Insomnia in Times of Pandemic - from Symptoms to Treatment

Insomnia is the most common sleep disorder. It is a state where people have problems falling asleep or maintaining sleep. At least a third of the population has one or more symptoms of insomnia, yet only 6% of them had insomnia diagnosed (1). In times of pandemic, acute insomnia is becoming more and more widespread. Since poor quality sleep can have disastrous consequences on your health such as increased risk for dementia, cardiovascular disease, cancer,psychiatric disorders and other, it is useful to know how to recognize insomnia and act timely.

What types of insomnia are there?

Insomnia can be divided into a couple of categories: time and etiology. In respect to time, insomnia can be either short-term (acute; up to a month) and long-term (chronic; months, years). Short-term (acute) insomnia may be caused by a traumatic event, stress in the environment, pressure from the environment and other. Common causes of long-term (chronic) insomnia are depression (important cause; up to 40% of depressed patients suffer from symptoms of insomnia), long-term anxiety and other psychiatric disorders, stress, pain or discomfort during sleep (1).

Etiologically, insomnia can be primary or secondary. Primary insomnia is a disorder by itself which is not caused by other diseases, drugs or sleep disorders. Long-term stress or emotional anxiety can be the cause, although the etiology is uncertain and poorly studied. Secondary insomnia, on the other hand, is a symptom or side reaction as part of another disease, drug or sleep disorder (1).

What are typical insomnia symptoms?

People who suffer from insomnia often experience daily sleepiness (especially dangerous for drivers who can fall asleep behind the wheel), lack of energy, difficulties falling asleep, irritability, daily tiredness, problems with concentration and forgetfulness (1).

Insomnia must be taken seriously and treated timely in order to avoid consequences of poor sleep quality, not in 10 years, but tomorrow.

Hypersomnolence is opposite to insomnia. It is a state of extreme sleepiness during the day which is not caused by other breathing related sleep disorders and is frequently associated with the poor sleep/wake cycle in the central nervous system (2).

How is it diagnosed?

Diagnosis of insomnia is not easy because there is no de?nitive test to con?rm it. It's important to exclude all other diseases which may have insomnia as a symptom before diagnosis is made. Insomnia can frequently be associated with thyroid disorders (hypothyreosis, hyperthyreosis and other). If the person does not have any significant disease, but has symptoms of insomnia, a sleep diary should be kept (time of going to bed, time of waking up, sleep time, sleep latency and so on). Also, questionnaires that aim for speci?c insomnia symptoms can be used, such as the Athens Insomnia Scale (AIS). Full-night polysomnography can also be performed as a part of second line diagnostics (3).

And how is insomnia treated?

Treatment in the form of changing sleep habits and stress relief/reduction, coping better with illness or trauma can help a significant number of people reduce their insomnia symptoms and put them on track of a better and calmer sleep. If these methods do not help, the first line of treatment is considered to be cognitive behavioral therapy (CBT) which eliminates negative thoughts, worries and activities that disrupt sleep and keep a person awake. Sometimes drugs like ramelteon, zolpidem can be prescribed so the person can fall asleep easier. Benzodiazepines like diazepam (Valium) are taken which, among others, have anxiolytic, sedative and hypnotic (induces sleep) action. Frequent use of benzodiazepines can lead to more frequent appearance of sleep spindles on the EEG during sleep, but the clinical meaning of the more frequent appearances has not been clari?ed (4). If insomnia becomes chronic and remains untreated, consequences like poorer academic or job success, other diseases (arterial hypertension, diabetes), reduced reaction time and daily tiredness can appear. The two latter are very important for drivers because they increase the risk of road traffic accidents. Psychiatric disorders like depression and anxiety can also occur.

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About the author

Alen Juginovi? is a medical doctor and postdoc at the Department of Neurobiology at Harvard Medical School in Boston, MA, USA working in the field of neuroscience/and sleep medicine, as well as organizing projects (Nobel Laureate conferences, international congresses, concerts and other) with great people and improving the community one step at a time.

Fields of Interest: Sleep Medicine, Neuroscience, Neurology, Project Management

Feel free to reach out for collaborations, inquiries or other at [email protected].

References:

1.              Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111.

2.              Sateia MJ. International classi?cation of sleep disorders-third edition: highlights and modi?cations. Chest. 2014;146(5):1387-94.

3.              Foundation             NS:             Insomnia             [Internet].             Available             from:https://www.sleepfoundation.org/insomnia/content/diagnosis [cited 2019 Jul 27].

4.              Plante DT, Goldstein MR, Cook JD, Smith R, Riedner BA, Rumble ME, et al. E?ects of oral temazepam on sleep spindles during non-rapid eye movement sleep: A high-density EEG investigation. Eur Neuropsychopharmacol. 2015;25(10):1600-10.