Staying wide awake at night

Sheela (name changed), a middle-aged woman, approached a sleep specialist, as she hadn’t slept in years. After just one session of counselling, she managed eight hours of sound sleep. Her specialist attributed her sleeplessness to her restless legs. However, insomnia or sleeplessness can be due to several reasons- from anxiety to depression and as in Sheela’s case, restless legs among others. Experts say that insomnia is just the symptom and the underlying cause is the actual diagnosis. 

Dr R Sathianathan, Professor of Psychiatry, Sri Ramachandra University, says that the moment a patient starts complaining about sleep disorders, one invariably looks for a psychological reason, if other reasons are ruled out. “We first diagnose the case for an organic problem. If not, we look for a psychological condition,” he says. 

Insomnia can be divided into early insomnia and middle or late insomnia. He says, “Early insomnia is when the person has trouble going to sleep and then falls asleep after a bout of restlessness. The main reason for the condition is anxiety. In the other category, a person finds himself awake in the middle of the night, only to find the rest of the world asleep. Here, the problem is depression, when the conscious state mixes with the unconscious mind and wakes up the person.” 

Dr N Ramakrishnan, director, Nithra Institute of Sleep Sciences, says that though women tend to suffer from the condition the most, it is men who come forward to seek help. “Though we do not have a study to understand the prevalence in the Indian set up, it is extremely common,” he says. 

Women, for long have battled sleep deprivation and have endured it without seeking help. “They try hard to adapt to it and keep it private, but men are forthcoming to seek expert advice,” he says. 

Insomnia often affects the 50- plus population, he says, adding, “The common reason is worry or anxiety in a majority of cases.” 

Apart from the middle aged, specialists say that the ubiquitous technology has triggered a new group — adolescents. Dr Ramakrishnan says, “They suffer from anxiety due to exams from school right through college. Adding to the sleeplessness is the technology that keeps them awake through nights in the form of chats or social networking sites. They spend the whole night looking at message updates, surfing sites, etc.” 

Correcting the cause is the most effective treatment for the condition, says Dr Ramakrishnan. “If the person has bed anxiety, a combination of counselling and  medicine is the solution. Just prescribing pills never works, if the underlying cause is not addressed. We also need to help them cultivate sleep hygiene—habits and practices that help one sleeping well daily,” he says. 

An estimated 30-50% of the general population is affected by insomnia, and 10% have chronic insomnia (lasting more than 4-6 weeks). Insomnia is a symptom, not a stand-alone diagnosis. 

What is insomnia? It is difficulty to initiate or maintain sleep, or both. 

Who is affected? All age groups.

Women more affected by insomnia than men.  

Young adults affected primarily due to irregular sleeping habits. 

Pregnant women and those experiencing menopause suffer from sleep problems. 

Those with medical or psychiatric conditions affected.

Frequent travellers or shift workers suffer from it.

Stress most commonly triggers short-term or acute insomnia.  

Misuse or overuse of sleeping pills leads to insomnia