Wednesday, November 9, 2016

Insomnia Treatment in Malaysia

Insomnia Meaning:
Insomnia is a lack of sleep due to insufficient sleep quality or quantity. The insomniac’s major complaint is awakening during sleep, followed by difficulty falling asleep. An insomniac may sleep but experience poor sleep quality, also known as nonrestorative sleep. As a result of a lack of quality sleep, impairments are experienced in social and occupational functioning.

The three types of insomnia are sleep insomnia involving difficulty falling asleep, sleep maintenance involving awakening during sleep, and late insomnia involving early morning awakenings. Insomnia can be episodic lasting for a period of one month within 3 months, or persistent lasting longer than 3 months. Recurrent insomnia is two or more episodes within a year. Insomnia disorder is one of the major three groupings of sleep disorders under DSM-5, together with hypersomnia and arousal disorders.

Insomnia Symptoms:
The DSM-5’s major criteria for a diagnosis of insomnia, in brief, are (APA, 2013):

  1. Dissatisfaction with sleep quantity or quality, with one or more of the following symptoms: difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening 
  2. The sleep disturbance causes significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning 
  3. The sleep difficulty occurs at least 3 nights per week, is present for at least 3 months, and despite adequate opportunity for sleep 
  4. The insomnia does not co-occur with another sleep disorder 
  5. The insomnia is not explained by coexisting mental disorders or medical condition
Insomnia is a precursor to, and comorbid with, a number of mental and medical disorders. To ensure proper treatment, DSM-5 recognizes that one or more disorders may be present at the same time. A medical condition such as chronic pain or mental disorder such as breathing-related sleep disorder may be the cause of the insomnia. However, DSM-5 does stipulate that the insomnia should be clinically significant on its own to warrant a diagnosis.

Insomnia Treatment:
Medication is the most commonly used treatment for insomnia. A class of sedatives called hypnotics is typically prescribed. Benzodiazepine has a high risk of side effects and long-term dependence, and therefore is recommended for short-term use. Nonbenzodiazepines are more commonly prescribed today but still have a risk of side effects and are habit forming. Doctors will first try non-drug approaches to treat insomnia. These may include mind relaxation exercises and avoiding stimulants before bedtime such as caffeine. Despite the complications, insomnia worsens when patients go off medication for insomnia.

Psychotherapy approaches (Such as CBT-I) include stimulus control to teach the association between the bed and sleeping, sleep restriction to restore sleep regulation, and cognitive restructuring to address anxiety-related thoughts that lead to a lack of sleep (Mitchell, 2012).
While almost half of us report being kept awake by stress or worry, increasing evidence suggests that a large proportion of chronic, long-term insomnia is caused not by environmental factors but by the very worry we feel about getting our prescribed eight hours. In short, this sleep performance anxiety – our worries about getting enough sleep – is stopping us from getting the sleep we need. Thus, sleep performance anxiety issue should be addressed first during the therapy session.
Study also finds that those highly suggestible to clinical hypnosis can have deeper sleep after hypnotic suggestion.

Message from Hiro Koo:
Our psychological hypnosis approach will combine psychotherapy and clinical hypnosis methods to deal with your insomnia problem. First, we will do an initial consultation (Include brainwaves analysis method) to find out the root cause of your insomnia problem. After that, we will recommend the most helpful method to deal with your insomnia. Please drop me an email if you need more info: [email protected]


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