Insomnia

Basic Information

Insomnia refers to a sleep disturbance that affects nearly one-third of Americans during their lifetime and is either temporary due to a crisis situation or change in lifestyle or place of dwelling or is chronic and is usually caused by:

depression
anxiety
drug or alcohol intake
underlying medical condition

The incidence of insomnia increases with age with those most at risk over 60. It is believed more women suffer with this disturbance than men however it can affect either sex at any age. Out of the one-third of Americans who have insomnia, one-third of them have chronic or recurrent insomnia that interferes with almost all aspects of their lives including normal work and social functioning. Seventy-five percent of patients who suffer from depression have insomnia.

How is insomnia defined? As a pattern of sleep problems that can occur in any one of the following ways or in combination:

inability or difficulty falling asleep
inability to remain asleep
waking intermittently
waking early in the morning

Most often the underlying causes of insomnia are stress and anxiety or depression, often exacerbated by other lifestyle factors. For instance, persons with stress who smoke and are obese are at increased risk. Anxiety-related insomnia and depression-related insomnia usually present in different ways. The kind of insomnia associated with stress and anxiety includes:

inability to fall asleep -- the person lies awake unable to sleep, often reliving worries of the day
interrupted sleep

With depression-associated insomnia, the most typical sleep disturbance is early morning awakening -- the person usually being awakened at two or three A.M. and unable to fall back asleep, for no seemingly good reason. Previous sleep prior to early morning awakening is often restless and tormented, often unnoticed by the person (but often noticed by someone else who is sleeping with the person). Thus not only the quantity of sleep time is affected but also the quality of the sleep itself. Nightmares can cause sleep disturbances -- they usually occur between an hour and an hour-and-a-half after the person has fallen asleep and are usually remembered.

For good sleeping patterns 7 ½ hours of uninterrupted sleep (at least during the work week) is advised. This is less than the 9 hours of sleep that was normal for Americans 100 years ago. There are a number of reasons for the reduced average sleep rate. They are thought to include:

work-related stress
family stress
a high-pressured lifestyle
watching late-night television or engaging in other late-night forms of entertainment

The person who has insomnia will suffer from daytime sleepiness which will affect every component of the person's life. Besides anxiety caused by stress and depression (which can be exacerbated by smoking and/or obesity) what are some other reasons causing or factors contributing to insomnia?

daytime napping
sexual problems such as impotence or inability to achieve sexual release, often encouraged before bedtime
alcoholism (knocks you out initially but your sleep is fragmented and you awaken and cannot fall back asleep)
erratic work hours
noisy environment
over activity of the thyroid gland
use of stimulants such as cola, coffee or tea (which should not be consumed late at night)
drinking a lot of fluids near bedtime (you will have to get up to urinate and be unable to fall back asleep)
drug abuse, including use of illicit drugs such as cocaine, or certain prescribed or over-the-counter medications such as decongestants, cortisone drugs or dextroamphetamines
overusing sleep-inducing drugs

Symptoms

Major symptoms include but are not limited to:

short sleep followed by wakefulness
difficulty trying to fall asleep, often with anxiety
sleep until early morning, usually from 2 to 4 A.M. then abruptly waking, often with alarming thoughts followed by an inability to return to sleep
alternating periods of sleeplessness with inordinate amounts of sleep or sleepiness at inappropriate times

Diagnosis/Treatment

Criteria for diagnosis is based on insomnia being present in the patient's life for at least one month with a disruptive influence in the patient's work or social life. For a correct diagnosis, your health care provider will want to rule out the presence of other sleep disorders such as sleep apnea or narcolepsy.

Once a diagnosis is established the prognosis for achieving healthy sleep patterns is good, once the underlying cause is treated. Treatment is essential because even temporary insomnia, without intervention, can become chronic and cause havoc (albeit at first it may seem innocuous and less damaging than it is) in the patient's life.

Your health care provider will want to rule out any medical condition that may cause or contribute to your insomnia then may recommend counseling or therapy in which medication may be indicated, at least temporarily, which will relieve symptoms and establish regular, healthy sleep patterns while underlying psychological stresses are addressed. Patients sometimes avail themselves of over-the-counter medications such as cough/cold preparations to induce sleep as well as natural herbal medicines such as melatonin or Valerian root.

Sedatives may be prescribed for you from the benzodiazepine family -- or if depression is involved, sedating antidepressants such as Elavil, Sinequan or Trazodone are often helpful in reestablishing regular sleep patterns. You must work closely in establishing what is the correct dosage for you with your health care provider and/or mental health team and follow-up to discuss the effectiveness of the medication. Once healthy sleep patterns return, you may be weaned off of these medications as some may be addictive in the long term though initially they may be needed and valuable.

Additionally, with or without sleep medication, there are a number of steps you can take to try and achieve healthy sleep patterns. These include:

avoid napping during the day or early evening -- even if tired
avoid trying to sleep if you are not tired -- get out of bed and do something else than lie there and try to sleep
put yourself on a consistent schedule so that you try to go to sleep at the same time each night
exercise several times a week -- but not before bedtime
practice relaxing techniques -- play soft music or relaxation tapes
make sure you have a comfortable setting for sleep -- don't use your office or den as a bedroom
take a warm bath before bedtime
try using earplugs, eye shades or an electric blanket if helpful

If you have symptoms of insomnia, please see your health care provider -- in most cases healthy sleep patterns can be restored.