WHAT IS INSOMNIA?
Insomnia is by far the most common type of sleep disorder with 10 to 12 percent of population affected. It is characterised by symptoms of inability to fall asleep or to stay asleep. This leads to lack of concentration, performance and memory, irritability and fatigue, depression and heightened anxiety.
Some sufferers react to the constant feeling of overwrought with social withdrawal. In addition, the risk of a potential accident rises.
WHAT IS THE CAUSE?
If there is no organic or psychiatric cause for insomnia, then it is called primary or psychophysiological insomnia. When insomnia is a consequence of an underlying organic or psychiatric illness, eg cardiovascular disease, a cancer or rheumatism illness accompanied by severe pain or an anxiety disorder, this is called secondary insomnia.
The spectrum of factors triggering a primary or secondary insomnia
- Irregular working hours
- Night work
- Frequent time-zone changes (jet lags)
- Insufficient sleep hygiene
- Environmental factors
- Repressed or unresolved mental trauma, etc.
WHO IS AFFECTED?
In principle, insomnia can affect anyone: women and men, the chronically ill and the healthy, babies and teenagers, and mid-agers and senior citizens. However, the probability increases beyond the 40th year of life, and women (24 percent seem to be affected more frequently than men (13 percent).
DIAGNOSIS - WHEN TO SEE A DOCTOR?
Today, the term insomnia is used widely similar to burnout or depression. However, everyone has occasional periods of poorer sleep. A few restless nights are no reason to worry. On the other hand, insomnia should be clarified by sleep specialist if you have
- Problems with falling asleep or sleeping through regularly for at least four weeks
- Increased daytime sleepiness
After initial sleep examination, in our LF Sleep Laboratory, we routinely use state of art sleep test – POLYSOMNOGRAPHY in order to properly diagnose insomnia.
THERAPY – SLEEPING PILL AS A LAST RESORT OPTION?
In the treatment of secondary insomnia should focus on the targeted therapy of the actual trigger - underlying disease. Whether additional sleeping strategies should be used must be decided in each individual case.
In the treatment of primary insomnia, depending on the individual cause, several treatment strategies have proven useful, which can also be used as a multimodal therapy:
1) SLEEP HYGIENE
Sometimes basic "sleep hygienic" principles can relieve
sleep disorder; however chronic or consistently recurring insomnia always
requires professional medical attention. In that regards, the sleep hygiene
principles listed can under no circumstances replace the doctor's examination.
- Getting up or going to bed regularly at the same time - even on the weekends
- Avoid the evening use of computers, smartphones and tablets: Their high proportion of blue light disturbs the slack-promoting melatonin secretion (so-called blue light shower).
- Remove TV from your bedroom
- Remove your watches and alarms out of sight -constant staring at the time disturbs sleep
- Darken your bedroom or get a pair of sleeping glasses
- Too high or too low temperatures have a disturbing effect on sleep. 15 ° - 18 ° C are ideal
- Optimize your bedroom: do not overload the room with furniture; position your bed according to your personal well-being; match mattress, slatted duvet and pillows optimally
- Irregular noise disturbs sleep: noise protection windows can be compensated if necessary with ear plugs
- Herbal teas, such as valerian, lemon balm, hops or lavender flowers, promote sleep - ritualize the drink as a warm nightcap
- Relaxing sleep rituals such as bedtime reading every night
- Alcohol, nicotine and caffeine disturb sleep - even in small amounts
- Avoid lush, fatty foods in the evening. Prefer light meals - and small portions
- Insomniacs should not take a nap: a siesta reduces the evening sleep pressure
- Exercise: Lack of exercise promotes sleep disorders. The last three hours before bed rest, however, you should pursue no extreme sports activities
- Relaxation techniques such as autogenic training or progressive muscle relaxation can sometimes be helpful in case of a passing overload
- Use the bed exclusively for sleeping and for sexual activities
2) BEHAVIOURAL - COGNITIVE THERAPY
The effectiveness of behavioural - cognitive treatment approaches against sleep disorders is well documented. Importantly, these forms of therapy should exclusively be carried out in otherwise healthy patients under strict medical / psychological supervision.
The most effective forms of therapy are:
- Sleep restriction
- Sleeping compensation
- Stimulus control
- Conversion of negative
- Mind Stop
3) RELAXATION METHODS
Many insomniacs are physically and mentally extremely tense. Whether the increased activation level results from insomnia or vice versa has not yet been scientifically determined. However, in addition to medical / psychological therapy, relaxation techniques have proven to be highly effective. Their goal is to: lower the level of excitement, reduce the psychosomatic complaints and increase the exercise capacity.
The most effective methods are:
- Autogenic training
- Progressive muscle relaxation
4) DRUG THERAPY
In most cases there is no objection to the use of drug therapy if
these general guidelines are followed: clear indication; smallest possible
dose; short prescription period; no abrupt withdrawal; consider
contraindications and interactions. The most commonly used drugs are:
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MEET THE TEAM
PETER JFM LOHUIS, MD PHD
BORIS FILIPOVIĆ, MD PHD
BORIS ŠIMUNJAK, MD PHD
MARINA MILOŠEVIĆ, MD
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