Insomnia: The invisible epidemic

That sleep is an essential part of life is obvious. Recent advances in sleep medicine suggest that it may have important restorative and protective functions. And, of course, sleep deprivation could adversely impact health and longevity.

So how much sleep do we really need? This seems to depend upon how old we are. Infants and children need it far more than adults do. Most people sleep for about six to nine hours every day while older people for about five to eight hours. Individuals who get less sleep than they need can find their daytime energy, concentration and memory to be poor.

This can affect their work efficiency. Amongst these people, studies suggest that even one extra hour of sleep every day (or a period of catch-up sleep over a weekend) can improve concentration and fatigue.

Insomnia refers to a perceived inability to get enough sleep. Roughly 20-35 per cent of the population report having the condition at some point during the past year, but the problem seems to be more common amongst women and older people. Insomnia could be an inability to fall asleep or frequent or early awakenings (with difficulties in returning to sleep) over a period of weeks.

That said, it is only diagnosed if one also experiences poor concentration, memory, fatigue and other daytime symptoms because of poor sleep. Acute insomnia often follows stressful events and is time-limited, with most patients recovering within days. In some however, it becomes chronic (>3 weeks). This is mediated by high levels of anxiety, conditioning and poor sleep hygiene- all of which perpetuate the sleep difficulty. Such individuals tend to have poorer quality of life and are more prone to fatigue-related accidents and associated anxiety / depressive illnesses.

A comprehensive evaluation and a clear diagnosis are essential to the management of chronic insomnia. This is usually conducted by a psychiatrist or another specialist with an interest in such disorders. Many medical and psychological problems can cause insomnia, and may need to be dealt with in the first instance. The patient may also be asked to keep a sleep-diary to monitor his/her sleep over a few days. This can quantify the problem and help arrive at a treatment plan- which could include behavioural (stimulus control) and sleep hygiene measures.

Medications (benzodiazepines like Alprazolam, Clonazepam and Lorazepam) have a limited role and are only useful in short-term management of insomnia (usually less than 1-2 weeks). Longer use has little evidence of therapeutic benefit and there are also risks of hangovers, coordination problems, habituation and dependence. (The writer is Senior Consultant Psychiatrist at Citizens Speciality Hospital.)

By Dr D Venugopal Duddu