Insomnia

INSOMNIA

DEFINITION

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Insomnia is the inability to get an adequate amount of sleep. The difficulty can be in falling asleep, remaining asleep, or both. Insomnia is a common disorder that affects millions of people. It can be caused by many different conditions, diseases, and circumstances.

DESCRIPTION

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Insomnia is a very common condition that probably affects most people at one time or another. However, it tends to occur more often in certain groups of people. For example, it is more common in women and older adults. People who are divorced, widowed, or separated seem to have the problem more often than those who are single or married.

Short-term, or transient, insomnia usually lasts no more than a few days. Long-term, or chronic, insomnia lasts for more than three weeks. Long-term insomnia is more of a problem. People who are deprived of sleep for extended periods of time are at risk to themselves and others. They are unable to concentrate normally while conducting daily activities. As a result, they are more likely to have accidents at work or while driving. They may also become moody and depressed. Chronic insomnia may also lead to immune disorders. The body's immune system fights off foreign invaders like bacteria and viruses. When a person does not get enough sleep, his or her immune system does not function properly, leaving them open to infection and disease.

CAUSES

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Transient insomnia is often caused by a temporary, upsetting incident in a person's life. For example, an argument with a loved one, a brief illness, or jet lag can cause the disorder. This form of insomnia usually does not require medical treatment. When the incident is resolved, a person's ability to sleep returns.

Insomnia: Words to Know

Biofeedback:

A technique that enables a person to gain some control over involuntary body functions.

Sleep disorder:

Any condition that interferes with sleep. The American Sleep Disorders Association has identified eighty-four different sleep disorders.

Chronic insomnia is caused by one or more of the following factors:

• A medical condition or a treatment for a medical condition
• Use of certain substances, such as caffeine, alcohol, and nicotine
• A psychiatric (mental) condition, such as depression or anxiety
• Stress, such as sadness caused by the loss of a loved one or a job
• Changes in one's sleep patterns, as when one's job shift has been changed
• Breathing problems, such as snoring
• Jerky leg movements that occur when a person is just falling asleep
• Nightmares or feelings of panic during sleep

Sometimes insomnia can be caused by the problem itself. That is, a person worries so much about falling asleep that he or she can't get to sleep. The more one worries about falling asleep, the harder it is to do.

SYMPTOMS

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Some people with insomnia have trouble falling asleep. Others are able to fall asleep but wake up in the middle of the night and have trouble falling back asleep. Or they doze off but sleep very lightly. People with insomnia wake up in the morning tired and unrested. They continue to be exhausted throughout the day. These sleep patterns are common among the elderly and among those who are depressed (see depressive disorders entry).

Sometimes sleep patterns are reversed. For example, a person may find it difficult to stay awake during the day and may take many naps. Then, at night, they find it hard to go to sleep or to stay asleep.

DIAGNOSIS

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Insomnia can be diagnosed easily by listening to a patient's symptoms. A doctor may ask the patient to keep records of his or her daily activities. This record can help the doctor determine the factors causing insomnia. For example, someone who eats just before going to bed may experience insomnia. Changing that person's eating patterns may cure the insomnia. A doctor may also conduct a physical examination to see if there are physical reasons for the insomnia.

People with chronic insomnia may need additional medical help. Some doctors specialize in treating sleep disorders. They can conduct additional tests and suggest treatment for more serious cases.

TREATMENT

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Treatment of insomnia first requires finding out the factors that are causing the problem. Removing those factors often leads to a solution for insomnia.

Change in Behavior

People can try a number of things to relieve their insomnia. They should go to bed only when sleepy and use the bedroom only for sleep. Other activities, such as reading, watching television, or snacking, should take place in a different room. If they are unable to go to sleep, they should go into another room and do something relaxing, like reading. Watching television is usually not a relaxing activity as television programs often make people more excited. People should go back to bed only when they feel tired.

People with insomnia should set the alarm and get up at the same time every morning, whether or not they had a good night's sleep. In this way, they establish a regular sleep-wake pattern. They should avoid taking naps during the day. If a nap is necessary, it should be taken early in the afternoon for no more than thirty minutes.

One successful form of treatment is called sleep-restriction therapy. A person first determines how long he or she can sleep at night. The person then remains in bed no longer than that length of time. Each night, the time spent in bed is increased slightly. Under this program, the person gets a little more tired each night, and his or her chance of sleeping improves.

Drug Therapy

The simplest way to deal with insomnia is to use drugs. Sedatives, tranquilizers, and anti-anxiety drugs can help a person sleep, but the use of drugs has some serious side effects. First, they may become habit-forming. A person may get to the point where sleep is possible only if he or she takes the drugs. Also, drugs become less effective over time. A person may have to take more and more of a drug to get the same result. Also, drugs can make a person feel groggy during the day. To avoid these problems, drugs should be used to treat insomnia only with a doctor's advice and under very strict supervision.

Other Measures

Relaxing before going to bed can help a person fall asleep faster. People can learn to substitute pleasant thoughts for unpleasant ones. This technique can reduce the effect of depression, anxiety, and other feelings that prevent people from sleeping properly. Audiotapes can also help a person relax.

Changes in diet and exercise routines can help. Certain foods tend to interfere with sleep and should be avoided in the evening. These foods include coffee, tea, colas, and chocolate (all of which contain caffeine), and alcohol. Alcohol makes a person sleepy at first, but a few hours later it has the opposite effect.

Maintaining a comfortable bedroom temperature, reducing noise, and eliminating light are also helpful. Regularly scheduled morning or afternoon exercise can relax the body.

Alternative Treatment

Many alternative treatments have been suggested for treating the symptoms of insomnia and its underlying causes. Practicing relaxation techniques before bed can help a person fall asleep and sleep more deeply. These techniques include meditation; breathing exercises; and a warm bath that contains rose, lavender, marjoram, or chamomile.

Eating a healthy diet rich in calcium, magnesium, and B vitamins can also be beneficial. Eating a high-protein snack like yogurt before going to bed is also recommended. Some people find that a cup of herbal tea made with chamomile, hops, or St. John's wort helps them relax. Acupuncture (a Chinese therapy that involves the use of fine needles) and biofeedback (therapy that involves behavior modification) have also proved helpful.

PROGNOSIS

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While short-term insomnia is disruptive to a person's natural balance, it can usually be solved by the methods described, and is therefore not considered a serious condition. However, chronic insomnia may lead to some serious secondary problems. If not treated, long-term sleep disturbance may lead to injuries due to lack of concentration, or possibly to a weakened immune system, which leaves a person at risk for infection or disease.

PREVENTION

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The best way to prevent insomnia is to develop a healthy lifestyle. This includes a balance of rest, recreation, and exercise. People should also learn how to manage stress in their lives. A healthy diet can also reduce the risk of insomnia.

FOR MORE INFORMATION

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Books

Bruno, Frank Joe. Get a Good Night's Sleep: Understand Your Sleeplessness—And Banish It Forever! New York: Macmillan General Reference, 1997.

Davies, Dilys. Insomnia: Your Questions Answered. New York: Penguin USA, 1999.

Idzikowski, Chris. The Insomnia Kit: Everything You Need for a Good Night's Sleep. New York: Penguin USA, 1999.

Simpson, Carolyn. Coping With Sleep Disorders. New York: Rosen Publishing Group, 1996.

Organizations

American Sleep Disorders Association. 6301 Bandel Road, Suite 101, Rochester, MN 55901. http://www.asda.org.