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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 51633
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I am struggling with anxiety, i need help, my sleep is very

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hi
JA: Hello. How can I help?
Customer: i am struggling with anxiety
JA: When did the anxiety start? Have you used any medication for this?
Customer: i need help
JA: The Psychologist will be able to answer that. How have you been sleeping? Any insomnia or other issues?
Customer: my sleep is very disturbed lately
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Psychologist should know?
Customer: noCustomer: Chat is completed

The best way to deal with anxiety is a comprehensive approach. It can be treated by the following measures by yourself;

1) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT); done by a psychologist but there is an internet-based approach nowadays too. CBT has higher efficacy and lower relapse rates.

2) Relaxation training and biofeedback.

3) Hypnosis

4) Acupuncture and acupressure

5) Yoga

6) Meditation

7) Group sporting activities

8) St. John's wort

9) Melatonin
10) Valerian root

11) Deep breathing exercises.

A major component of therapy involves understanding and assuring yourself that the symptoms are neither from a serious medical condition nor from a mental deficiency but rather from a chemical imbalance in the fight or flight response.

CBT helps to understand how automatic thoughts and false beliefs/distortions lead to exaggerated emotional responses, such as anxiety, and how they can lead to secondary behavioral consequences. Cognitive restructuring involves substituting positive thoughts and getting rid of negative thoughts. Some studies have suggested that high importance to religion and religious practices also improve anxiety symptoms and prevent recurrences.

Physical illness is uncommon with the sleep issue. An off and on sleeplessness need to dig the cause for underlying anxiety, depression, or another related issue. A thorough evaluation of history is done to reach a conclusion. Accordingly, medical treatment is commenced. The precipitating factors can be;

1) depression,

2) anxiety,

3) sleep-wake schedule changes,

4) medications,

5) other sleep disorders,

6) medical conditions

7) work-related issues

8) family problem,

9) health events.

All these in isolation or in combination play problems in sleep issues. Good sleep cycle, handling the specific problem, counseling, cognitive-behavioral therapy, medications are employed for the treatment.

Following measures are helpful;

1) Avoid if you do;

a) caffeine or alcohol use,

b) environmental noise,

c) inappropriate room temperature,

d) watching TV in bed.

e) avoid large meals at dinner.

2) Relaxation techniques

3) Acupressure and acupuncture.

A study comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. Please see the reference;

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. [Medline].

Dietary measures which are useful:

1) Avoid caffeinated beverages in the late afternoon or evening.

2) Avoid alcohol in the evening.

3) Avoid large meals near bedtime.

Acupressure on the Shenmen points of both wrists significantly decreased insomnia, with the benefit persisting for up to 2 weeks afterward. Please see the reference;

Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. Jul 2010;47(7):798-805. [Medline].

Cognitive-behavioral therapy (CBT) is also considered the most appropriate treatment for patients with insomnia. The components of CBT are;

1) Sleep hygiene education

2) Cognitive therapy

3) Relaxation therapy

4) Stimulus-control therapy

5) Sleep-restriction therapy

Phytotherapy for the treatment of insomnia is an exciting new therapeutic option, which might benefit patients suffering from different degrees of insomnia. Insomnia or sleeplessness is a disorder characterized by difficulty initiating or maintaining sleep. It affects sleep quality and quantity leading to increased morbidity. Sleep disturbances are thought to be caused by abnormalities of the circadian system as indicated by misalignments of the endogenous circadian cycle and the sleep-wake cycle. Several contributory factors may be involved such as stress, health status, and medicines (e.g. caffeine).

Treating insomnia is a big challenge as the available medications are associated with several side-effects. Herbal medicines are being looked at as an ideal replacement for these medications. Among the ethnobotanicals used for sleep disorders, only Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy against insomnia.

Please feel free for your follow up questions.

I would be happy to assist you further if you need any more information.

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