What is insomnia?

Insomnia is difficulty falling or staying asleep, or waking up too early, or simply wake up with the impression of not having a good sleep. The consideration for people suffering from insomnia is different for each patient, and varies between cultures, so it is not possible to define normal sleep in a manner acceptable to different people and populations. What each considered normal in quantity and quality of sleep is very variable.

Why did it happen?
Insomnia may be due to the effects of substances, drugs or toxic or organic disease, a mental disorder, a related sleep disorder breathing (sleep apnea), neurological injury or abnormal sleep situations , such as sleepwalking or sleep terrors in children. In these cases, it is called secondary insomnia. There is talk of primary insomnia when it is associated to another cause, treatment or illness. The description of the night insomnia include discomfort at not being able to sleep satisfactorily, and also the consequences for daytime activity: irritability, poor concentration, drowsiness. There may be a deterioration in social, occupational, or other areas of life of people. In turn, the insomnia itself can cause other illnesses such as depression or headache.

What are the symptoms?
Insomnia is more common in women, and becomes more common as age increases. Subsequent daily activity to cause fatigue, difficulty concentrating and reduced performance, both physically and intellectually. It is often accompanied by other symptoms such as:
* Nervousness, tension, anxiety. Personal concerns, household, social relations bedtime.
* Previous history of depression, obsessive or compulsive traits, or other type relevant psychopathological symptoms.
* Symptoms of restless legs or other automatic movements.
* Changes in the usual hours of sleep and wake.
* Snoring or other symptoms of sleep apnea.
* Symptoms or history of abusing alcohol or other intoxicants.
* Current medications (diuretics, antihypertensives).
* Other diseases.
* Environmental conditions: noise, excessive temperature or cold.
* Dietary habits (consumption of coffee, alcohol), especially at dinner.
* Making excessive exercise during the day.
* Labor intensive or stressful activity.

It is usually differentiated by duration, in:
* Transient Insomnia: Last two or three days.
* Short Term Insomnia: It lasts longer than two or three days, and less than three weeks.
* Chronic Insomnia: Longer than three weeks.

How is it diagnosed?
The diagnosis is made based on clinical examination and interview. If the patient sleeps with another person, it is important to collect this information to learn more about how the night progresses and the environmental factors that may be influencing. It is very important to rule out diseases or problems that are causing, for which it may be necessary to perform additional studies. In certain cases, you may need a firm specializing in sleep units.

How is it treated?
The first steps to take if you suffer from insomnia is to acquire good habits and activity patterns, schedules, diet and lifestyle that facilitate sleep. The following information related to lifestyle and environment, will help to reconcile and maintain a restful sleep:
* Do not consume caffeine 6 hours before bedtime.
* Avoid smoking and drinking alcohol at least two or three hours before bedtime.
* No excessive physical exercise or stimulating activities before bed.
* Practice regular moderate exercise.
* Do not carry heavy dinners, and not to drink large quantities of food and / or liquids before bedtime.
* Do not go to bed hungry or thirsty.
* Use a suitable mattress.
* Maintain a friendly atmosphere: 23C °, no noise, low light.
* Do not look at the time.

This procedure has been insufficient by itself, but is useful in combination with other therapies based psychological stimulus control. It consists of a set of guidelines aimed at reducing behavioral conduct incompatible with sleep when bedtime, and to regulate the sleep-wake schedule. The main objective of these guidelines is to establish an association between stimuli in the room and the generation of sleep. It consists of the following instructions to be followed strictly to be effective:
* Use the bed only for sleeping (sleep occasionally, sexual activity). Not allowed TV, telephone, radio, eating, reading in bed.
* Going to bed only when sleepy.
* Should perform some activity bedtime deceleration, ie that does not require much effort and concentration (not dense readings or work).
* Establish a bedtime routine and do it every day, and always in the same order (hot drink, read a while, brushing teeth, going to the bathroom).
* If you do not sleep within 30-45 minutes, get out of bed and room, and doing a relaxing activity until sleepy monotone, and only then go back to bed, not before. Repeat if necessary.
* Getting up at similar time.
* Do not take naps during the day.

The changes of pace and lifestyle above are accompanied, especially in people with high levels of both physical and cognitive activity during the night as during the day, under stress, pressure, excitement … with the completion of exercises relaxation. There are various methods of relaxation such as progressive relaxation, autogenic training, meditation or training in imagination.

The aim of relaxation is to achieve deep levels of muscle relaxation quickly and easily at the time of going to sleep, to facilitate sleep. Requires a longer or shorter training (estimated at four weeks or longer for elderly patients), during which they gradually learn to identify the level of muscle tension in different parts of the body, and relax. The training consists of exercises for stress-relaxation of muscle groups first and largest small later.

Drug treatment.
In cases in which the methods without medicamentosson insufficient, pharmacological therapy may be needed. It is important to know that the more convenient use of hypnotic drugs or tranquilizers, is for short periods of time, or occasionally in moments. Avoid taking drugs or regular routine for sleeping, since these drugs habit and develop tolerance, meaning that the body adapts and cease to be effective or require increasing doses, with increased side effects. While the patient is in treatment, should be days where you do not take the treatment, for example, on weekends.

The most commonly used drugs are benzodiazepines. Please be aware that any of these drugs, with a long duration of action can interfere with daytime activities, an aspect that must be taken into account in the event that the affected person using dangerous machinery at work, drive cars, etc.. You should also avoid alcohol and you should always check the incompatibility with the capture of other drugs, as described in the prospectus.

We recommend a gradual reduction of doses to lolargo two or three weeks, or substitution by another medication withdrawal easier. One of the difficulties that appear most often arises from insomnia, a rebound, which must meet and overcome to avoid maintaining the use of drugs. It should also be noted that while under the effect of the action of the hypnotic, and sleep is disrupted for other reasons, may have increased risk of falls and dizziness upon rising, especially in older people.