how Insomnia get cured with Homeopathy?

Article by Dr Sunitha Devi Vannemreddy M.D(Hom)
                                    drsunithavannemreddy@gmail.com

Sleep soothes and relaxes us after hectic hours of mental and physical exertion. Most of the people think that sleep is dormant and most inactive part of the day, but brain is more active during the sleep. Sleep effects our daily functioning and physical and mental health. Neurotransmitters controls sleep by acting on different group of nerve cells and neurons in the brain. The brainstem produces neurotransmitters such as serotonin and nor epinephrine keep some part of the brain active. Adenosine; a chemical which produces drowsiness during awake will break down during the sleep.

Sleep and wakefulness are influenced by different neurotransmitters, are affected by some foods, medicines, caffeinated drinks, diet pills and smoking. We can’t define how much sleep sufficient for 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 health of the person. 

Insomnia is a sleep disorder in which inability to fall asleep or sleep for as long as desired. Insomnia is functional impairment when awake. It is always accompanied by sleep, medical and psychiatric disorders. Insomnia itself is problem without any pathological cause or it is secondary complication after any pathological and psychiatric disorders. Insomnia characterised by difficulty in falling asleep, staying asleep for long time or poor quality of sleep.

It can occur in any age, but more problematic in older people. Insomnia can be short term or long term with consequences of irritability, memory problem, and increased risk of heart related troubles and automobile accidents.

Types of insomnia:

Transient insomnia: Lasts for less than a week, caused by 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.

Acute insomnia: Persistent inability to sleep or poor quality of sleep despite of 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 bowels irregularities.

Chronic insomnia: it lasts for more than a month. Mostly caused

 by secondary disorders but sometimes there is primary causes also involved.  Severe insomnia leads to shift in high levels of stress hormones or cytokines. Effect may vary according to causes like muscular fatigue, double vision, hallucinations and mental fatigue.

Criteria for insomnia:

• Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.)
• Difficulty 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.)
• Early-morning awakening with inability to return to sleep.

• The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
• The sleep difficulty occurs at least 3 nights per week.
• The sleep difficulty is present for at least 3 months.
• The sleep difficulty occurs despite adequate opportunity for sleep.
• The 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, a parasomnia).
• The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
• Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.
• feeling un refreshed upon waking
• Daytime sleepiness, irritability or anxiety.

Differential Diagnosis:

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.

Early morning awakening is an awakening occurring earlier (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 properties.
Major depression leads to alterations in the function of the hypothalamic-pituitary-adrenal axis, causing excessive release of cortisol which can lead to poor sleep quality.

Nocturnal polyuria, excessive night time urination, can be very 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, caffeine, nicotine, cocaine, or excessive alcohol intake.
• Withdrawal from anti-anxiety drugs or pain-relievers such as opioids.
•  Previous thoracic surgery.
• Heart disease.

•  Deviated nasal septum and nocturnal breathing disorders.
•  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.
• Pain, 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.
• Hormone shifts such as those that precede menstruation and those during menopause.
•  Life events such as fear, stress, anxiety, emotional or mental tension, work problems, financial stress, birth of a child and bereavement.
•  Gastrointestinal issues such as heartburn or constipation.
•  Mental disorders such as bipolar disorder, clinical depression, generalized anxiety disorder, post traumatic stress disorder, schizophrenia, obsessive compulsive disorder, dementia, and ADHD
• Disturbances 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.
•  Medical 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 prion-based, 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.

Sleep studies using polysomnography have suggested that people who have sleep disruption have elevated night time 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 insomnia.

• Individuals older than 60
• History of mental health disorder including depression, etc.
• Emotional stress
• Working late night shifts
•  Travelling through different time zones.

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Diagnosis:

Insomnia is widely measured using the Athens 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.

It is measured by assessing eight factors amongst which first five factors are related to nocturnal sleep and 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 the 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 of insomnia.

Sr No	Sleep factor	0	1	2	3
1	Sleep induction	No problem	Slightly delayed	Markedly delayed	Did not sleep at all
2	Awakening during night	No problem	Minor problem	Considerable problem	Severe problem/did not sleep at all
3	Final awakening	Not earlier	A little earlier	Markedly earlier	Did not sleep at all/ serious problem
4	Total sleep duration	Sufficient	Slightly insufficient	Markedly insufficient	Severe problem/did not sleep at all
5	Quality of sleep	Satisfactory	Slightly unsatisfactory	Markedly unsatisfactory	Severe problem/did not sleep at all
6	Wellbeing during the day	Normal	Slightly decreased	Markedly decreased	Very decreased
7	Functioning capacity during the day	Normal	Slightly decreased	Markedly decreased	Very decreased
8	Sleepiness during the day	None	Mild	Considerable	Intense

Past medical history and a physical examination need to be 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, including delayed 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 psychiatric disorder.

Treatment:

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 insomnia:

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 medications.
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 been given.

Rubrics which helps to treat insomnia:

Sleeplessness, day and night, children, in  
Sleeplessness, alcohol agg.
Sleeplessness, anxiety from
Sleeplessness, anger after
Sleeplessness, calamity after domestic
Sleeplessness, caressed unless
Sleeplessness, causeless
Sleeplessness, children in
Sleeplessness, chronic
Sleeplessness, coffee agg
Sleeplessness, delusions, with
Sleeplessness, desire for, fruitless
Sleeplessness, drugs, after
Sleeplessness, drunkards, in
Sleeplessness, excitement, from
Sleeplessness, fear, fright, from
Sleeplessness, fancies, from
Sleeplessness,hysterical,
Sleeplessness, insane people, in
Sleeplessness, joy from excessive
Sleeplessness, mania, in
Sleeplessness,narcotics.
Sleeplessness, newborn, in
Sleeplessness, nicotinism, chronic
Sleeplessness, night watching, from
Sleeplessness, old people, in
Sleeplessness, periodical
Sleeplessness, persistent
Sleeplessness, pregnancy, during.
Sleeplessness, restlessness, from
Sleeplessness, shock, from
Sleeplessness, sleepiness with
Sleeplessness, tea, after abuse of
Sleeplessness, tobacco, after abuse of
Sleeplessness, wine, after abuse of
Sleeplessness, woman, in
Sleep, disturbed, morning, 3am-5am
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 sided.

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.

Cypripedium: Hydrocephaloid 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 the complaints.

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 aroused.

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. Emotional sensitiveness.


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.