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Insomnia

Definition

Insomnia refers to inadequate or poor-quality sleep. Insomnia may be due to difficulty falling asleep, or problems with middle-of-the-night or very early morning awakening. 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 or short term insomnia. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more. This form usually needs treatment.

Causes

There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • A life crisis or stress, including the loss of a life partner, divorce, or loss of a job
  • Environmental noise
  • Extreme temperatures (eg, a room that is too hot or too cold)
  • Change in the surrounding environment (one of the most common causes)
  • Sleep/wake schedule problems such as those due to jet lag
  • Hormonal shifts during the menstrual cycle, pregnancy, perimenopause, or menopause
  • Side effects of medicine
    • Nonprescription: diet aids, decongestants, cold and cough remedies
    • Prescription: steroids, theophylline, phenytoin, levodopa

Chronic insomnia sometimes results from the following conditions:

Chronic insomnia may also be due to behavioral factors, including:

  • Misuse of caffeine, alcohol , or other substances
  • Disrupted sleep/wake cycles from shift work or other nighttime activities
  • 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—This behavior usually starts in young adults.
  • Smoking cigarettes before bedtime
  • Excessive napping in the afternoon or evening

Insufficient Sleep Syndrome

Insufficient sleep syndrome results from a person not getting adequate sleep due to life circumstances. The person may be working more than one job or working and going to school at the same time. This results in not getting adequate sleep every day and over a longer period of time. This may lead to daytime sleepiness, as well as problems with focusing and unexplained muscle aches and pains.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

  • Age: 50 or older
  • Sex: female (especially during and after menopause)
  • Stress
  • A history of mental disorders such as anxiety and depression
  • Chronic pain
  • Alcohol, drugs , or certain medicines
  • Shift work
  • Obesity
  • Use of multiple medications

Symptoms

Symptoms include:

  • Difficulty falling asleep
  • Waking up frequently during the night with difficulty returning to sleep
  • Waking up too early
  • Feeling unrefreshed after sleep
  • Irritability, anxiety , inability to concentrate, unexplained symptoms like muscle aches or pains

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. You will also be asked about your job, eating habits, drug and alcohol use, schedules, and travel patterns. Your physician may also ask you to keep a sleep diary which will include information about your naps, bedtime, and how frequently you awaken during the night.

Laboratory Testing

Polysomnography

Sometimes with certain types of insomnia or, especially, severe daytime sleepiness, your doctor may ask you to spend a night sleeping in a “sleep lab.” This experience may allow your doctor to identify a treatable condition that is affecting the quality of your sleep. During testing, the individual’s movement, breathing, and brain activity are monitored.

Monitored Breathing During Polysomnography

Sleep monitor apnea

Schizophrenia affects many different areas of the brain causing a wide range of behavioral, emotional, and intellectual symptoms.

© 2008 Nucleus Medical Art, Inc.

Treatment

Treat Underlying Medical Conditions

A number of physical and mental disorders can disrupt sleep. Diagnosis and treatment of underlying illness, such as restless legs syndrome, may help alleviate insomnia.

Identify and Modify Behaviors That Worsen Insomnia

  • Reduce or avoid caffeine, alcohol, and drug use.
  • Go to bed and wake up at the same time each day.
  • If you must take naps, keep them short.
  • Do not smoke close to bedtime.

Medications

Sleeping pills are available by prescription or over-the-counter. Some doctors advise against the long-term use of sleeping pills for treating chronic insomnia because they may cause dependence. Properly chosen prescription sleep medicine can be effective and should not interfere with memory, work functioning, or daytime drowsiness, which is very important for driving safety.

Most over-the-counter sleep medications contain diphenhydramine. This antihistamine will help many people fall asleep more rapidly and probably improve subjective sleep quality. Elderly persons may experience a variety of adverse effects from diphenhydramine and should discuss its use with their physician.

Herbal Therapies and Supplements

Some people use the herb valerian to reduce insomnia. Others take melatonin. In the United States, herbal products and dietary supplements do not undergo the same testing as drugs. Their long-term impact, side effects, and possible interactions with other drugs or medical conditions are often unknown.

Relaxation Therapy

Techniques such as deep breathing, stopping thought, and using progressive relaxation may reduce or eliminate anxiety and body tension. This stops the mind from "racing" and allows the muscles to relax so that restful sleep can occur.

Sleep Restriction

A sleep restriction program at first allows only a few hours of sleep during the night. This is usually about five hours. Gradually, the time is increased until a more normal night's sleep is achieved.

Reconditioning

Reconditioning helps people associate the bed and bedtime with sleep. This means not using the bed for activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy.

Prevention

To reduce your chance of having insomnia:

  • Minimize intake of caffeinated food and drinks (coffee, tea, chocolate, cola drinks) after lunch.
  • Avoid eating too fast, too much, or too close to bedtime.
  • Avoid drinking fluids before bedtime.
  • Don't smoke.
  • Exercise regularly, but not within less than three hours of bedtime.
  • Use the bedroom only for sleep and sex.
  • Schedule relaxing bedtime routines. Listen to quiet music or soak in warm water.
  • Make sure that the bedroom is not too cold or too hot.
  • Use a humidifier or dehumidifier as needed.
  • Get more sunlight or ultraviolet light during the day.
  • Use shades, lined drapes, or wear an eye mask to reduce sleep disruption.
  • Use earplugs or listen to relaxing music or white noise. This helps reduce the disturbing effects of noise.
  • Make sure your mattress is supportive and the bedding is comfortable.
  • Avoid "clock watching" after going to bed.
  • Keep bedtimes and wake-times consistent throughout the week.
  • If you cannot avoid naps, keep them short.

RESOURCES:

National Center on Sleep Disorders Research
http://www.nhlbi.nih.gov

National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES:

The Canadian Sleep Society
http://www.css.to/

Better Sleep Council Canada
http://www.bettersleep.ca/default_main.aspx

References:

American Academy of Sleep Medicine website. Availible at http://www.aasmnet.org/PatientsPublic.aspx .

American Sleep Apnea Association website. Available at: http://www.sleepapnea.org/ .

Insomnia. EBSCO Publishing Health Library, Natural and Alternative Treatments website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?token=da29d243-e573-4601-8b42-77cd0ccb14b2chunkiid=21730 . Accessed March 4, 2008.

National Center on Sleep Disorders Research website. Available at: http://www.nhlbi.nih.gov/about/ncsdr/index.htm .

National Heart, Lung, and Blood Institute website. Available at: National Heart, Lung, and Blood Institute.

National Sleep Foundation website. Available at: http://www.sleepfoundation.org .



Last reviewed February 2008 by Jill D. Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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