Are you also having trouble sleeping at night? Let's talk about this insomnia problem!

Imagine, the discomfort you feel when you go to bed at night after a hard day's work and can't fall asleep, tossing and turning... or waking up in the morning and not being able to fall back asleep again, thinking about it... This is the problem that many of us have with insomnia, or in medical terms, insomnia . While for some, this is just a minor annoyance, for others, insomnia can be a major problem that disrupts their entire lives. So why does this happen? Let's talk about this simply and in detail.

What exactly is Insomnia?

Simply put, insomnia is when you can't sleep properly. That means you can't sleep long enough, can't get a good night's sleep, or have trouble falling asleep or staying asleep.

Sleep is essential for our bodies. It's like gasoline for a car. Our bodies and minds, which are tired from working all day, are recharged through sleep. So, when we don't get enough sleep, we experience sleep deprivation . This makes us unable to perform our daily tasks properly, and our bodies feel very uncomfortable.

Does everyone sleep the same?

No. Everyone's sleep habits and needs are so different. That's why even doctors consider different sleep patterns to be "normal." Think about it this way...

• Early birds: Some people like to go to bed a little earlier at night and wake up early in the morning.
• Night owls: Others work late into the night, go to bed late, and wake up late in the morning.
• Short-sleepers: Some people get less sleep than others. Some research suggests that there may even be a genetic cause for this.
• Sleep changes due to habit: Some people change their sleep patterns due to things like their job. For example, those in the military tend to wake up at the slightest sound. Similarly, some people are accustomed to sleeping soundly no matter how loud it is.
• Sleep changes with age: Our sleep needs change throughout our lives. While a small baby sleeps about 14-17 hours a day, an adult (18+ years) usually only needs 7-9 hours of sleep.

What are the main types of insomnia?

Doctors classify insomnia into two main types. It will be useful for you to know this too.

How do you know if you have insomnia? - Symptoms

Insomnia symptoms can be divided into several main categories. Let's take a look at what they are.

1. Sleep problems

This is divided into three parts, depending on how you are having sleep problems.

• Difficulty falling asleep (Initial insomnia): Inability to fall asleep no matter how long you stay in bed.
• Middle insomnia: Waking up in the middle of the night and falling back asleep. This is the type that most people have.
• Late insomnia: Waking up much earlier than expected, in the morning, and not being able to fall back asleep.

2. Effects felt during the day

When you don't get enough sleep at night, the effects are felt the next day. See if this happens to you too.

• Feeling tired, sluggish, or sleepy throughout the day.
• It takes longer to react. For example, it is difficult to make quick decisions while driving a car.
• Things get forgotten.
• Thinking speed slows down, confusion occurs, or it becomes difficult to concentrate .
• Mood changes, especially anxiety, depression, and irritability .
• This interferes with your work, social activities, hobbies, or other daily activities.

3. Special characteristics of chronic insomnia

See if your insomnia problem has any of these symptoms. If so, you may have chronic insomnia.

• Current situation: You are unable to sleep despite having a good environment and time to sleep (e.g., without an external reason such as a shift change, a major life problem).
• Frequency: If you have this problem at least three days a week.
• Duration: If this problem persists for at least three months .
• Absence of other causes: If the condition is not caused by drugs, alcohol, medications, or another sleep disorder, and if it cannot be fully explained by another physical or mental illness.

Why do we get insomnia? - What are the causes?

It is difficult to pinpoint a single cause of insomnia. There are many factors that can contribute to this. Sometimes, one or more of these factors come together to cause this condition.

• Family history (Genetics): Sleep problems can run in families. If someone in your family has insomnia, you are more likely to develop it too.
• Changes in brain activity: The brains of people with insomnia may be slightly more active than others. Changes in brain chemicals can also disrupt sleep.
• Other physical illnesses: Your physical health can directly affect your sleep. Sleep can be disrupted by temporary things like a minor infection or injury, as well as long-term illnesses like gastritis (acid reflux) or Parkinson's disease. This condition can also be caused by changes in the circadian rhythm, which controls our body's natural sleep/wake cycle.
• Mental health issues: About half of people with chronic insomnia have another mental health condition, such as anxiety or depression .
• Stressful situations in life: Things like excessive stress, problems at work, and family disputes can cause sleep deprivation.
• Life changes: Temporary changes, such as moving to a new country (jet lag), having to sleep in a new place, or changing shift work, can also disrupt sleep.
• Your daily habits: Insomnia can also be caused by poor sleep habits (we call this sleep hygiene ). Things like napping during the day, drinking things like coffee at night, and not having a set bedtime can contribute to this.

Complications that may occur if insomnia persists

If insomnia persists for a long time, it can lead to sleep deprivation . The biggest risk here is daytime sleepiness. This is very dangerous if you are driving a vehicle or doing any work that requires you to be alert.

In addition, long-term sleep deprivation increases the risk of many other diseases.

• Depression
• Anxiety
• High blood pressure/Hypertension
• Heart attack
• Stroke
• Obstructive sleep apnea
• Type 2 diabetes
• Obesity

How can a doctor confirm this?

When you visit a doctor, he or she will ask you detailed questions about your health history, personal information, sleep habits, and symptoms. There is no specific test to diagnose insomnia. However, some tests may be recommended to check for other medical conditions that are interfering with your sleep.

Examples of this are:

• Sleep apnea testing: This can be done using a sleep study (polysomnography) done in a hospital or a device that can be done at home.
• Actigraphy: A wrist-worn device that monitors your sleep and wake patterns over several days.
• Multiple sleep latency test (MSLT): A test that measures how quickly you fall asleep during the day.

What are the treatments for insomnia?

There are many treatments for insomnia. They range from simple lifestyle changes to medications. The main treatments are:

1. Establish and maintain good sleep habits (Sleep hygiene).

2. Medications that help you fall asleep or stay asleep.

3. Treatment for mental health.

Medications that help you sleep

There are many types of medications that can help you sleep. Some of these require a doctor's prescription, while others can be purchased at pharmacies.

• Prescription drugs:
• Benzodiazepines and Z-drugs: These are powerful drugs that reduce brain activity and induce sleep. For example: `(temazepam)`, `(zolpidem - Ambien®)`.
• Dual orexin receptor antagonists (DORAs): These block a chemical in the brain that helps you wake up and induce sleep.
• Sedating antidepressants: Some medications used for depression (e.g. amitriptyline) are also used for insomnia because they cause drowsiness.
• Melatonin and related drugs: Melatonin is a chemical naturally produced by our brain that signals when it's time to sleep. It can also be taken as a medication.

• Nonprescription drugs:
• Some antihistamines used for allergies (e.g. diphenhydramine - found in Piriton) can cause drowsiness. However, these are not recommended for long-term use.

Things we can do for ourselves when living with insomnia (Sleep Hygiene)

In addition to treatments, there are many things you can do yourself to improve the quality of your sleep. This is what we call Sleep Hygiene or "good sleep habits."

• Establish a sleep schedule: Get into the habit of going to bed and waking up at the same time every day. Try to keep this routine consistent, even on weekends and holidays. Avoid napping during the day.
• Take time to calm down: Before going to bed, clear your mind of the day's problems. Set aside a little "buffer time" between when you finish work and when you go to bed. Do something during that time, like reading a book or listening to calming music. If you can't fall asleep after going to bed, instead of tossing and turning in bed, get up and do something that calms you down before going back to bed.
• Create a comfortable environment: Comfort is essential for good sleep. Adjust the lighting, sound, and temperature of the room to suit you.
• Stay away from phones, tablets, and TVs: Stop using these devices at least an hour before bed. The blue light they emit signals to the brain that it is daytime, delaying the production of sleep-inducing chemicals.
• Be careful about what you eat and drink: Avoid eating large meals at night and eating late at night. Nicotine, caffeine (coffee, tea, some soft drinks), and alcohol in particular disrupt sleep.
• Stay active: Getting a little exercise during the day, even just walking, can help you sleep better at night.
• If the problem persists, see a doctor: If your sleep problem persists despite following these habits, be sure to see your family doctor.

When should we see a doctor?

If insomnia lasts for more than a few days and is affecting your daily activities, it is important to see a doctor. Especially if you have the following symptoms, be sure to seek medical advice.

• If you feel uncontrollably sleepy during the day.
• If you fall asleep quickly during the day, especially while working or driving (this is called `microsleeps`).
• If you have other mental or physical conditions that affect sleep.

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