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.
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.
Certain conditions seem to make individuals
more likely to experience insomnia.
Examples of these conditions include:
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
Interference
-
Noise
-
Extreme temperatures
-
Change in the
surrounding environment
-
Sleep/wake schedule
problems such as those due medication
side effects
-
Jet lag
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.
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.
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. 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 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.
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