What is the Scientific Reasoning of Insomnia or Somnipathy?
In somnipathy, there is a change in the sleep patterns of a person or an animal. Many of them interfere with the healthy physical, mental, social and emotional functioning. There are many reasons for it. It could be from grinding teeth to night terrors. When a person does not get sleep without any purpose called as insomnia. These disorders are usually divided as dyssomnias, parasomnias or circadian rhythm. It differs in the timing of sleep or by medical or psychological conditions and sleeping sickness of the person. In apnea breathing during sleep is stopped.
In narcolepsy and hypersomnia, there is excessive sleepiness that happens at inappropriate times. In cataplexy, there is a sudden and transient loss of muscle tone when the person is still awake. However, when there is disruption of sleep cycle due to infection, it is known as sleeping sickness. Other disorders include sleepwalking, night terrors, and bed wetting. Management of sleep disturbances is essential to be done.
The various symptoms of different types of sleeping disorder include Bruxism which is grinding or clenching of the teeth while sleeping which is an involuntary action. Catathrenia happens during prolonged exhalation which is night groaning. Delayed sleep phase disorder (DSPD) occurs when a person is not able to wake up and fall asleep at socially acceptable times. This is a disorder of circadian rhythms. Other such diseases are advanced sleep phase disorder (ASPD), non-24-hour sleep-wake disorder (non-24) in the sighted or the blind. In Hypopnea syndrome the breathing has slow respiratory rate while sleeping.
The Idiopathic hypersomnia or long-sleeping hours is primarily neurologic. Insomnia happens when there is a chronic difficulty in falling asleep when no other cause is found for these symptoms. Kleine–Levin syndrome is a rare disorder which is characterized by persistent episodic hypersomnia and cognitive changes. Narcolepsy includes high rate of daytime sleepiness (EDS). It has been found that 70% of the cases with narcolepsy have cataplexy. The motor muscles become weak and there can be collapse on the floor even with full consciousness. In Night terror known as Pavor nocturnus which is also called as sleep terror disorder there is an abrupt awakening from sleep with behaviour of terror. In another case of Nocturia, a person needs to get up and urinate at night again and again. It differs from enuresis or bed-wetting where the person does not arouse from sleep, but the bladder gets emptied.
Parasomnia involves with sleep walking, night-terrors and catathrenia. Periodic limb movement disorder (PLMD) or nocturnal myoclonus involves involuntary movement of arms and/or legs during sleep. Rapid eye movement sleep behavior disorder (RBD), acting out violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self (REM sleep disorder or RSD).Restless legs syndrome (RLS), an irresistible urge to move legs. Shift work sleep disorder (SWSD) is a situational circadian rhythm sleep disorder. Sleep paralysis is characterized by temporary paralysis of the body shortly before or after sleep. This may be accompanied by visual, auditory or tactile hallucinations. It is not considered as a disorder unless severe.
In Sleepwalking or somnambulism engages a person in activities normally associated with wakefulness (such as eating or dressing), which may include walking, without the conscious knowledge of the subject.In Somniphobia, is a cause of sleep deprivation in which a person feels a dread/ fear of falling asleep or going to bed. Signs of the illness include anxiety and panic attacks before and during attempts to sleep.In Dyssomnias, the sleep disorders are characterized by either hypersomnia or insomnia. Hypersomnia could be Narcolepsy which is a chronic neurological disorder (or dyssomnia). In this the brain loses the ability to control sleep and wakefulness.
In Idiopathic hypersomnia which is a chronic neurological disease there is an increased amount of fatigue and sleep during the day. There are recurrent hypersomnia, posttraumatic hypersomnia and menstrual-related hypersomnia. There can be sleep disordered breathing, sleep apnea, snoring, upper airway resistance syndrome, restless leg syndrome or periodic limb movement disorder. Under Circadian rhythm sleep disorders there can be delayed sleep phase disorder, advanced sleep phase disorder or non-24-hour sleep–wake disorder.
Under Parasomnias in which sleep disorders involve abnormal and unnatural movements, behaviour’s, emotions, perceptions and dreams in connection with sleep. This could be bedwetting or sleep enuresis, bruxism (tooth-grinding), catathrenia nocturnal groaning. In exploding head syndrome the symptoms include waking up in the night, hearing loud noises or even sleep terror. There can be REM sleep behaviour disorder like sleepwalking, sleep talking (or somniloquy) or even sleep sex. The causes are usually like alcoholism, mood disorders, depression, anxiety disorder, panic, psychosis (such as Schizophrenia) or sleeping sickness which is a parasitic disease and can be transmitted by the Tsetse fly. It has been found out that traumatic childhood experiences are the main cause of such disorders or a traumatic brain injury (TBI).
During slow-wave sleep, humans secrete bursts of growth hormone. All sleep even during the day is associated with secretion of prolactin. In obstructive sleep apnea the muscles around the patient’s airway relax during sleep which causes the airway to collapse and block the intake of oxygen. Use of psychoactive drugs like some medications, herbs, caffeine, nicotine, cocaine, amphetamines, methylphenidate, aripiprazole, MDMA, modafinil, or excessive alcohol intake or withdrawal from pain-relievers such as opioids may disturb sleep.
It is possible to treat Narcolepsy with modafinil. Histamine can be helpful as it wakes the brain. Often any allergy produces high amount of histamine which keeps a person awake and inhibits sleep. Sleep problems are common in people with allergic rhinitis. The use of acupuncture needs further study. Hypnotherapy and music therapy can improve sleep quality has helped with nightmares and sleep terrors. Melatonin is found useful to fall asleep faster, longer with improved sleep quality.
There are physiological methods to monitor and measure changes during sleep. These include electroencephalography (EEG) of brain waves, electrooculography (EOG) of eye movements, and electromyography (EMG) of skeletal muscle activity. Simultaneous collection of these measurements is called polysomnography. Electrocardiography (EKG) is also used for cardiac activity and actigraphy for motor movements.
It has been found out by the scientists that there is depletion of glycogen and accumulation of adenosine in the forebrain that disinhibits the ventrolateral preoptic nucleus. This allows the inhibition of the ascending reticular activating system. Functional imaging studies have shown that frontal regions of the brain are very responsive to homeostatic sleep pressure. One neurochemical indicator of sleep has been found to be adenosine which is a neurotransmitter. This inhibits many of the bodily processes that help in wakefulness.
It has also been found that the adenosine levels increase in the cortex and also in the basal forebrain during prolonged wakefulness. This decreases during the sleep-recovery period. It acts as a potential homeostatic regulator of sleep. Coffee and caffeine temporarily block the effect of adenosine, prolong sleep latency and therefore reduce the amount of total sleep time and quality. A genome-wide association study (GWAS) identified 3 genomic loci and 7 genes that influence the risk of insomnia and showed that insomnia is highly polygenic. It has also been observed that the monozygotic (identical) but not dizygotic (fraternal) twins have similar sleep habits. Neurotransmitters, molecules whose production can be traced to specific genes are the ones which have genetic influence on sleep. The circadian clock has its own set of genes. Genes which may influence sleep include ABCC9, DEC2 with variants near PAX 8 and VRK2. Anabolic hormones such as growth hormones are secreted preferentially during sleep. Sleep has also been theorized to effectively combat the accumulation of free radicals in the brain, by increasing the efficiency of endogenous antioxidant mechanisms.
The concentration of the sugar compound glycogen in the brain increases during sleep which gets depleted through metabolism during wakefulness. Sleep loss impairs the immune function, increases the white blood cell counts. It also increases cancer growth and dampens the immune system’s ability to control cancers. Medications such as Ambien and Lunesta are popular. Drugs which induce sleep, known as hypnotics, include benzodiazepines, although these interfere with REM benzodiazepines which include alprazolam, clonazepam, lorazepam, and diazepam. These drugs are usually used to treat short-term insomnia.
Nonbenzodiazepine hypnotics are eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien), antihistamines like diphenhydramine(Benadryl) and doxylamine and sometimes use of alcohol (ethanol). Stimulants, which inhibit sleep, include caffeine as it is an adenosine antagonist. Other drugs like amphetamine, MDMA, empathogen-entactogens and cocaine can alter the circadian rhythm. The mechanisms of few drugs like Methylphenidate and other analeptic drugs like modafinil and armodafinil are not much understood.
Dietary and nutritional choices may affect sleep duration and quality. One 2016 review indicates that a high carbohydrate diet promotes longer duration sleep than a high fat diet. A 2012 investigation indicates that mixed quantities of micronutrients and macronutrients are required for a quality sleep. A varied diet with fresh fruits and vegetables, low saturated fats along with whole grains seems to be optimal to improve sleep quality. However, good clinical trials need to be done to define the influence of diet on sleep quality. Sleeping pills are associated with injuries, dementia and addiction and therefore should be avoided.