Insominia –is the complaint of poor sleep and usually presents as difficulty in maintaintaing or initiating sleep.
People with insomnia are dissatisfied with their sleep and feel that it impaires daytime functioning.
Insomnia often lead to fatigue, decreased mood , irritability, malaise and cognitive impairement.
Insomnia can be Acute or Chronic:
Short term or Acute insomnia often precipitated by stressful life events such as a major illness or loss, change of occupation, medications and substance abuse.
Chronic insomnia , lasting > 3 months , is more common in older adults, women , people of lower socio-economic status and individual with medical, psychiatric and substance abuse disorders.
If acute insomnia triggers maladaptive behaviours such as frequently checking the clock, or attempting to sleep more by napping , increased nocturnal light exposure , it can lead to chronic insomnia.
Insomnia can coexist with both psychological illnesses like depression and anxiety physical illness, like thyroid disease .
Etiology-
Animal models and clinical studies indicate that insomnia is associated with activation during sleep, of brain areas normally active only during wakefulness.
Inadqequate sleep hygiene-
Patients with insomnia may develop counterproductive behaviours that contribute to insomnia.
- These include, an irregular sleep wake schedule that disrupts their circadian rhythms;
- daytime napping that reduces sleep drive at night ,
- using wake promoting substances ( caffeine, tobacco) too close to bed time; engaging in alerting or stressful activities close to bed time.
- routinely using bedroom for activities like tv , work , which will cause the bedroom to become associated with arousing or stressful feelings.
Assessment –
- specific questions concerning:-
- sleep onset
- sleep maintenance,
- early morning wakening,
Theses will provide clues to both the causative agents and management of insomnia.
- enquire about previous sleep problems,
- screen for depression and anxiety
- ask about symptoms of thyroid disease
- caffine and alcohol are prominent causes of sleep problems ,a careful history of the use of theses substance should be obtained.
Some Imporatnt Remedies-
- Belladonna-sleeplessness of plethoric children, from local congestion, from irritation in various parts, from nervous excitement. flushed face; headache ; restlessness and anguish ; starting on first falling asleep; moaning and tossing about; drowsy evenings , but no sleep follows, in the mornings feels as if he had not slept enough.
- Bryonia- sleeplessness on account of uneasiness in the blood and anxiety, thoughts crowd one upon the another; night very restless , disturbed by frequent dreams, no sleep before midnight, frequent shivering sensation over one arm and foot , followed by sweat, prattling, murmuring delirium, especially of business.
- Gelsemium- for insomnia of brain workers. In business men who pass restless nights, awaken early in the morning and worry over their business affairs. In case of alternate excitement and depression.sleeplessness after emotional disturbance .
- Sulphur– sleeplessness from nervous excitement , cutaneous irritations and external heat.the patient is drowsy all day and sleepless at night. Sleeps in “ cat naps” , wakes frequently.
- Coffea-sleeplessness from overexcitement of mind and body , from joy or agreeable surprise, from excessive use of coffea, all the senses are more acute, persistent insomnia of children , without cause.
- Cannabis indica-insomnia of drunkards with hallucinations; nighmare everynight as soon as he falls asleep.
- Ambra grisea– sleeplessness from worry and business troubles. Patient goes to the bed tired , but immediately becomes wakeful.
- Passiflora incar– sleeplessness from nervous exhaustion , as from severe acute disease, from mental overwork with headache.
- Pulsatilla– sleepless after , or eatimg too much: from ideas crowding on mind forepart of night. Sleeps late in morning; wide awake in the evening, does not want to go to bed, first sleep restless, sound sleep when it is time to get up; wake unrefeshed ; insomnia of neurasthenic young women suffering from menstrual irregularities.
- Rhododendron- -cannot go to sleep or remain asleep unless her legs are crossed; deep heavy sleep before midnight but sleepless after midnight : morning sleep disturbed by pain and restless in body.
- Selenium– patient sleeps In cat-naps; awakes often during night or is easily aroused by the slightest disturbance; awakens at precisely same hour every morning; before his usual rising time, when all his complaints are worse; hungry during night.
- Sepia– sleeplessness during pregnancy or childbed or from uterine diseases and menstrual irregularities; awakes early in the morning thinking she has been called; awakes too early and cannot go to sleep again ,sad and depressed , irritable and indifferent ; sleep restless and unrefreshing; awakes in a fright and screaming ; cold feet.
- Phosphorous-cannot fall asleep before midnight, must get up, after lying down he falls asleep, but awakes often, feels so hot ;insomnia of the aged ; memory feeble, giddiness, trembling gait ; sleeplessness following intense mental overwork and anxiety , with headache , confusion and distressing vertigo; sleeplessness from physical nervous exhaustion , caused by excessive sexual indulgence or onanism ; from spinal troubles and hepatic affections.
- Nux vomica– sleeplessness caused by excessive late at night and no exercise in daytime, hence dyspeptic insomnia, awake tired and unrefreshed after a short morning sleep with headache, bitter taste, coated tongue etc. Insomnia from a recent drunk a late and rich supper, causing flatulence and constipation.
Reference-
- Homoeopathic Therapeutics – Samuel Lilienthal
- Practical Homoeopathic Therapeutics- W A Dewey
- Textbook of Medicine –K V Krishna Das
- API Textbook of Medicine
About Author:
Dr.Medha.V
Assistant Professor
Yenepoya Homoeopathic Medical College and Hospital
