Bengaluru filmmaker Gaurav Krishna’s sleeping issues started seven years ago while he was shooting for a film.
“I would suddenly sit up in the middle of the night and sometimes walk around. There were also bouts of sleep paralysis and a considerable amount of lethargy during the day,” recalls Krishna.
A paper by Thomas Roth from the Sleep Disorders and Research Centre at the Henry Ford Hospital in Detroit finds that across a number of countries, a third of respondents reports experiencing one or more of the symptoms of insomnia: difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and in some cases, non-restorative or poor quality of sleep.
What is insomnia?
“Insomnia isn’t a disease in itself, but rather a symptom of something else. A person’s insomnia could be caused by a range of internal and external factors,” explains Dr Raviraj Kowligi of Lakeside Medical Centre and Hospital in Bengaluru.
He lists out probable causes of sleep disruption as physiological conditions like hypothyroidism, IBS (irritable bowel syndrome) or hypertension, social factors like career or relationship problems, lifestyle-driven issues like smoking or consumption of alcohol before bed, working on the smart phone or watching television late into the night. It could also be due to underlying mental health conditions like anxiety or depression.
Dr Kowligi’s reasoning somewhat explains Krishna’s case. “I’ve now realised that my depression diagnosis also contributed to my sleep issues. Fortunately, the last few years of therapy have improved both these areas, but I still struggle with sleep deprivation from time to time, especially if I’m on a prolonged shoot,” Krishna shares.
The treatment spectrum
Generally, treatment for insomnia falls into one of these two categories — pharmacological and behavioural.
The former spans a wide range of pharmaceuticals. Depending on the severity of the condition, these range from mild over-the-counter medications like antihistamines and melatonin to a variety of prescription medications.
Dr Alok Bajpai, Consultant Psychiatrist at Regency Hospital and IIT-Kanpur, agrees that medications can play an important role in the treatment of insomnia but he also places importance on the role of behavioural interventions.
“Unless there is an underlying health condition that is causing the insomnia, in the vast majority of cases, changes made to the person’s lifestyle, sleep environment, thought patterns and sleep [discipline] can make a huge difference,” he says.
Behavioural interventions like Cognitive Behavioural Therapy for Insomnia (CBT-I) have been shown to significantly improve sleep efficiency (i.e., of the total time in bed, how long one sleeps); sleep onset latency (how much time it takes one to fall asleep); wake after sleep onset; and total sleep time as outlined by the team led by Eduard J. de Bruin from the Research Institute of Child Development and Education at the University of Amsterdam.
In fact, in 2012, a systematic review for randomised controlled trials (comparing CBT-I to medication in patients with primary or comorbid insomnia concluded that the behavioural intervention was more effective at treating insomnia when compared with medications, and it also had robust durable effects. Led by Matthew D Mitchell of the Centre for Evidence-based Practice, University of Pennsylvania, the study also recommended that primary care providers consider CBT-I as a first-line treatment option for insomnia.
Nutrition and sleep health
Experts suggest having melatonin-rich food to overcome irregular sleep cycles and improve one’s sleep health. Foods rich in carotenoids and glucosinolates contribute to melatonin production. Foods like berries, cherries, egg yolk, carrots, pumpkin, bell peppers, cauliflower, and cabbage help in melatonin production. Sour fruits like pineapple, orange, sweet lemon, and tomatoes contain melatonin in them.
Unwind & reset the day
“A consistent sleep-wake schedule, getting sufficiently tired during the day, not compensating sleep with naps, exercising regularly with a hot shower before bed, and no screens in the bedroom are just some of the steps one can take to improve their broken sleep architecture. It’s a lot harder than taking a pill but will make more of a long-term impact,” says Dr Bajpai.
“The most important thing is to not be obsessed about your inability to get proper sleep, as this will create a vicious cycle preventing you from achieving the calm state required to fall asleep,” he explains.
Krishna agrees. “Worrying about my sleep only exacerbated the issue. Nowadays, I usually try to finish what I set out to do during the day. This keeps me occupied and engaged with what I’m doing at the moment. As long as I’m doing that within a routine, I don’t worry too much about sleep. Of course, my routine also includes getting at least eight hours of sleep,” he says.
“We speak to people with insomnia about potential causes and decide the treatment plan accordingly. If the underlying cause is a mental health condition like anxiety or depression, the person is referred to a psychiatrist who can determine the kind of therapist they require”
– Dr Raviraj Kowligi of Lakeside Medical Centre and Hospital, Bengaluru.
Women and the aged
A 2011 study led by Rohit Budhiraja from the Arizona Respiratory Centre found that insomnia is more common in women (25 percent) than in men (18 percent), and its prevalence increases with age, affecting approximately 50 percent of the elderly population.