and physical exertion. Most of the people think that sleep is dormant and most
inactive part of the day, but the brain is more active during the sleep.
affects our daily functioning and physical and mental health. Neurotransmitters
control sleep by acting on a different group of nerve cells and neurons in the
brain. The brainstem produces neurotransmitters such as serotonin and norepinephrine
keep some part of the brain active. Adenosine; a chemical which
produces drowsiness during awake will break down during the sleep.
neurotransmitters, are affected by some foods, medicines, caffeinated drinks,
diet pills, and smoking. We can’t define how much sleep sufficiently for a normal
human being. It depends on many factors like age, time of sleep and many more. But
scientists suggest that once we awake we should feel light, fresh and
energetic. Sleep deprivation is always a dangerous sign for the health of the person.
asleep or sleep for as long as desired. Insomnia is a functional impairment when
awake. It is always accompanied by sleep, medical and psychiatric disorders.
Insomnia itself is a problem without any pathological cause or it is a secondary
complication after any pathological and psychiatric disorders. Insomnia
characterized by difficulty in falling asleep, staying asleep for a long time or
poor quality of sleep.
people. Insomnia can be short term or long term with consequences of
irritability, memory problem, and increased risk of heart-related troubles and
changes in the sleep environment, timings of sleep and other disorders like
stress, simple cough, and cold to depression. Leading to sleepiness and
impaired psychomotor performance.
quality of sleep despite adequate circumstances and opportunities for sleep
which lasts for less than a month. Mostly it is related to stress, so-called as
stress-related insomnia. It simply affects the day time activities which in
turn lead to depression and other physical conditions like loss of appetite and
involved. Severe insomnia leads to shifting
in high levels of stress hormones or cytokines. The effect may vary according to
causes like muscular fatigue, double vision, hallucinations, and mental fatigue.
initiating sleep. (In children, this may manifest as difficulty initiating
sleep without caregiver intervention.)
maintaining sleep, characterized by frequent awakenings or problems
returning to sleep after awakenings. (In children, this may manifest as
difficulty returning to sleep without caregiver intervention.)
awakening with inability to return to sleep.
sleep disturbance causes clinically significant distress or impairment in
social, occupational, educational, academic, behavioral, or other
important areas of functioning.
sleep difficulty occurs at least 3 nights per week.
sleep difficulty is present for at least 3 months.
sleep difficulty occurs despite adequate opportunity for sleep.
insomnia is not better explained by and does not occur exclusively during
the course of another sleep-wake disorder (e.g., narcolepsy, a
breathing-related sleep disorder, a circadian rhythm sleep-wake disorder,
insomnia is not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication).
mental disorders and medical conditions do not adequately explain the
predominant complaint of insomnia.
unrefreshed upon waking
- Daytime sleepiness, irritability
Sleep-onset insomnia is
difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed
sleep phase disorder can be
misdiagnosed as insomnia, as sleep onset is delayed too much later than normal
while awakening pills over into daylight hours.
It is common for patients who
have difficulty falling asleep to also have nocturnal awakenings with
difficulty returning to sleep. Two-thirds of these patients wake up in middle
of the night, with more than half having trouble falling back to sleep after a middle
of the night awakening.
(more than 30 minutes) than desired with an inability to go back to sleep, and
before total sleep time reaches 6.5 hours. Early morning awakening is often a
characteristic of depression.
Poor sleep quality can occur as a
result of, for example, restless legs, sleep apnea or major depression. Poor sleep quality is caused by the
individual not reaching stage 3 or delta sleep which has restorative
Major depression leads to
alterations in the function of the hypothalamic-pituitary-adrenal
excessive release of cortisol which can lead to poor sleep
disturbing to sleep.
Some cases of insomnia are not
really insomnia in the traditional sense. People experiencing sleep
state misperception called as
subjective insomnia; often sleep for normal durations, yet severely
overestimate the time taken to fall asleep. They may believe they slept for
only four hours while they, in fact, slept a full eight hours.
Causes for Insomnia:
Symptoms of insomnia can be
caused by or be co-morbid with:
- Use of psychoactive drugs, herbs,
or excessive alcohol intake.
from anti-anxiety drugs or pain-relievers such as opioids.
- Previous thoracic surgery.
- Deviated nasal septum and nocturnal
- Restless legs syndrome, which can
cause sleep onset insomnia due to the discomforting sensations felt and
the need to move the legs or other body parts to relieve these sensations.
- Periodic limb movement disorder
(PLMD), which occurs during sleep and can cause arousals of which the
sleeper is unaware.
an injury or condition that causes pain can preclude an individual from
finding a comfortable position in which to fall asleep, and can in
addition cause awakening.
shifts such as those that precede menstruation
and those during menopause.
- Life events such as fear,
emotional or mental tension, work problems, financial stress, the birth of a
child and bereavement.
- Gastrointestinal issues such as heartburn
disorders such as bipolar disorder, clinical depression, generalized anxiety disorder,
post-traumatic stress disorder,
of the circadian rhythm, such as shift
work and jet lag can cause an inability to sleep
at some times of the day and excessive sleepiness at other times of the
day. Chronic circadian rhythm disorders
are characterized by similar symptoms.
- Certain neurological
disorders, brain lesions, or a history
of traumatic brain injury.
conditions such as hyperthyroidism
and rheumatoid arthritis.
- Abuse of over-the-counter or prescription
sleep aids (sedative or depressant
drugs) can produce rebound insomnia.
- Poor sleep
hygiene, e.g., noise or over-consumption of caffeine.
- A rare genetic condition can cause a prison-based,
the permanent and eventually fatal form of insomnia called fatal familial insomnia.
- Physical exercise. Exercise-induced
insomnia is common in athletes in the form of prolonged sleep onset latency.
have suggested that people who have sleep disruption have elevated nighttime
levels of circulating cortisol and adrenocorticotropic hormone (ACTH). They
also have an elevated metabolic rate. Studies of brain metabolism using positron emission tomography (PET) scans
indicate that people with insomnia have higher metabolic rates by night and by
day. Till now scientists could not understand that these are whether causes of
insomnia or consequences.
Insomnia affects people of all
age groups but people in the following groups have a higher chance of acquiring
older than 60
of mental health disorder including depression, etc.
late night shifts
- Traveling through different time zones.
Insomnia Scale (AIS). AIS was first introduced in the year 2000 by a group
of researchers from Athens,
Greece to assess the insomnia symptoms in patients with sleep disorders.
are related to nocturnal sleep and the last three factors are related to daytime
dysfunction. These are rated on a 0-3 scale and the sleep is finally evaluated
from the cumulative score of all factors and reported as an individual’s sleep
outcome. Over a period of time, AIS is considered to be an effective tool in
sleep analysis, and it is validated in various countries based on the local
patients. A cut-off score of ≥6 on the AIS is used to establish the diagnosis
Did not sleep at all
Awakening during night
Severe problem/did not sleep at all
A little earlier
Did not sleep at all/ serious problem
Total sleep duration
Severe problem/did not sleep at all
Quality of sleep
Severe problem/did not sleep at all
Wellbeing during the day
Functioning capacity during the day
Sleepiness during the day
done to eliminate other conditions that could be the cause of the insomnia. The
sleep history should include sleep habits, medications (prescription and
non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid
illnesses, and sleep environment. A sleep diary can be used to keep track of
the individual’s sleep patterns. The diary should include time to bed, total
sleep time, time to sleep onset, number of awakenings, use of medications, and
time of awakening and subjective feelings in the morning. Some patients may
need to do a sleep study to determine if insomnia is present. The sleep study
will involve the assessment tools of a polysomnogram and the multiple sleep
latency tests and will be conducted in a sleep centre or a designated hotel.
Patients with various disorders,
sleep phase syndrome, are often
mis-diagnosed with primary insomnia. When a person has trouble getting to
sleep, but has a normal sleep pattern once asleep, a delayed circadian rhythm
is the likely cause. In many cases, insomnia is co-morbid with another disease,
side-effects from medications, or a psychological problem. Approximately half
of all diagnosed insomnia is related to psychiatric disorders. It is possible
that insomnia represents a significant risk for the development of a subsequent
It is important to identify and
rule out medical and physiological causes before deciding the treatment of
insomnia. If insomnia caused due to some physiological or medical causes, if
primary causes can be treated which improves the sleep and insomnia will get
cured. If the insomnia is primary thing, then cognitive behavioural therapy is
more affective in chronic insomnia cases than medications. In acute insomnia,
sleep inducing medications will help somewhat, but its long term use intern
develops some side effects. Meditation also good non medical treatment for
insomnia cases. Relieving from stress, avoiding caffeinated products before
sleep, warm bathing before the sleep, taking warm milk before the sleep and
taking long deep breath after lying on bed will help somewhat to reduce
insomnia and have good sleep.
Non pharmacological strategies
provide long lasting improvements to insomnia and are recommended as a first
line and long term strategy of management. The strategies include attention to sleep hygiene, stimulus control, behavioral interventions,
sleep-restriction therapy, paradoxical intention, patient education and
relaxation therapy. Stimulus control therapy is a treatment for patients who
have conditioned themselves to associate the bed, or sleep in general, with a
negative response. As stimulus control therapy involves taking steps to control
the sleep environment.
Homeopathic treatment for
In Homeopathy insomnia can be
treated with constitutional treatment. Classical Homeopathy helps in taking
complete case history of the patient, in which we can understand the mental,
emotional and physical plane of person’s constitution. If we can prescribe
constitutional medicine for the person’s totality of the symptoms, it will cure
insomnia. Homeopathy can also treat the side effects from sleep inducing pills,
other effects of medication. Alcohol induced, or caffeine induced and other
drug induced insomnia can be treated with homeopathic constitutional
In Homeopathy, sleep has given
major importance. As we think that it will alter the person’s emotions and
physical complaints. That’s why in repertory, one complete sleep chapter has
Rubrics which helps to treat insomnia:
Sleeplessness, day and night,
Sleeplessness, alcohol agg.
Sleeplessness, anxiety from
Sleeplessness, anger after
Sleeplessness, calamity after
Sleeplessness, caressed unless
Sleeplessness, children in
Sleeplessness, coffee agg
Sleeplessness, delusions, with
Sleeplessness, desire for,
Sleeplessness, drugs, after
Sleeplessness, drunkards, in
Sleeplessness, excitement, from
Sleeplessness, fear, fright, from
Sleeplessness, fancies, from
Sleeplessness, insane people, in
Sleeplessness, joy from excessive
Sleeplessness, mania, in
Sleeplessness, newborn, in
Sleeplessness, night watching,
Sleeplessness, old people, in
Sleeplessness, pregnancy, during.
Sleeplessness, restlessness, from
Sleeplessness, shock, from
Sleeplessness, sleepiness with
Sleeplessness, tea, after abuse
Sleeplessness, tobacco, after
Sleeplessness, wine, after abuse
Sleeplessness, woman, in
Sleep, disturbed, morning,
Sleep, disturbed, easily
Sleep, interrupted, morning.
Sleep, interrupted, midnight.
Some of important medicines which
help in insomnia:
Argentum nitricum: Sleepless,
from fancies before his imagination. Horrible dreams of snake and of sexual
gratification. Drowsy, stupor.
Arnica: Sleepless, restless from
overexcited. Awakens in middle of night with hot head, fear of sleeping again
with recurrence. Dreams of death and mutilated bodies. Anxious and restless.
Terrible horror in the night. Involuntary stools and urine.during sleep. Great drowsiness during the day, without
being able to sleep. During sleep, groans, talks and snoring.
Arsenicum album: Disturbed,
anxious, restless. Head must raised by pillows. Suffocative fits during sleep. Lying
with hands under the head. Frequent awakening from sleep, with fear and
anxiety. Dreams of dead people, frightful dreams, waking from sleep with sweat
all over the body.
Belladonna: Restless, crying out,
gritting of teeth, kept away by sensation of blood vessels. Screams out in
sleep. Sleeplessness with drowsiness. Starting when closing the eyes during
sleep. Sleeps with hands under the head. Worse by lying, better by semi erect
position. On waking headache with increased suffering.
Calcarea carb: Ideas crowding in
the mind prevents the sleep. Horrid vision when opening the eyes. Starts at
every noise. Fears that she will go crazy. Drowsy in early parts of night.
Frequent awakening from sleep. Disagreeable ideas from every slumber. Night
terror, dreams of death.
China: Drowsiness, unrefreshing
and constant stupor. Wakens early. Protracted sleeplessness. Anxious, frightful
dreams with confused consciousness on waking, so that sleep cannot be rid of
frightened dream, remains in affect of dream. Snoring, especially in children.
Citrus vulgaris: Frequent and
irresistible yawing. Disturbed sleep, due to facial neuralgia, especially right
Coffea: Wakeful on constant move.
Sleeps till 3 am after which only dozing. Wakes with starting. Sleep disturbed
by dreams. Sleepless on account of mental activity. Flows of ideas with nervous
excitability. Disturbed by itching on anus.
symptoms results of long exhausting sleeplessness. Especially in young children
with overstimulation of brain. Child cries out and wakes during the night. Is
wakeful and begins to laugh and play. Efficient antidote for Rhus poisoning.
Kali phos: Wakes early with heat
and restlessness. Mumbling, grinding the teeth and talking during the sleep.
Sleepy, yawing, hard to wake. Eyes hurt, they feel so sleep. Pains frequently
change the positions and makes him to wake from 2-3 am to 4 am. Dreams as if he
is partially clothed in public. Lascivious dreams with emissions, wakes with
angry and cross. Sleeplessness during latter part of night. Night terror in
children, awakens from sound sleep screaming with fright. Sleeplessness fro
mental exertion, worry from business load and nervous exhaustion.
Lachesis: Patient sleeps into an
aggravation. Sudden starting when falling asleep. Sleepiness yet cannot sleep.
Wide awakening in the evening. Cannot lie on left side. Sleep aggravates all
Nux vomica: Cannot sleep after 3
am until morning. Awakens feeling wretchedly. Drowsy after meals and in early
evening. Dreams full of bustles and hurry. Better after short sleep, unless
Opium: Great drowsiness, falls
into stupid sleep. Loss of breath in falling asleep. Picking of bed clothes.
Very sleepy but cannot go to sleep, distant noises and sounds wakes him up.
Child dreams of cats, dogs and black forms. Bed feels so hot that cannot lie on
it. Shaking chills, with heat and heat, thirst during sleep.
Phosphorus: Great drowsiness
after meals. Sleeplessness in older people. Vivid dreams of fire, of
haemorrhages. Lascivious dreams. Goes to sleep late and wakes early. Short naps
and frequent awakening. Disturbed sleep.
Rhus tox: Dreams of great
exertion. Heavy sleep with stupor. Sleepless before midnight.
Pulsatilla: Wide awake in the
evening. First sleep restless. Wakes languid and unrefreshed. Sleepiness in the
afternoon. Sleeps with hands over the head.
Silicea: Night walking gets up
while asleep. Sleepless with great orgasm of blood and head in the head. Frequent starting during sleep. Anxious
dreams. Excessive gaping.
Thuja: Persistent insomnia.
Tabacum: Insomnia with dilated
heart. With cold, clammy skin with anxiety.
even though these are some indicated remedies in treating the insomnia, but in my opinion, treating the person with constitutional homeopathic medication will give a good success rate in primary insomnia cases. in secondary insomnia, treating the actual cause for insomnia with improving healthy living style with diet, exercise and stress free life will helps in cure rate in Homeopathy.