Sleepless In Srinagar

Sleeping peacefully has become a distant dream for many Kashmiris. Saima Bhat reports on the increasing number of insomnia cases.

Representational Picture

Shazia, 21, hasn’t slept well for a year now. She takes sleeping pills every night which makes her feel drowsy, but her eyes stay open. Shazia has insomnia—the chronic inability to fall asleep or remain asleep for an adequate length of time.

Shazia says she feels bored and hates her life. Her mind always remains preoccupied with new job opportunities. She wants to work and feels she should be financially independent. Shazia is a graduate and says that if she gets a job, it could help be a distraction from her problems. After exams in 10th, she wanted to become a doctor; so she went to ask a doctor for memory-enhancing medication to help her study. Unfortunately, she says, her memory only started fading away.

Shazia has been aggressive since her mother died when she was still a child. Back then, if her father or siblings did not give her what she wanted, she would start banging her head against the walls. Shazia remembers, “Once, my father said no to my demand, and I started hitting my head against the wall. That day I got five or six stitches on my head.” But with time she realized that this behaviour was dangerous, so she stopped.

“Sometimes, I feel like I should kill myself for all the mistakes I’ve made,” she says. “I know I used to irritate my father a lot and my siblings too. Last time I scratched our childhood photographs, and now I’m feeling sorry for that too,” says Shazia while she frowns and looks down.

Dr Arshid Hussain, a psychiatrist of Kashmir says, “Insomnia is not a disease, it is the manifestation of something underlined—either physiological or pathological.” Sometimes physical illness or even environmental changes like room temperature changes can also cause insomnia. “It usually occurs in patients who are going through stress in life or are suffering from other health issues.”

Shazia is one such patient. She actually has epilepsy—a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.

She also has a thyroid disorder which adds to her sleeplessness. “At night I feel cold one minute, and hot the next,” she says. “And I always feel restless.” When her family started noticing her gradual memory loss, they consulted an Unani doctor so she did not have to deal with the side effects of allopathic medications. When the herbal medicines did not help, she consulted a psychiatrist. Her family says they are seeing some improvement now, but there is still a long way to go; because Shazia still feels tired when she wakes up every morning.

Shazia’s sister says, “She used to help me in the kitchen and with other day-to-day responsibilities, but now she prefers to stay in bed. All she says is that she doesn’t have the energy to do anything. I believe that all the medication that’s been given to her since childhood is responsible for her condition today. Her sister adds, “Yes, she had problems, but the medicines have only added to her problems.”

The human body works in a systematic pattern with coordination between various chemicals and hormones released from body organs in response to a stimulus.  The adaption of this response to stimuli is regulated by the brain in a circadian rhythm. To perform various functions, a body needs energy in the form of nutrition and adequate rest in the form of sleep. Anything which disturbs the balance between work and rest leads to an alteration in the sleep pattern. The human body usually requires 8 hours of sleep.

Medical doctors state that insomnia develops in people under stress due to the loss of their loved ones, or divorce. Health problems like asthma, high blood pressure, allergies, arthritis, cancer and environmental factors also result in disturbed sleep.  Besides, any instability in life can lead to stress.

People suffering from insomnia avoid consulting a psychiatrist in Kashmir as there is a social stigma attached to it.  Dr Hussain adds, “Insomnia is not defined by a specific number of hours of sleep that one gets since individuals vary widely in their sleep needs and practices. Insomnia has become an issue worldwide but here in Kashmir, it has become a grave issue. Psychiatric disorders are increasing in Kashmir and so is insomnia. At first, the conflict played its role and now the changing cultural trend is adding to it”.

Tariq Ahmad, a businessman, was interrogated by troops continuously for 10 days for being an undercover worker of a militant group. He says, “I was a victim of third-degree torture. I was hung upside down continuously for 4 days, sometimes with my head in the water.

Sometimes, I was continuously beaten by belts or canes, or a big roller was rolled over my legs which pulled off my nails too.”  His condition had worsened and the Special Operations Group (SOG) then handed him over to the state police, so that if he dies, the police could handle the case. But not only did Tariq survive, but he was also proven to be innocent and was released.

Tariq says, “After I was released, I couldn’t sleep properly. As soon as I would feel sleepy, my mind would be filled with flashbacks of my interrogation. There was no light left in the darkness, and the thought of going to bed exhausted me.” He adds, “My brother suggested that I take sleeping pills for some time, and so we consulted a doctor about it.” Tariq says this helped to some extent, but he still needed some additional help. “I used to keep the music player playing for the whole night so that I couldn’t hear any kind of sound from outside during night”.

Dr Hussain says, “Pre-1989, the reasons for insomnia have been nightmares, perceived fears, and imagined fears which didn’t have real connotations. And insomnia was usually related to ageing, only elderly people used to complain of insomnia.” But he says things changed after the situation worsened in Kashmir. “Post-1989, perceived fears changed into real fears like Midnight Knock Syndrome (which resulted in frequent panic attacks), and symptoms were usually shown by young people and it also started developing in the patients with PTSD. And now, when conflict is in a somewhat passive stage, new reasons which add to insomnia are the changing cultural patterns, depressions, stressful lives, and the kind of work people are doing.” Psychiatrists believe the younger generation force themselves into developing insomnia due to a highly stimulated environment that includes TV and mostly the Internet.

Many people who are active on social networking sites are also believed to be having insomnia. Saiba is an active user of Facebook, but she has a different story to narrate. She is having thyroid disorder and was operated on a few years ago, due to which she now has a disturbed sleep pattern. She says, “I used to feel sleepy at a particular time, 11 PM, but then in the middle of the night my legs feel restless and they hurt, or sometimes my body sides start aching and ultimately I can’t sleep for the entire night.

Sleeping had become a nightmare”. But now she keeps herself busy with Facebook and then sleeps when she feels exhausted, usually around 1 or 2 am so that she sleeps without any disturbance.  Another problem, which still persists for her is breathlessness during nights due to which her respiratory tract always remains congested.

Dr Hussain says, “Kashmir was a good sleeping nation and Kashmiris were very fond of sleep but now the trend has changed and a good proportion of Kashmiri people are getting insomniac as Kashmiris are imitating West who are considered as less sleeping nations.”

Amir, 25 years old, is working in an international BPO in Delhi. He works night shifts. He is working there for the last 4 years now. Amir says, “Whenever I come home for holidays I realize some changes like I can never sleep during nights and then feel sleepiness during the day, most of the times I have tiredness, irritability and problems with concentration. My mother actually noticed these changes. I never noticed these things while working but my schedule of work is actually affecting my health somehow”. Amir’s job has forced him to have insomnia.

A person facing sleeping problems doesn’t always mean they must be having some more health issues. Insomnia can be primary when it is not directly associated with any other health problem. But if a person is having sleep problems due to other problems, it is a secondary form of insomnia where consulting a doctor is a must. Sleep is an active physiological variant, it is in synchronization with all other functions of the body.  Psychiatrists say, sleep is an important tool in psychiatric problems and they usually start their investigation with the sleep question.

“Once a boy, 10, was brought to OPD (outdoor patient department of Psychiatric hospital), his parents complain that their kid only slept during the day and remains awake for the whole night from last one week. When we examined him, he was schizophrenic. Schizophrenia is a complex mental disorder” says a psychiatrist. He adds, “Only sleep is evident to families so families come with sleep disorder problems initially but later, patients sometimes have some other bigger problems and sometimes they are drug addicts too”.

Worldwide an estimated 30 – 50 per cent of the general population is affected by insomnia and 10 per cent also have chronic insomnia which lasts for a longer time.

In Kashmir, psychiatrists say less physical exertion is also an important reason for less sleep. And they treat primary insomnia with normal physical exercise and they believe psychiatrist are forced to believe in spirituality so most of the times they take the help of religious things as the power of the belief is the ultimate belief.

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