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Insomnia | Dr. Elsade Kruger

Although the concept of insomnia (sleeplessness) has been around for centuries, it was only really in the late 19th and early 20th centuries that insomnia was recognised as a medical condition in western culture.

Insomnia, which affects 35% of adults, is classified as a primary disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-4)[1] , and can be defined in  the following ways:

1. Difficulty falling asleep/initiating sleep.

2. Difficulty maintaining sleep.

3. Early morning awakenings.

4. Non restorative sleep.

The condition may be short-term – i.e. it lasts just a few weeks; or chronic, i.e. it lasts 3 months or more. Each person’s experience of insomnia can differ, but it can have serious effects, such as excessive daytime sleepiness and poor concentration, leading to a higher  risk of accidents, as well as physical conditions such as heart problems, metabolic disturbancies and cognitive impairment among others.

There are many potential causes of insomnia. According to The Sleep Foundation: “On a holistic level, insomnia is believed to be caused by a state of hyperarousal that disrupts falling asleep or staying asleep. Hyperarousal can be both mental and physical, and it can be triggered by a range of circumstances and health issues”.[2]

Let’s take a look at some of these.

  1. Mental health conditions such as anxiety, depression or bipolar disorder: insomnia can make these conditions worse, and even lead to suicidal thoughts in depressed people.
  • Stress:  if a person has been exposed to a stressful situation, this may lead to hyperarousal, which blocks or disrupts sleep. Such situations might arise in the workplace, in relationships or in a broader social context. Exposure to traumatic situations can cause chronic stress, including Post-Traumatic Stress Disorder (PTSD). In some cases, the inability to sleep can in itself cause stress, which perpetuates the cycle.[3]
  • Drug induced insomnia: certain medications can cause insomnia as a side effect, and withdrawal from other drugs can have a similar effect.
  • Medical conditions:  certain physical illnesses, such as diabetes, can have health complications that cause pain, which then affects sleep. Hormonal imbalances, such as those caused by   menopause, can also interfere with sleep quality and duration.  Pregnancy is another condition which frequently comes with health issues leading to sleep disturbance.
  • Sleep Apnoea: there are 2 types – Obstructive Sleep Apnoea (OSA – this is a condition where the airway at the back of the throat gets blocked, leading to snoring, daytime sleepiness and headaches on waking, among other things). Central Sleep Apnoea (CSA) occurs when the brain fails to communicate with the muscles used for breathing, leading to irregular breathing, notable periods of shallow breathing or pauses between breaths. CSA is the more serious of the two, but both conditions require medical evaluation. [4]

6.  Working shifts: alternating between daytime and night-time shift working can disrupt the body’s circadian rhythm and lead to insomnia.


Newer treatments for insomnia start with psycho-behaviourable interventions, where patients are guided to adopt better sleep hygiene techniques, such as:

  • trying to go to bed at the same time each night;
  • reducing  screen time before going to bed;
  • ensuring that the room is dark, that all screens are shut off and devices silenced;
  • ensuring a comfortable temperature;
  • cutting out caffeinated and alcoholic drinks or reducing intake in the latter part of the day;
  • ensuring adequate exercise during the day.

Some practitioners also recommend the use of relaxation techniques such as meditation, or listening to meditation soundtracks to relax the mind.

Medication is only used if natural methods do not induce proper sleep. The danger with sleep inducing medication is that it can be addictive and/or have undesirable side effects. There is a plethora of natural sleep aids available on the market which may also help with insomnia, such as valerian, which is a herb, or melatonin, a natural product found in plants and animals, which is used as a food supplement for the treatment of short-term insomnia.

Chemical medication varies from mild sedatives to antipsychotic meds, to induce or maintain  sleep, but they are prescribed only for short term use.


Some studies indicate that adults should get between 6  and 8 hours sleep per night, but this may vary, as long as  they can maintain normal productivity during the day.

That is why a healthy lifestyle is so important to reaching your sleep goals. Less stress, a  good healthy diet and enough exercise can make a huge difference to anyone’s sleep quality.

Counting sheep doesn’t always work!


[1] The American Psychiatric Association The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-4-TR, 2000).




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