Sleeplessness some idea and management

1. INSOMNIA / SLEEPLESSNESS
GAJASARAJ

2. HISTORY
Sleeplessness was a chronic problem since the beginning of mankind
1623, Word Insomnia coined from word ‘somnus’ in Latin Meaning
Sleep and so ‘in’ in the prefix was added to coin the term ‘insomnia’
or opposite of ‘somnus’ or sleep in the third known English
Language dictionary, written by Henry Cockeram.

3. STATISTICS
• 30 to 50 % People worldwide experience insomnia
symptoms at some time.
• 10% of those impacted by insomnia go on to develop long
term, chronic insomnia.
• Insomnia is very common – 10% of the population
• People over the age of 60 are the age group that have the
highest reported levels of insomnia.
• Women are 40% more likely to have insomnia than men.
• 35% of people with insomnia have a family history of the
condition.
• People with insomnia are five times more likely to suffer
from depression.
• 78% of women experience insomnia during pregnancy

4. SURVEY TAKEN 2019 BY
PHILIPS (N = 11,006) FOR WORLD
SLEEP DAY – MARCH 15TH 2019
• Average sleep weekday – 6.8 hrs and
weekend – 7.8 hrs
• 80% want to improve sleep
• 67% wake up once at night
• 63% Long sleep in weekend
• 49% sleep well
• 10% sleep really well
• India had the best sleepers, South Korea
and Japan the worst
• Strategies they use
• 39% Reading
• 37% Tv and Music
• 35% Sleep apnea therapy
• 30% Scheduling and alarm
• 25% Reduce coffee and do Meditation
• 20% Special bedding and Eye Mask

5. DEFINITION
• It is a type of sleep disturbance.
• Sleep disturbances are classified as Dyssomnias and Parasomnias
• Dyssomnias – Dyssomnia refers to the collection of sleep disorders that negatively impact the quantity
and quality of sleep e.g. Intrinsic disorders - Insomnia, Narcolepsy, Obstructive sleep apnea,
Hypersomnia, Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD). Extrinsic
disorders – Environment and Circadian Rhythm Disorders – work shift, place we stay, ICU, Jet Lag.
• Parasomnias – Parasomnia sleep disorders cause abnormal activities during sleep e.g. sleep terrors,
sleepwalking, nightmare disorder, sleep-related eating disorder and sleep paralysis
• Insomnia - The primary problem is falling asleep (sleep onset) while others struggle with staying asleep
(sleep maintenance)
• Atleast 3 times a week
• Acute - <3 months and Chronic - >3 months
• Cut off time Adult – 30 min and Children – 20 min

6. RISK FACTORS / CAUSES

7. CAUSES / RISK FACTORS
• Age
• Gender
• Psychological
• Medications
• Substances use
• Enviroment
• Lifestyle

8. SYMPTOMS

9. SYMPTOMS
• drowsiness
• irritability and changes in mood
• changes in appetite/ nausea
• frequent yawning
• poor productivity and focus
• poor decision-making
• forgetfulness
• frequent sickness

10. WHAT WILL YOU DO?

11. HISTORIC TREATMENTS
• Alcohol and opiates to induce sleep onset
• Chloralhydrate – Mid 19th century
• Faradization / Electrization studied by Dr.Beard & Dr.Rockwell for
insomnia late 19th & early 20th century
• Faradic current is interrupted direct current with a frequency
of 50–100 Hz and pulse duration of 0.1–1 ms. Galvanic current
is also an interrupted direct current but with a slower
frequency (∼30 Hz) and longer pulse duration (>1 ms) than
faradic current.
• Faradic current stimulates innervated muscles, whereas
galvanic current stimulates denervated muscles.
• Faradic current or faradization was the method of choice to
treat insomnia by applying the electrical current directly to
innervated muscles of the individual’s head and occasionally to
other areas of their body.
• Until Mid 20 century finding of barbiturates and other medical
options later

12. HOW TO ADDRESS INSOMNIA
• Identify the cause and correct it . E.g. Optimizing pain management, Psychiatric illnesses
• Non – Pharmacological
• Sleep hygiene (table 1), Sleep Restriction Measures(table 2), Stimulus control (table 3), Relaxation (table 4),
Circadian rhythm Modulators (table 5)
• Cognitive Behavioral Therapy (CBT), Mindfulness, Meditation , Physical exercise & Daily routine
• Medication
• Restrict corticosteroids and diuretics to morning dose
• Hypnotics with behavioral therapy – benzodiazepines e.g. alprazolam and Z-drugs e.g. zolpidem, zopiclone and
• With Clinical Depression - sedative antidepressant e.g. amitriptyline (25 to 100mg) or mirtazapine (15 to 30mg)
• With Delirium and Psychosis – Haloperidol (0.5 to 5mg), Olanzipine (5 to 10mg), Quetiapine (25mg)
• Other techniques
• Hypnosis
• Faradization

13. NON –
PHARMACOLOGICAL
METHODS

14. NON –
PHARMACOLOGICAL
METHODS

15. RISKS / COMPLICATIONS

16. COMPLICATIONS /
RISKS
• depression
• obesity
• hypertension
• anxiety
• Diabetes
• Low Immunity
• obstructive sleep apnea
• stroke
• psychosis
• cardiovascular disease
• Reduced life expectancy
• accidents

17. PERCEPTION & OTHER TYPES
• Paradoxical insomnia: Also referred to as sleep state misperception, paradoxical insomnia occurs when
a person feels their sleep is greatly disturbed but no other evidence confirms the presence of sleep
difficulties. People with paradoxical insomnia may greatly underestimate how much sleep they actually
get.
• Sleep-onset insomnia: Both chronic and short-term insomnia can involve trouble falling asleep when
first lying down for the night, which may be referred to as sleep-onset insomnia.
• Sleep-maintenance insomnia: Difficulty staying asleep throughout the night may be called sleep-
maintenance insomnia, and this can also affect people with either chronic or short-term insomnia.
Middle-aged and older adults with insomnia are more likely to experience issues with maintaining sleep
throughout the night than with falling asleep.
• Behavioral insomnia of childhood: In the past, a child’s inability to sleep without specific items or
routines was called behavioral insomnia of childhood. Example, a child unable to sleep without a toy
• Fatal insomnia: Also called fatal familial insomnia (FFI), is a very rare genetic disorder that causes
progressive brain damage. Fatal familial insomnia is a neurological disorder that involves many
symptoms, including increasingly severe sleep difficulties.

18. FAMOUS PEOPLE
• Winston Churchill had two beds and if he couldn’t sleep in one, he would lie down in the second.
• Benjamin Franklin wanted sheets that had low temperature as this always helped him sleep.
• Sir Isaac Newton suffered from a severe case of depression and, consequently, had trouble sleeping.
• Thomas Edison was the best in everything he did, but was unable to have a normal night sleep pattern so he
started catnapping during the day.
• Charles Dickens believed that the position he had in bed and the position of the bed itself are key factors in
getting a good sleep. His bed was always facing north and he slept exactly in the middle of the mattress. No
matter how silly this may seem to some of you, these two tricks worked excellent for the great writer.
• Even the great Napoleon couldn’t sleep more than three hours every night but it seemed that this was
enough for him.
• Marilyn Monroe had a tumultuous life and she took up to 20 Phenobarbital daily hoping she will get some
sleep.
• Margaret Thatcher stated that “Sleep is for wimps” so what can we say more than that’s truly an “Iron Lady”.

19. SUMMARY

20. DOUBTS
KINDLY FEEL FREE TO ASK WILL TRY TO SOLVE BUT THESE WHERE MINE
• How much sleep do I need a day?
• 7 hours recommended (6 to 8 hours) Normal average is 8 hours
• How long is a sleep cycle?
• About 90 minutes, N 1 (light) – 5 min, N 2 – 30 to 60 min, N 3 (deep) – 20 to 40 min, Random Eye Movement
(REM) dream time – 10 min to 1 hour. 4 to 6 cycles / 7hr sleep
• I have an exam can I sleep less for sometime?
• Sleep debt – can happen which you need to pay off later, try short 20min nap in dark room, eat healthy, light
exercise, avoid screens (phone, tv, distractions), reduce coffee & avoid alcohol
• Is there a chance I can need less sleep than others?
• Rare mutation of the DEC2 and ADRB1 gene in people feel rested with less than 6.5 hours of sleep per night
without any health consequences. Found to live longer with 4 to 6 hours of sleep (Short Sleep Syndrome)
• Is it ok for older people to sleep less?
• Sleep needs stabilise around 20 years of age

21. REFERENCES
• Introducing Palliative care by Robert twycross
• The MD Anderson Supportive and Palliative care Handbook
• https://jcsm.aasm.org/doi/10.5664/jcsm.8958
• https://www.healthline.com/health/dyssomnia
• https://www.webmd.com/sleep-disorders/what-is-dyssomnia
• https://www.sleepfoundation.org/insomnia
• https://www.ucsf.edu/news/2019/08/415261/after-10-year-search-scientists-find-second-short-sleep-
gene
• https://www.stress.org/get-rid-of-sleep-anxiety-and-insomnia-your-guide-to-a-better-nights-rest
• https://sleepcottage.com/the-history-of-insomnia/
• https://warwick.ac.uk/newsandevents/pressreleases/global_145sleeplessness_epidemic146/
• https://info.ancsleep.com/blog/risk-factors-for-developing-insomnia-0
• https://www.consultant360.com/articles/sleep-disruptions-and-insomnia-older-adults

22. THANK YOU EVERYONE FOR PATIENT LISTENING
• Thank you all for the Wonderful opportunity to treat insomnia with this lecture
• Sorry for not being able to be there in person.
• Feel free to discuss @ gajasaraj@gmail.com / 7010004141