Many are living daily with insomnia. It has become a way of life for so many that they think it is normal. Worldwide, over 90% of adults at one time or the other in their lives has suffered insomnia. Everyone deserves a good night sleep. Insomnia has been described by various physician groups as repeated difficulty with falling asleep or staying asleep or quality that occurs despite adequate time and opportunity for sleep and that result in some form of daytime impairment. Taking longer than 30minutes to fall asleep, staying asleep for less than 6hours, waking more than 3 times a night or poor quality sleep that is not relaxing can all be grouped under insomnia. Difficulties with falling asleep are commoner in young adults while difficulties in staying asleep is commoner in the middle-aged and elderly.

Insomnia sometimes occur over a short period lasting upto one month but in few cases it can be prolonged lasting more than one month. Insomnia in the short term is commonly seen when adjusting to situational stress such as occurs during upcoming examination or office deadline reports. Prolonged insomnia can be associated with a wide variety of medical conditions.

The causes of insomnia are numerous and vary from; emotional discomfort, physical discomfort, illness, interferences in normal sleep schedule/ routine (jetlag, switch from day job to night duty), situational stress (examination, job deadline, job loss, divorce, death of a loved one), drugs to environmental factors like noise, extreme temperatures and light. Other significant causes are; use of tobacco, alcohol, caffeinated products, illegal drugs, depression, anxiety, long-term stress and discomfort at night.

As a young medical student, having to balance the volume of personal academic study and class lectures was a daunting task and I thought that a shift in sleep hours could help me create a balance. However, I learnt the hard way that the effects of not sleeping could be made manifest in ways that are more tasking on the person than if the hours had been used to sleep.

Insomnia is a diagnosis made by your physician following detailed medical history, sleep history and examination. Common symptoms seen at presentation includes; sleepiness during the day, poor concentration, forgetfulness, irritability, reduced work performance and general tiredness. Your Physician may also ask you questions to ascertain snoring, restless feelings in legs on lying down which may improve with sleep, bedsheets in disarray in the morning and periodic kicking during the night. In some cases, your bed partner may be questioned to ascertain your sleep quality and quantity.

Insomnia may not require treatment such as short-term situational stress like examination. However, mild insomnia may require education on the sleep problem and improvement in appropriate sleep hygiene measure. The insomnia that is distressing enough to cause daytime impairment and as such decrease performance in daily activity may require prescription of sleeping pills for a very short time.
Sleep hygiene measures addresses habits that are not compatible with sleep such as noise in the bedroom, extreme temperatures, watching TV in bed, alcohol or caffeine use.

More severe insomnia requires treating the underlying cause such as medical or psychiatric illness if any and non-drug therapy like cognitive and behavioural therapy are highly beneficial but can only be provided by healthcare workers trained in it. Here, the client is taught how to change behaviours that are not compatible with sleep and learn behaviours that promote sleep.

To combat insomnia, the following measures may be highly beneficial;
1. Sleep at the same time each night and get up at the same time each morning.
2. Avoid daytime naps.
3. Avoid prolonged use of phones or reading devices (“e-books”) that give off light while on bed.
4.Avoid caffeinated drinks, tobacco, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
5. Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. It is recommended that you should stop exercise for at least three to hours before bedtime.
6. Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep better.
7. Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs.
8. Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
9. Avoid using your bed for anything other than sleep or sex.
10. If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
11. If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.

My advice at all times is to avoid over-the-counter sleeping pills. In the long run, it has rebound effects that are undesirable and most of them tend to lose effectiveness and efficiency over time.