What is Dyssomnia?
Dyssomnia is a sleep disorder associated with a sleeping situation where the affected individual has difficulty falling asleep or staying asleep. It refers to any sleep disorder, characterised by symptoms such as difficulty getting to sleep, remaining asleep, or feeling excessive sleepy during the day possibly from the reduced quantity, quality of sleep they get at night. Dyssomnia may be caused due to multiple reasons. These can be extrinsic reasons such as excessive noise while sleeping or other physical disturbances; or it could be due to intrinsic reasons such as such disrupted circadian rhythm. Other factors which affect the quality and quantity of sleep includes caffeine intake, daytime sleeping, early bedtime, physical discomfort etc.
Types of Dyssomnia
Based on the external or internal factors which affect sleep, dyssomnia are of 2 types as mentioned below:
Intrinsic Type Dyssomnia:
- Idiopathic hypersomnia
- Periodic limb movement disorder
- Central sleep apnea.
Extrinsic Type Dyssomnia:
- Substance abuse insomnia
- Altitude insomnia
- Environmental sleep disorder
- Limit setting sleep disorder
- Inadequate sleep hygiene.
Signs and Symptoms of Dyssomnia
The signs and symptoms of dyssomnia depend on the underlying cause of the condition. However, the most common signs and symptoms of dyssomnia include:
- Difficulty waking up in the morning
- Difficulty staying awake during the day
- Constant feeling of drowsiness
- Frequent napping can also be a sign of dyssomnia
- Lack of energy, feeling tired and fatigue
- Feeling sleepy through the day
- Sudden uncontrolled urge to sleep
- Increase in appetite
- Unintentional weight gain.
Causes of Dyssomnia
Individuals who are affected by intrinsic dyssomnia, usually do not have any underlying psychiatric issue. However, sleep issue can affect the normal functioning of the person during hours of wakefulness. Lack of sleep can cause stress and tension, which may worsen the sleep issue even more. In some cases, there may be extrinsic factor affecting the quality and quantity of sleep initially (for a couple of days), after which there may be a fear of more sleepless night to follow, even after removal of the extrinsic disturbance affecting sleep.
The most common causes of dyssomnia area:
- Disturbance in wake-sleep pattern
- Inadequate exposure to bright light during waking hours
- Jet lag is a common cause of dyssomnia
- Over activity of thyroid glands
- Alcoholism or sudden discontinuation of alcohol consumption
- Side effect of certain medication
- Excessive intellectual or physical stimulation at bedtime can also cause dyssomnia
- Sudden discontinuation of medications
- Stress, anxiety, or worry
- Excessive sleep during the day
- Intake of nicotine, caffeine, alcohol or other stimulants just before bedtime.
Diagnosis of Dyssomnia
Diagnosis of dyssomnia involves obtaining a detailed case history including a detailed sleep history. The sleep history incudes details such as onset, frequency and duration of sleep. The physician may also inquire about lifestyle habits such as substance abuse etc. Other symptoms such as physical discomfort, headache, weight gain, psychological disturbances are also noted. It is also important to look for other health related issues which may cause sleep issues such as nervous issues, cardiovascular issues, rheumatoid disease, endocrine issues, respiratory issues etc.
How is Dyssomnia Treated?
The treatment of dyssomnia is based on the identification of the cause of the condition. Steps are taken to eliminate or alter the cause of the condition. This may involve treating the underlying medical condition, psychiatric issues or eliminating other stressors such as drugs or alcohol abuse. Treatment modality often involves use of sleep aid medication and psychological treatment techniques which includes sleep hygiene counselling for improving sleep. In some cases, cognitive behaviour technique is used to solve the issue. If the conservative treatment does not solve the issue, medication is often prescribed to improve the sleep issue. Medication includes melatonin, which is often used to alter sleep cycle. Other drugs may be prescribed to maintain alertness during the day time. Treatment also involves bright light therapy which is used to alter the circadian rhythm (or the body’s internal clock).
Prevention of Dyssomnia
Preventive measures are often very helpful in this condition. This involves practice of good sleeping habits. Studies have shown that avoiding bright screen (such as TVs, computers, cell phone, tablets etc.) for at least 30 minutes before bedtime can help in improving sleep. This is mainly because, bright screens emit a blue light which can trigger the brain to believe its sunlight outside, even though it may be pitch dark outside. This in turn affects the natural circadian rhythm and imbalance in the melatonin level, thus making it difficult to fall asleep. Having a warm bath in the evening followed by a warm cup of caffeine free tea, or a protein rich light snack can help in calming the body and avoiding hunger pangs at night, thus ensuring good sleep. Intake of alcohol or caffeinated beverages should be avoided before sleeping. It is advised to relax before bedtime by reading a light book or listening to soothing music before sleeping.
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