Insomnia: A Chronic Problem That Should Not Be Underestimated

This article explores insomnia as a chronic health issue, examining its causes, the connection to the body clock as understood in Thai traditional medicine, and sustainable solutions for improved sleep. By synthesizing current research with traditional perspectives, we aim to provide a comprehensive understanding of insomnia and offer evidence-based strategies for long-term management.

1. Introduction

Insomnia is one of the most common health problems in modern society. The World Health Organization (WHO) reports that approximately 10-30% of the global population experiences this issue [1]. In Thailand, a 2019 survey found that about 20% of the Thai population suffers from insomnia [2]. This condition significantly impacts quality of life, work efficiency, and overall health.

The objectives of this article are to:

1. Analyze the causes of insomnia from the perspective of modern medicine
2. Explain the connection between the body clock and sleep according to Thai traditional medicine concepts
3. Present sustainable solutions for improvement, referencing relevant research

2. Causes of Insomnia

Insomnia can result from various factors, which can be broadly categorized as follows:

2.1 Physical Factors

• Physical illnesses such as chronic pain, respiratory diseases, or hyperthyroidism [3]
• Hormonal changes, especially during menopause or pregnancy [4]

2.2 Psychological Factors

• Stress, anxiety, or depression [5]
• Other mental health issues such as bipolar disorder or generalized anxiety disorder

2.3 Environmental and Lifestyle Factors

• Shift work or jet lag [6]
• Use of electronic devices before bedtime, which affects melatonin secretion [7]
• Consumption of caffeine, alcohol, or nicotine close to bedtime

2.4 Genetics

Recent research has found that certain genes, such as CLOCK and PER3, may increase the risk of developing insomnia [8]

3. The Body Clock and Insomnia: Perspectives from Thai Traditional Medicine

In Thai traditional medicine, the concept of the body clock is crucial to understanding health and treating diseases, including sleep problems.

3.1 The Body Clock Concept in Thai Traditional Medicine

According to Thai medical theory, the human body consists of four essential elements: earth, water, wind, and fire. Each element is prominent at different times of the day [9], for example:

• 6:00-10:00 AM – Earth element (related to the digestive system)
• 10:00 AM-2:00 PM – Fire element (related to metabolism)
• 2:00-6:00 PM – Wind element (related to movement)
• 6:00-10:00 PM – Water element (related to excretion)

3.2 Relationship with Sleep

In this concept, the period from 10:00 PM to 2:00 AM is when the body should rest, as it’s the time when the wind and fire elements work together to restore the body [10]. Insomnia or sleeping at the wrong time may lead to an imbalance of the four elements, affecting overall health.

3.3 Comparison with the Circadian Rhythm Concept in Modern Science

The body clock concept in Thai traditional medicine aligns with the circadian rhythm theory in modern science [11]. Both concepts emphasize the importance of aligning activities with the body’s daily cycle to maintain balance and promote good health.

4. Modern Research on Circadian Rhythms and Sleep

4.1 Basics of Circadian Rhythms

Circadian rhythms are biological processes that occur in approximately 24-hour cycles, controlled by the “master clock” in the brain’s Suprachiasmatic Nucleus (SCN) [12]. The SCN regulates various bodily functions, including the sleep-wake cycle.

4.2 Neurochemical and Hormonal Regulation of Sleep-Wake Cycles

• Melatonin: A hormone secreted at night that induces sleepiness and prepares the body for sleep [13]
• Cortisol: A hormone secreted in the morning that promotes wakefulness and alertness [14]

4.3 Impact of Circadian Disruption on Sleep Quality

Research has shown that circadian disruptions, such as night shift work or exposure to blue light from electronic devices before bedtime, can negatively affect sleep quality and lead to insomnia [15].

5. Sustainable Solutions for Better Sleep

5.1 Lifestyle Modifications

• Maintain consistent sleep and wake times, even on weekends [16]
• Avoid using electronic devices at least 1 hour before bedtime [17]
• Exercise regularly, but avoid intense exercise 2-3 hours before bedtime [18]

5.2 Cognitive-Behavioral Therapy for Insomnia (CBT-I)

CBT-I is a proven effective treatment for chronic insomnia [19]. It includes techniques such as:

• Stimulus control: e.g., using the bed only for sleep
• Sleep restriction: to increase sleep pressure and improve sleep efficiency
• Relaxation techniques: e.g., breathing exercises, meditation
• Cognitive restructuring: addressing inappropriate thoughts about sleep

5.3 Pharmacological Interventions

While medication is not the first choice for chronic insomnia, in some cases, doctors may consider using drugs in conjunction with non-pharmacological therapies [20]. Medications may include:

• Benzodiazepines and non-benzodiazepine sleeping pills
• Certain antidepressants
• Melatonin supplements

However, medication use should be closely monitored by a physician due to potential side effects and the risk of dependency.

5.4 Integration of Thai Traditional Medicine Approaches

Incorporating Thai traditional medicine concepts with modern treatments may enhance the effectiveness of insomnia management [21], such as:

• Aligning behaviors with the body clock: e.g., eating and sleeping at appropriate times
• Using Thai herbs known to promote sleep: e.g., holy basil, white joss flower [22]
• Thai massage to relax muscles and reduce stress

6. Conclusion

Insomnia is a complex health problem that significantly impacts quality of life. Understanding its causes from both modern medical and Thai traditional medicine perspectives allows us to develop more comprehensive and effective treatment approaches.

Sustainable problem-solving requires a combination of methods, including lifestyle changes, cognitive and behavioral therapy, and in some cases, medication. Incorporating Thai traditional medicine concepts may enhance treatment effectiveness and promote holistic health.

Future research should focus on further studying the integration of traditional and modern medical approaches to develop effective treatment strategies that are culturally appropriate for each region.

References

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