Insomnia
is the perception or complaint of inadequate or poor-quality sleep because of one
or more of the following:
- · difficulty falling asleep
- · waking up frequently during the night with difficulty returning to sleep
- · waking up too early in the morning
- · unrefreshing sleep
Insomnia
is not defined by the number of hours of sleep a person gets or how long it takes
to fall asleep. Individuals vary normally in their need for, and their
satisfaction with, sleep. Insomnia may cause problems during the day, such as
tiredness, a lack of energy, difficulty concentrating, and irritability. Insomnia
can be classified as transient (short term), intermittent (on and off), and
chronic (constant). Insomnia lasting from a single night to a few weeks is
referred to as transient.
If
episodes of transient insomnia occur from time to time, the insomnia is said to
be intermittent. Insomnia is considered to be chronic if it occurs on most
nights and lasts a month or more.
WHAT CAUSES IT?
Certain
conditions seem to make individuals more likely to experience insomnia.
Examples
of these conditions include:
- § advanced age (insomnia occurs more frequently in those over age 60)
- § female gender
- § a history of depression
If
other conditions (such as stress, anxiety, a medical problem, or the use of
certain medications) occur along with the above conditions, insomnia is more
likely.
There
are many causes of insomnia. Transient and intermittent insomnia generally occur
in people who are temporarily experiencing one or more of the following:
- § stress
- § environmental noise
- § extreme temperatures
- § change in the surrounding environment
- § sleep/wake schedule problems such as those due to jet lag
- § medication side effects
Chronic
insomnia is more complex and often results from a combination of factors,
including underlying physical or mental disorders. One of the most common
causes of chronic insomnia is depression. Other underlying causes include
arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy,
restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However,
chronic insomnia may also be due to behavioral factors, including the misuse of
caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur
with shift work or other nighttime activity schedules; and chronic stress.
In
addition, the following behaviors have been shown to perpetuate insomnia in
some people:
- § expecting to have difficulty sleeping and worrying about it
- § ingesting excessive amounts of caffeine
- § drinking alcohol before bedtime
- § smoking cigarettes before bedtime
- § excessive napping in the afternoon or evening
- § irregular or continually disrupted sleep/wake schedules
These
behaviors may prolong existing insomnia, and they can also be responsible for
causing the sleeping problem in the first place. Stopping these behaviors may
eliminate the insomnia altogether.
WHO GETS INSOMNIA?
Insomnia
is found in males and females of all age groups, although it seems to be more
common in females (especially after menopause) and in the elderly. The ability
to sleep, rather than the need for sleep, appears to decrease with advancing age.
HOW IS IT
DIAGNOSED?
Patients
with insomnia are evaluated with the help of a medical history and a sleep
history. The sleep history may be obtained from a sleep diary filled out by the
patient or by an interview with the patient’s bed partner concerning the
quantity and quality of the patient’s sleep. Specialized sleep studies may be
recommended, but only if there is suspicion that the patient may have a primary
sleep disorder such as sleep apnea or narcolepsy.
HOW IS IT
TREATED?
Transient
and intermittent insomnia may not require treatment since episodes last only a
few days at a time. For example, if insomnia is due to a temporary change in
the sleep/wake schedule, as with jet lag, the person’s biological clock will often
get back to normal on its own. However, for some people who experience daytime
sleepiness and impaired performance as a result of transient insomnia, the use
of shortacting sleeping pills may improve sleep and next-day alertness. As with
all drugs, there are potential side effects. The use of over-the counter sleep
medicines is not usually recommended for the treatment of insomnia.
Treatment
for chronic insomnia consists of:
§ First, diagnosing and
treating underlying medical or psychological problems.
§ Identifying behaviors that
may worsen insomnia and stopping (or reducing) them.
§ Possibly using sleeping
pills, although the long-term use of sleeping pills for chronic insomnia is controversial.
A patient taking any sleeping pill should be under the supervision of a
physician to closely evaluate effectiveness and minimize side effects. In
general, these drugs are prescribed at the lowest dose and for the shortest
duration needed to relieve the sleep-related symptoms. For some of these
medicines, the dose must be gradually lowered as the medicine is discontinued because,
if stopped abruptly, it can cause insomnia to occur again for a night or two.
§ Trying behavioral techniques
to improve sleep, such as relaxation therapy, sleep restriction therapy, and
reconditioning.
Relaxation Therapy. There are
specific and effective techniques that can reduce or eliminate anxiety and body
tension. As a result, the person’s mind is able to stop “racing,” the muscles
can relax, and restful sleep can occur. It usually takes much practice to learn
these techniques and to achieve effective relaxation.
Sleep
Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully
trying to sleep. They may benefit from a sleep restriction program that at first
allows only a few hours of sleep during the night. Gradually the time is
increased until a more normal night’s sleep is achieved.
Reconditioning.
Another treatment that may help some people with insomnia is to recondition
them to associate the bed and bedtime with sleep. For most people, this means not
using their beds for any activities other than sleep and sex. As part of the
reconditioning process, the person is usually advised to go to bed only when
sleepy. If unable to fall asleep, the person is told to get up, stay up until
sleepy, and then return to bed. Throughout this process, the person should
avoid naps and wake up and go to bed at the same time each day. Eventually the
person’s body will be conditioned to associate the bed and bedtime with sleep.
Courtesy
NCSDR