Insomnia

Insomnia is a common sleep disorder. If you have insomnia, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

Insomnia can be acute (short-term) or chronic (ongoing).

• Acute insomnia may last for days or weeks.
• Chronic insomnia lasts for a month or longer and may be classified as either secondary or primary insomnia.

More women have insomnia than men. Insomnia can occur at any age; however, older adults are more likely to have insomnia than younger people.

Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering.

Insomnia diagnosis will be based on your medical and sleep histories as well as a physical exam.

Treatment for insomnia may include lifestyle changes, Cognitive-Behavioral Therapy (CBT), and medications.

Symptoms of insomnia include:

• Lying awake for a long time before you fall asleep
• Sleeping for only a short period of time
• Being awake for much of the night
• Not feeling refreshed when you wake up
• Waking up too early
• Waking up several times during sleep

Insomnia can be acute (short-term) or chronic (ongoing).

• Acute insomnia. Acute insomnia is often caused by stress at work, family pressures, or a traumatic event.
• Chronic insomnia.
  • Primary insomnia: Primary insomnia is not due to medical problems, medicines, or other substances (caffeine and stimulants). Primary insomnia is considered its own disorder, and its cause is not well understood. Primary insomnia can be caused by life changes such as long-lasting stress and emotional upset. Travel as well as work schedules that disrupt your sleep routine, may also lead to primary insomnia. Primary insomnia usually lasts for at least 1 month.
  • Secondary insomnia: Most cases of chronic insomnia are secondary, which means insomnia is a symptom or side effect of another problem such as certain medical conditions, medicines, sleep disorders, and substances (caffeine, stimulants).
    

    Many other disorders or factors also can cause secondary insomnia, such as:

    • Conditions that cause ongoing pain (arthritis, headache disorders)
    • Conditions that make it hard to breathe (asthma and heart failure)
    • Hyperthyroidism
    • Gastrointestinal disorders (heartburn)
    • Stroke
    • Restless legs syndrome and sleep-related breathing problems
    • Menopause and hot flashes
    • Medications such as theophylline, beta blockers, and some allergy and cold medicines
    • Substances such as caffeine and other stimulants, tobacco and other nicotine products, and alcohol

Physical, social, and mental health issues, such as depression, can affect your sleep patterns. In most cases, insomnia is the symptom that causes people with depression to seek medical help.

Your doctor will diagnose insomnia based on your medical and sleep histories as well as a physical exam. Your doctor may recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.

1) To find out what is causing your insomnia, your doctor may ask many questions about your health problems, medicines you take, substance use, and your stress level.

Your doctor will also ask you questions about your sleep habits. Your doctor may also ask certain questions to see what may be worsening your insomnia.

To help your doctor, consider keeping a sleep diary for 1 or 2 weeks. Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, as well as how sleepy you feel throughout the day.

2) Your doctor will do a physical exam to rule out other medical problems that might be causing insomnia. Your doctor may order blood tests to rule out certain conditions such as thyroid problems which can be causing sleep problems.

3) Your doctor may recommend a sleep study, otherwise known as polysomnogram (PSG). For the sleep study, you will more than likely need to stay overnight at a sleep center for the study. The PSG records brain activity, eye movements, heart rate, and blood pressure.

Not getting 8 hours of sleep every night does may not be a bad thing. Different people have different sleep needs.

Avoid substances that may worsen insomnia such as:

• Caffeine, tobacco, and other stimulants (the effects of these substances can last as long as 8 hours)
• Certain over-the-counter and prescription medicines that can disrupt sleep such as certain some cold and allergy medicines
• Alcohol. Although an alcoholic drink before bedtime might make it easier for you to fall asleep, drinking alcohol can result in a lighter than normal sleep. As a result, you are more likely to wake up during the night.

Sleep hygiene

Make efforts to follow bedtime habits that make it easier to fall asleep and stay asleep:

• Follow a routine that helps you wind down and relax before bed.
• Try to schedule your daily exercise at least 5 to 6 hours before going to bed.
• Avoid eating heavy meals or drinking a lot before bedtime.
• Make your bedroom sleep-friendly.
  • Avoid bright lights.
  • Limit possible distractions, such as a TV or a computer.
  • Make sure the temperature of your bedroom is cool and comfortable.
  • Ensure your bedroom is dark and quiet.
• Go to sleep around the same time each night and wake up around the same time each morning, even on weekends.
• If you can, avoid night shifts, alternating schedules, or other issues that may cause a disruption in your sleep schedule.

Acute insomnia:

Lifestyle changes usually help relieve acute insomnia.

Chronic insomnia:

Your doctor may recommend cognitive-behavioral therapy (CBT) and/or medications.

If your insomnia is the symptom or side effect of another problem, treating the underlying cause (if possible) is important.

1) CBT for insomnia targets thoughts and actions that can cause disruption in your sleep. CBT promotes good sleep habits and uses several methods to relieve sleep anxiety.

• CBT is replaces sleep anxiety with a more positive approach. CBT focuses on what to do if you are not able to fall asleep within a reasonable time.
• CBT may involve talking with a therapist one-on-one or in group sessions to help you evaluate your thoughts and feelings about sleep. You may need to see a therapist weekly over 2 to 3 months.
• CBT focuses on limiting the time you spend in bed while awake. This tactic may make you feel more tired, but the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.

CBT may provide better long-term relief than medicine alone.

2) Medications

Many prescription medications are used to treat insomnia. Some medications are used for short-term use, while others are used for a longer period of time.

Talk to your doctor about the risk versus benefit of insomnia medications. Medications may include Ambien (zolpidem), Lunesta (eszopiclone), Sonata (zaleplon) and Rozerem (ramelteon). These medications may help you fall asleep, but you may feel groggy the next morning.

Some doctors may prescribe Restoril (temazepam) which is a benzodiazepine indicated to treat insomnia.

• These medications can result in sleep eating, sleep walking, or driving while asleep. If you have side effects from your medication, or if it does not work well, tell your doctor. An alternative medication may be a better option for you.
• Some insomnia medications can be habit forming and cause tolerance and dependence.

In some cases your doctor may prescribe lower doses of certain antidepressant medications for the management of insomnia.

Some over-the-counter (OTC) products state they treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts. (Note: The Food and Drug Administration does not regulate “natural” products and some food supplements. As a result, the dose and purity of these substances can vary.)

• Some OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them. Antihistamines are not for everybody and can cause more harm than good for some people. Your doctor will determine if you should take antihistamines for sleep.

There is ongoing research to look at sleep disorders, including insomnia.

The most common complication of insomnia is daytime sleepiness. A lack of sleep is also a common cause of auto accidents. If you are driving and feel sleepy, you should stop and take a break.

There has also been evidence that has shown a lack of sleep can lower your immune system's ability to fight infections.