Insomnia Disorders

Cause and Non-Pharmacology Management of Insomnia

Sleep is a very important biological phenomena and it can affect quality of life.
Everyone has needs different of sleep depending on age, sex, daily work load and
so on. If the circulation of normal sleep is irregular it can make daily activities
disorder. Sleep is a regular and repetitive human need to eliminate physical and
mental fatigue. Sleeping within 6 - 7 hours a day will give good quality of sleep
and give positive effect to body when waking up, so that can do activity well.
Sleep is a part of human life that has a large portion, an average of nearly a
quarter to one third of time used to sleep. Sleep is a necessary process by humans
for the formation of new body cells, repair of damaged body cells (natural healing
mechanism), giving the body time to rest or to maintain the balance of metabolism
and biochemistry of the body.

Definition of Insomnia
Difficulty sleeping or insomnia is a complaint about lack of quality of sleep such
as difficulty entering sleep, waking up during the night then being unable to fall
back to sleep, wake up too early, and can’t sleep well. The consequences can be
caused by lack of sleep at night such as fatigue, lack of passion, and difficulty
concentrating when on daily activity. Difficulty sleeping also results in feelings of
not being refreshed during the day and difficulty with daytime functions including
completing daily activities. (Helen.D, et al. 2012)

Signs and symptoms

• Difficulty to start sleeping at night
• Awakened at night
• Wake up too early
• Fatigue or daytime sleepiness
• Irritability, depression or anxiety
• Concentration and attention are reduced
• Often encountered an error or accident
 • Tension and headaches
• Gastrointestinal symptoms

Risk factor
Almost everyone has trouble sleeping at night but the risk of insomnia increases if
it occurs in:
1. Women
Almost all women have experienced insomnia. Hormonal changes during
menstruation and menopause can play a role. During menopause, frequent
night sweats and hot flashes often interrupt sleep.
2. Age over 60 years
Because parents over 60 years old have changes in sleep patterns,
insomnia increases with age.
3. Have a mental health disorder
Many disorders, including depression, anxiety, bipolar disorder and post-
traumatic stress disorder can interrupt sleep.
4. Stress
Stress can cause insomnia, long-term stress such as the death of a loved
one or divorce, can lead to chronic insomnia. Being poor or unemployed
also increases the risk of insomnia.
5. Long journey (Jet lag) and Change of work schedule
Working at night often increases the risk of insomnia. (Kaplan, H.I,
Sadock BJ. 2010)

Type of Insomnia
Based on the type, Insomnia is grouped into three types, it is :
 The first type
Someone who can’t or difficult to sleep for 1 to 3 hours. However, because
of fatigue finally fell asleep as well. This type is usually experienced by
young people who are experiencing anxiety.
  The second type
Someone can sleep easily and soundly, but after 2 to 3 hours of sleep
she/he is awake. This incident can take place repeatedly.
 The third type
Someone can sleep easily and soundly, but in the early morning he/she
woke up and could not sleep anymore. This is usually experienced by
people who are experiencing depression.

Based on the intensity of Insomnia is divided into three it is :

 Intermittent insomnia
Intermittent insomnia is insomnia to occurs within a few nights. The
factor of intermittent insomnia is stress, noise, cold or hot water etc.
 Transient Insomnia
Transient insomnia is when symptoms appear suddenly not for days.
Factors that cause is no sleep in place usually, changing sleep schedule,
drug side effects. Etc
 Chronic insomnia
Chronic Insomnia is the severe sleeplessness and usually caused by a
psychiatric disorder. Factors cause it is physically and mentally. (Helen.D,
et al. 2012)

Impact of Insomnia
Insomnia and bad sleep complications can affect brain function. The brain uses
sleep to train all the nerve cells. When the brain doesn’t get the appropriate
amount of sleep, it can’t store or retrieve information and the ability to tolerate
stressful situations. The main consequence of lack of sleep is the brain will be
drained and lead to decreased function.
Sleep is required for memory formation and various types of sleep are required for
different types of memory consolidation. For this reason, it is important that
someone not only have the right amount of sleep but must have the correct
composition of sleep, balance of sleep well and dream.
The physical effects of insomnia are less clear until now. now it isnknown that
insomnia affects the immune system. Lack of sleep has been shown to cause
weight gain which can cause to other diseases such as diabetes, heart disease and
arthritis in adults and children. Although insomnia is not the only cause of
obesity, fatigue causes a lack of energy that causes people to rarely exercise.
(ATS, 2014)

Management of Insomnia
Management of insomnia can be done with non-pharmacological therapy,
consisting of:
A. Sleep Hygine
Sleep Hygine is one component of therapy for insomnia. Simple steps can
be taken to improve the quality and quantity of sleep. These steps include:
Wash your face, brush your teeth, urinate before bed, sleep as much as
needed, exercise regularly at least 20 minutes a day ideally 4-5 hours
before bedtime, avoid forced to sleep, avoid caffeine, alcohol , and
nicotine 6 hours before bedtime, avoid other activities that have nothing to
do with sleep.
B. Sleep Restriction,
Sleep Restriction is limit time in bed just to sleep so as to improve the
quality of sleep. This therapy is called sleep restriction. This is achieved
by the average time in bed spent only to sleep. Someone is forced to wake
up at the appointed time while still feeling sleepy. It may help to sleep
better the next night due to lack of sleep from the night before.
C. Relaxation Therapy
Relaxing Therapy including progressive muscle relaxation, deep breathing
exercises and meditation. Progressive muscle relaxation trains the patient
to recognize and control the tension by performing a series of exercises, on
deep breathing exercises, the patient is asked to inhale and exhale slowly.
D. Stimulus Control Therapy
Stimulus Control Therapy consists of several simple steps that can help
patients with symptoms of insomnia, by going to bed when feeling sleepy,
 avoid watching TV, reading, eating in bed. Bed is only used for sleep. If
not asleep 30 minutes after lying down, get up and go to another room and
continue the relaxation technique, set the alarm clock to wake up at a
certain time every morning, even on weekends, avoid waking up late,
avoid long afternoon naps.
E. Cognitive Therapy
The goal of cognitive therapy is to break the cycle of insomnia, emotional
distress, dysfunctional beliefs, and further sleep disturbances. It consists of
identifying a patient's dysfunctional beliefs about sleep, challenging their
validity, and replacing them with more adaptive substitutes. May be more
important when dealing with insomnia in older patients.
F. Paradoxical Intention
Paradoxical intention is another therapy proven to be effective for
insomnia. This therapy seeks to remove the fear of not being able to sleep
by advising the patient to remain awake. The patient is asked to follow
other sleep hygiene instructions and to remain awake as long as possible.
(Parul.H, Kessmann.J. 2009)
DAFTAR PUSTAKA

Helen.D, et al.(2012). Insomnia In Adults And Children. Joli Joco Publication

Inc., ISBN 978-0-9683576-6-8

American Thoracic Society.(2014).Patien Educational Series : Insomnia. Respir

Crit care Med, Vol. 190, P9-P-10,

Sumirta,N.Laraswati.I.(2014).Faktor Yang Menyebabkan Gangguan tidur

(Insomnia) Pada Lansia. Denpasar : Poltekes

Parul.H, Kessmann.J.(2009). Nonpharmacologic Management of Chronic

Insomnia. Volume 79, Number 2 ;79(2):125-130,131-132. Texas : American
Academy Of Family Phsycian

Jack D. Edinger et al. 2001.Cognitive Behavioral therapy for treatment of chronic

primary insomnia. Jama: American Medical Association.

Kaplan, H.I, Sadock BJ. (2010). Kaplan dan Sadock Sinopsis Psikiatri.
Tangerang: Bina Rupa Aksara Publisher

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 ENGLISH NURSING
INDIVIDUAL LEARNING
ARTICLE
Insomnia Disorders
Cause and Non-Pharmacology Management of Insomnia

By :
Ni Putu Anggi Dewi Pertiwi
1402105031

PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS KEDOKTERAN UNIVESITAS UDAYANA
2017