Insomnia

Middle Insomnia Treatment – How to Treat Middle Insomnia ?

Insomnia Types

Prolonged inability to get a proper sleep is called Insomnia. Insomnia is categorized into three different types according to the patterns of sleep. These are –

Onset insomnia

When you find it difficult to fall asleep as soon as you go to bed in the night, it is called Onset Insomnia. It is often associated with anxiety disorders.

Middle-of-the-Night Insomnia

Difficulty to sleep after awakening in the middle of the night or early morning is called Middle-of-the-night Insomnia. It is often referred as nocturnal awakenings or Middle Insomnia. Difficulty to maintain sleep is often associated with medical illness or pain.

Terminal Insomnia

Often a clinical depression makes us wake in the early morning. This is termed as Terminal or Late Insomnia. It is often a characteristic of clinical depression.

Treatment of Middle-of-the-night Insomnia

Medications
  • Often medicines are prescribed to treat this kind of sleeplessness. But no drugs have been approved by the US FDA which can specifically treat nocturnal sleeplessness.
  • Most medicines are used at bedtime on a daily basis to promote at least 6-8 hours of sleep and avoid lingering effects the following day.
Faulty habits that must be avoided
  • Staying on the bed too long to get sleep. This often results in occupying the mind with worries and anxiety.
  • Oversleeping in the morning or day time.
  • Reading book or watching programs that can cause anxiety and excitement in you.
  • Falling sleep in places other than bed.
Good sleeping habits to practise
  • Alcohol, nicotine and caffeine should not be taken within 4-6 hours before going to sleep. These products must not be taken even when you wake up in the middle of your sleep.
  • Do not eat a heavy meal, eat a light snack before going to bed.
  • Do not undergo any physical exhaustion 3-4 hour before your sleeping time. But exercises must be done on a regular basis during the day.
  • Minimize all the disturbances like light, noise, excessive temperature etc. Use ear plugs, blankets, heater, air conditioners, window blinds etc.
  • Avoid sleeping for more than 8 hours.
  • Do not increase your day time nap for more than an hour and must be completed before 3 pm.
  • Go to bed whenever you feel sleepy.
  • Get up from your bed at the same time regularly.
  • Relaxation techniques may be practised.
  • Keep your bedroom for sleeping purpose only.

Facts about Sleeping Maintenance Insomnia

  • One person may exhibit more than one kind of Insomnia.
  • Sometimes, melatonin can be given to treat this kind of sleeping disorder.

The most common problem associated with middle insomnia is the feeling of fatigue the following day. Nocturnal awakenings also result in an increase in the day time sleeping hours by twice compared to the night time sleep. This is the most reported kind of sleeplessness. The following facts and figures were noted in the US alone.

  • About 35% American more than 18 years of age reported waking up 3 or more time in a week.
  • 43% of nocturnal awakening cases reported difficulty in resuming sleep after waking.
  • More than 90% of Insomniacs reported the condition persisted for more than 6 months.
  • Greater than 50% suffered from nocturnal awakenings for more than 5 years.

Causes of Middle Insomnia

  • Anxiety
  • Age (common in older patients)
  • Children
  • Diet and drinks
  • Dreams
  • Difficulty breathing
  • Discomfort due to Temperature (extreme heat or cold)
  • Hunger or thirst
  • Illness or medical complications
  • Light
  • Lack of ventilation
  • Need to go to the wash room
  • Need to brush teeth to sleep back
  • Noise
  • Pain
  • Sleeping partner
  • Gender (Women undergoing menstrual periods or menopause are more prone)

Treatment for Middle Insomnia in Elders

Middle insomnia is mostly observed in the elderly patients (age is factor, as mentioned above). Thus, it is very important to seek an immediate elderly insomnia treatment as it leads to serious health problems if untreated for prolonged periods. Lack of proper sleep can lead to many symptoms like decreased memory, increased fall risks, decreased response time, decreased cognitive performance and attention.

Non-Pharmacological Treatments

Non-pharmacological treatments are the primary approaches for treating elderly insomnia. These are natural treatment methods that include no physician or medical intervention.

  • The elderly person and the family should be aware of the sleep hygiene.
  • Maintain a correct sleeping schedule i.e going to bed and awakening at the same time everyday.
  • Set up a correct routine in the evening for the elder to fall asleep.
  • Long periods of wakefulness on the bed should be avoided. The bed should only be used for sleep.
  • Exercise is important for getting good sleep, but it should not be done during bedtime.
  • Elderly insomniacs should avoid taking naps.
  • Smoking, alcohol and caffeine consumption should be avoided.
  • Relaxation and stress management therapies are very helpful for elderly insomniacs.
Pharmacological Treatments

In some cases, medications become necessary when non-pharmacological treatments do not work in completely curing insomnia in the elderly. The medications approved by the FDA and are commonly prescribed by the health experts include:

  • Barbiturates

    These are less commonly prescribed for elderly insomniacs. The reason behind is they become addictive and are dangerous. They cause side effects such as confusion, irritation, nervousness, nightmares, thinking abnormality, dizziness and hallucinations.

  • Benzodiazepines

    These are commonly prescribed drugs for insomnia but still carry a few side effects. They include dizziness, over-sedation, unsteadiness, weakness, mental confusion, increased falls, memory impairment, amnesia, nausea, headache, agitation, sleep disturbance and change in appetite.

  • Antihistamines

    Though this drug is not FDA approved, it is commonly prescribed for treating elderly insomnia. The active ingredient dephenhydramine present in these medications acts to treat insomnia.

Severe Insomnia

Insomniacs will spend several nights with little or no sleep, when affected with severe insomnia. The symptoms are mostly same with severe insomnia, but would be more prolonged and more intense.

Four common signs of an insomniac are –

  • difficulty to get sleep
  • waking up many times during the night sleep
  • waking up too early
  • not feeling refreshed even after a night’s sleep

Insomnia is characterized into three different types –

  • Transient or mild insomnia
  • Short-term or moderate insomnia
  • Severe or chronic insomnia
Symptoms of Severe Insomnia
  • Inability or reduced ability to perform logical or mental tasks
  • Increased irritability during the waking hours
  • Regular difficulty in falling asleep
  • Waking up from sleep during night on a regular basis
  • Uncontrollable sleepiness during the daytime
  • Waking up too early in the morning regularly
Causes of Severe Insomnia

There are several causes that can lead to chronic sleeplessness. A few of them are mentioned below –

    • Prolonged stress

Sometimes a long-lasting stress like financial turmoils, illness of a loved one or marital problems can lead to Chronic sleeplessness.

    • Psychiatric problems

Anxiety and depression along with a few other psychiatric problems are often the cause of Sleeplessness. When these illnesses worsen, they occur for a longer period causing chronic sleeplessness.

    • Disruptive sleep

Intense bouts of sleeplessness is also common in people with frequent loss of sleep during regular hours. Any disturbance caused to our sleep pattern in our body can lead to Chronic sleeplessness. These include shift jobs etc.

    • Intense pain

Regular pain caused due to some medical ailments like fibromyalgia, arthritis and neuropathy often disturbs the night sleep.

Treatment of chronic sleeplessness

Chronic sleeplessness often requires medical attention. A change in the lifestyle often helps in improving sleeping patterns.

A major loss of vitality and strength occurs to the face in case of severe insomnia. It often results in several risk factors like irregular bowel habits, decreased mental function, reduced logical abilities and several other medical conditions. Sleep is very important for our health.

Sleeping pills

The doctors might prescribe sleeping pills to patients of chronic insomnia. Although this is only for a temporary period and not advisable for long term. Most of the sleeping pills might lead to addiction and further worsen the condition. They also come with harmful side effects.

Reconditioning

Another chronic insomnia treatment is reconditioning. The patient is asked not to use the bed for any other purpose except sleeping. For example no work or reading in the bed. He should go to bed only when he feels sleepy. Taking naps is discouraged. This will condition the body and associate bed with sleep.

Bright light

This process reprograms the patient’s biological clock. It helps in the scheduling of the patient’s sleep time at night and wake up time in the morning. It is done through the exposure to bright lights. A professional therapist should monitor the bright light treatment.

Sleep restriction

This treatment reduces the sleeping time of the insomniacs to force them to sleep at the suggested time. By doing things other than sleeping in bed can affect the sleep. By restricting this lounging location and hours, chronic insomnia is treated.

Relaxation therapy

The anxiety and tension is reduced through relaxation therapy. Such therapies require time and effort to prove fruitful. Mental relaxation is the best chronic insomnia treatment and is recommended by one and all.

If not treated appropriately, the condition would only worsen. In some people, middle insomnia can last up to 5 years.

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