Sleep is a vital need that accompanies us throughout life. We have spent an average of 25 years of our life asleep.
Indeed, sleeping well is essential to be able to develop our daily life normally, and it is a very important factor that promotes our quality of life. In this article we will talk about a group of sleep disorders: insomnia. Within them, we will also talk about one in particular: insomnia.
What does insomnia mean to the sufferer? How can it be treated? Let’s see below.
Dysomnias: definition and causes
Dysomnias are disturbances in the quantity, quality, timing and duration of sleep. They are psychogenic and primary sleep disorders, which means they cannot be explained by an underlying medical condition.
The usual causes are most often psychological: altered or intense emotional states (anxiety, stress, …), ruminative thinking style, etc., or extrinsic to the subject: rhythm of life, poor sleep habits (sleep hygiene) , etc.
Classification of dysomnias
According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), in the group of sleep disorders, insomnia they are classified in turn in the main sleep disorders with parasomnias.
Insomnia includes primary insomnia (or insomnia disorder in DSM-5), primary hypersomnia (hypersomnia disorder in DSM-5), narcolepsy, sleep-related sleep disorders, sleep disorders circadian sleep rhythm and unspecified dysomnia.
Unspecified insomnia includes restless leg syndrome (awkward sensations in the limbs – mainly the legs – at rest) and nocturnal myoclonus (periodic movements of the limbs during sleep).
In DSM-5, on the other hand, the term insomnia disappears and insomnia disorder, hypersomnia disorder and narcolepsy remain independent categories, without belonging to a particular group.
Symptoms and characteristics associated with insomnia
Insomnia is the most common insomnia in the general population. Studies show that around 30% of the population has at least some of the characteristics of insomnia.
Based on the DSM-IV definition, the prevalence of people diagnosed with insomnia is reduced to 6%. According to the ICD-10 (International Classification of Diseases), between 1 and 10% of the adult population suffers from it.
The predominant symptom of insomnia is difficulty starting or maintaining sleep, Or not having restful sleep, for at least 1 month (DSM-IV-TR) (the DSM-5 sets 3 months). Impaired sleep or associated daytime fatigue causes discomfort or clinically significant impairment in the subject.
According to the ICD-10, symptoms should appear at least 3 times a week for at least 1 month. It is more common in women and its prevalence increases with age.
Types of insomnia
There are three types of primary insomnia: onset (which appears when you start to sleep), maintenance (while asleep), and discontinuation (where the main symptoms are early awakening in the morning and inability to sleep. back to sleep).
Psychological treatments for insomnia
Some of the most effective psychological treatments for insomnia are:
1. Stimulus control
Treatment of choice is considered. It is based on classic conditioning and is associate bed use with sleep, By restricting activities that serve as cues to stay awake and setting the time to wake up to stabilize the sleep-wake rhythm.
The aim is therefore for the bedroom / bed to be associated with a rapid onset of sleep.
2. Gradual relaxation
It is the second most effective for this type of insomnia. One of the modalities applied is Jacobson’s progressive muscle relaxation, where all muscles are relaxed to facilitate sleep induction.
3. Paradoxical intention
It is the third most effective. It consists of thinking precisely the opposite of what you want to achieveIn other words, to think that “we don’t want to sleep”. By reducing the pressure or anxiety associated with the ability to sleep, as well as the discomfort of not doing so, it is easier for sleep to occur naturally.
4. Multi-component programs
They include stimulus control techniques, sleep hygiene, and cognitive techniques that help reduce inappropriate cognitions associated with the disorder.
5. Sleep exclusion
This technique is intended to produce a state of mild sleep deprivation that makes it easier to fall asleep earlier, Sleep with fewer interruptions and sleep more soundly.
This is about reducing the number of hours spent in bed by trying to get as close as possible to the time deemed appropriate. Subsequently, the time spent in bed is increased until an optimal duration of sleep is reached.
6. Sleep hygiene
They are a set of routines, recommendations and healthy habits before bedtime, Which must be applied in order to obtain healthy and restful sleep.
The ultimate goal is to sleep better, by acquiring better habits that allow you to have a healthy lifestyle or to change those that interfere with sleep.
- Consultation tools for the management of patients with insomnia in primary care (2009). CLINICAL PRACTICE GUIDELINES AT THE SNS MINISTRY OF HEALTH AND SOCIAL POLICY. Madrid: Ministry of Science and Innovation
- Manrique, JJ (2011). Sleep hygiene, 39 (3), 49-51.
- Vallejo, MA (2012). Handbook of Behavioral Therapy. Volume I. Madrid: Dykinson
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: 5.ª ed. (DSM-5). (2013). Arlington (VA), Washington, DC: American Psychiatric Association