7-13 October 2016 #829

The republic of insomnia

Nepalis face an epidemic of post-traumatic stress and sleep deprivation as the country copes with the aftermath of the earthquake and is tangled in endless turmoil

Gopen Rai

Going by the number of pictures in the media of Members of Parliament dozing off in the august House, you would think lack of sleep is the least of Nepal’s problems. But recent studies have shown that insomnia has become a national epidemic, spawning a host of other physical and mental ailments in the population. 

An entire generation of Nepalis has faced one trauma after another: The violence of the Maoist conflict, impunity and lawlessness for the decade since it ended, the death and destruction caused by the earthquake, and chronic economic hardships amplified by a merciless blockade. There are now indications all this has had an impact on the mental wellbeing of Nepalis

One way to measure psychological stress is insomnia, the other is by tallying the prescription of certain medications. A survey by our sister publication Himal Khabarpatrika recently showed that 60 out of 80 patients who came in for a checkup at the Teaching Hospital Mental Health OPD last week complained of insomnia. Pharmacies also report that Nepal’s consumption of sleeping pills, tranquillisers, sedatives and other psychotropic drugs has grown 15 per cent in the past year and has surpassed Rs 2 billion. 

Researchers say factors contributing to this spread of sleeplessness among Nepalis are economic hardships, trauma and phobia after the earthquake, family separation caused by mass outmigration, residual violence and threats after the conflict, as well as general worry about the future due to ongoing political turmoil.

Insomnia is one of the first indications of mental stress, and if not addressed tends to escalate into more serious symptoms of psychological disorders as well as physical manifestations on the health of individuals. Over-prescription of drugs leads to even more complications, addiction to sedatives, or in many cases alcohol and drug abuse — which in turn exacerbate symptoms of mental illness.

The conflict left many mentally scarred. People who witnessed the brutal murders of family members, or endured torture themselves added many thousands of new patients with post-traumatic stress disorders for a beleaguered health system to deal with. A decade later, many still suffer from insomnia, are startled by loud noises, or break into sweat.

More recently, relief groups working in earthquake-affected districts are still coming across psycho-social impact even among people who did not lose any family members. Totalling the volume of psychotropic drugs that health NGOs have had to prescribe indicate the extent of the problem. Many survivors have phobia about being indoors, tremble at every aftershock and spend night after night without sleep. One NGO survey showed that 90 per cent of the people counselled in a Kavre village in which many houses were destroyed, suffer from chronic insomnia.

The fact that 2 million people are still living in temporary shelters, and families have to cope with daily survival while at the same time worrying about rebuilding their homes when help from the government is delayed, has added to stress levels. 

Psychiatrists are also worried about a growing trend of sleep deprivation, anxiety attacks and phobias among urban adolescents and young adults that they say is related to overconsumption of social media. More than 6 million Nepalis are now on Facebook, and an increasingly larger number are spending late nights on their phones or computers. Sleep deprivation due to internet addiction is emerging as a major health issue in Nepal, just as it has in Hong Kong and other East Asian societies. 

Insomnia is regarded as a precursor to and a factor leading to mental illness. Stress-related sleeplessness can induce physical and mental ailments, adding a huge burden to a country in which hospital care is already inaccessible and unaffordable. Only 3 per cent of Nepal’s national budget is devoted to health, and only 1 per cent of that is for mental health. 

Nepal is a country afflicted with endemic post-traumatic stress. Only political stability that spurs the economy to create jobs will allow us to sleep better, and gain our equanimity. 

Read also:

The silent scream, Anjana Rajbhandary

All in mind, Anjana Rajbhandary

Disturbed care, Hemlata Rai