and the individual will have a stroke. So, it is not impossible that there is an increased risk of mortality because of the associated medical conditions. In risk population, untreated sleep disorders is associated with neurovascular and cardiovascular complications including resistant hypertension, heart failure, cardiac arrhythmias, stroke and hormonal derangement (diabetes mellitus) as a consequence of a adrenergic response.

Does aging contribute to insomnia?

Yes; aging is a great factor. The older you become, the more vulnerable you are because many other medical conditions arise.

When is it appropriate to see a doctor and which doctor can best handle the condition?

Appropriate time to see the doctor includes disordered sleeping pattern associated with symptoms of morning headaches, memory lapses, snoring, etc.

We have trained sleep specialists that will evaluate to know if the patient is suffering from insomnia. The eventual management of insomnia is multi-disciplinary and individualised because it depends on underlying medical problems. For example, if you have a high blood pressure or diabetes that has not been properly managed, go to their specialists.  The same thing applies when one has mental health issues that have not been managed. The person should see a psychiatrist. So, it is a multi-disciplinary approach.

(PUNCH)