Disorders & Treatments
Insomnia is a symptom, not a stand-alone diagnosis or a disease. People with insomnia can have trouble falling asleep, staying asleep, or awakening too early, or any combination of these and it may be due to inadequate quality or quantity of sleep. 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. Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia.
According to the Center for Disease Control (CDC), insufficient sleep is a public health epidemic and is linked to motor vehicle crashes, industrial disasters, and medical or other occupational errors.
Clinical studies have shown links between insomnia and increased risks of depression, obesity, and cardiovascular disease. In fact, research indicates adults with a history of insomnia are almost 4 times as likely to become depressed. Chronic insomnia can also result in reduced health-related quality of life, decreased job performance, and increased risks of disability.
Insomnia is generally classified based on the duration of the problem. Not everyone agrees on one definition, but generally:
- Transient insomnia- symptoms lasting less than one week
- Short-term insomnia- symptoms between one to three weeks
- Chronic insomnia- symptoms lasting longer than three weeks
What are the signs and symptoms of Insomnia?
Doctors associate a variety of signs and symptoms with insomnia. Often, the symptoms intertwine with those of other medical or mental conditions.
Some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night. The problem may begin with stress. Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.
Most often, daytime symptoms will bring people to seek medical attention. Daytime problems caused by insomnia include the following:
- Poor concentration and focus
- Difficulty with memory
- Impaired motor coordination (being uncoordinated)
- Irritability and impaired social interaction
- Motor vehicle accidents because of fatigued, sleep-deprived drivers
How is Insomnia diagnosed?
The doctor will seek to identify any medical or psychological illness that may be contributing to the patient's insomnia. A thorough medical history and examination occurs when evaluating a patient with sleep problems.
Who does Insomnia affect?
Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30%-50% of the general population is affected by insomnia, and 10% have chronic insomnia. Insomnia affects all age groups. Among adults, insomnia affects women more often than men. The incidence tends to increase with age. It is typically more common in people in lower socioeconomic (income) groups, chronic alcoholics, and mental health patients.
What is the cause of Insomnia?
Insomnia may be caused by a host of different reasons.
- Psychological related insomnia- The most common psychological problems that may lead to insomnia include: anxiety, stress, schizophrenia, mania (bipolar disorder), and depression.
In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.
- Physiological related insomnia- Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. Many medical problems can lead to insomnia as well.
- Medication related insomnia- Certain medications have also been associated with insomnia.
- Caffeine and nicotine- you should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake.
- People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of nonrefreshed sleep in the morning.
- A disruptive sleep environmental can impair your ability to get a good night sleep. Loud snoring from a bed partner or other noises, too much light or an uncomfortable temperature (too hot or too cold) can all affect your sleep.
- Other sleep disorders such as restless legs or periodic leg movements may also impair your ability to get a good night's sleep.
What are the treatments of Insomnia?
Generally, treatment of insomnia entails both non-pharmacologic (non-medical) and pharmacologic (medical) aspects. It is best to tailor treatment for individual patient based on the potential cause. Studies have shown that combining medical and non-medical treatments typically is more successful in treating insomnia than either one alone.
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Sleep hygiene is just one of the components of cognitive behavioral therapy for insomnia. Several simple steps can be taken to improve a patient's sleep quality and quantity:
- Sleep as much as you need to feel rested; do not oversleep.
- Exercise regularly at least 20 minutes daily, ideally 4-5 hours before your bedtime.
- Avoid forcing yourself to sleep.
- Keep a regular sleep and awakening schedule.
- Do not drink caffeinated beverages later than the afternoon (tea, coffee, soft drinks etc.) Avoid "night caps," (alcoholic drinks prior to going to bed).
- Do not smoke, especially in the evening.
- Do not go to bed hungry.
- Adjust the environment in the room (lights, temperature, noise, etc.)
- Do not go to bed with your worries; try to resolve them before going to bed.
- Go to bed when you feel sleepy.
- Do not watch TV, read, eat, or worry in bed. Your bed should be used only for sleep and sexual activity.
- If you do not fall asleep 30 minutes after going to bed, get up and go to another room and resume your relaxation techniques.
- Set your alarm clock to get up at a certain time each morning, even on weekends. Do not oversleep.
- Avoid taking long naps in the daytime.
There are numerous possible medications to treat insomnia. Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies. In a study, it was noted that when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone.
- Benzodiazepine sedatives: Six of these sedative drugs have been used to treat insomnia. There are reports of subjective improvement of quality and quantity of sleep when using these medications. These include temazepam (Restoril), flurazepam (Dalmane), triazolam (Halcion), estazolam (ProSom, Eurodin), lorazepam (Ativan), and clonazepam (Klonopin).
- Nonbenzodiazepine sedatives: These include eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).
Melatonin: Melatonin is secreted by the pineal gland, a pea-sized structure at the center of your brain. Melatonin is produced during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. At night, melatonin is produced to help your body regulate your sleep-wake cycles. The amount of melatonin produced by your body seems to decrease as you get older. Melatonin may be beneficial in patients with circadian rhythm problems.
- Antihistamines with sedative properties [for example, diphenhydramine (Benadryl) or doxylamine] have also been used in treating insomnia as they may induce drowsiness, but they do not improve sleep and should not be used to treat chronic insomnia. Identifying and treating an underlying medical problem or sleep disorder may be the first step in treating insomnia.