What is Insomnia?
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
- un-refreshing 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
(more about alcohol and sleep...), 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 short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there
are potential side effects.
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. 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. More about sleeping pills...
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.
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