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Sleeplessness / Insomnia

Definition :
Nearly everyone has occasional sleepless nights, perhaps due to stress, heartburn, or drinking too much caffeine or alcohol. Chronic insomnia is defined when you have problems falling asleep, maintaining sleep, or experience nonrestorative sleep that occurs on a regular or frequent basis, often for no apparent reason.

How much sleep is enough varies from person to person. Although 7 1/2 hours of sleep is about average, some people do well on four to five hours of sleep. Other people need nine to 10 hours of sleep each night.

Insomnia can affect not only your energy level and mood, but also your health as well because sleep helps bolster your immune system. Fatigue, at any age, leads to diminished mental alertness and concentration. Lack of sleep caused by insomnia is linked to accidents both on the road and on the job.

Insomnia is a common problem that may be temporary or chronic. As many as one in 10 Americans have chronic insomnia, and at least one in four has difficulty sleeping sometimes. But that doesn't mean you have to just put up with sleepless nights. Some simple changes in your daily routine and habits may result in better sleep.

Causes:
Common insomnia causes include:
  • Stress. Concerns about work, school, health or family can keep your mind too active, making you unable to relax. Excessive boredom, such as after retirement or during a long illness, may occur and also can create stress and keep you awake.
  • Anxiety. Everyday anxieties as well as severe anxiety disorders may keep your mind too alert to fall asleep.
  • Depression. You may either sleep too much or have trouble sleeping if you're depressed. This may be due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep.
  • Stimulants. Prescription drugs, including some antidepressants, high blood pressure and corticosteroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants. Antihistamines may initially make you groggy, but they can worsen urinary problems, causing you to get up more during the night.
  • Change in your environment or work schedule. Travel or working a late or early shift can disrupt your body's circadian rhythms, making you unable to get to sleep when you want to. The word "circadian" comes from two Latin words: "circa" for "about" and "dia" for "day." Your circadian rhythms act as internal clocks, guiding such things as your wake-sleep cycle, metabolism and body temperature.
  • Long-term use of sleep medications. If you need sleep medications for longer than several weeks, talk with your doctor, preferably one who specializes in sleep medicine.
  • Medical conditions that cause pain. These include arthritis, fibromyalgiaand neuropathies, among other conditions. Making sure that your medical conditions are well treated may help with your insomnia.
  • Behavioral insomnia. This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they're away from their usual sleep environment or when they don't try to sleep, such as when they're watching TV or reading.
  • Eating too much too late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of acid and food from the stomach to the esophagus after eating. This uncomfortable feeling may keep you awake.

Insomnia and changes of aging
Insomnia becomes more prevalent with age. As you get older, changes can occur that may affect your sleep. You may experience:

  • A change in sleep patterns. Sleep often becomes less restful as you age, but a lack of restful sleep isn't a normal consequence of aging. You spend more time in stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stages 3 and 4 are deep (delta) sleep, the most restful kind. Because you're sleeping more lightly, you're also more likely to wake up. With age, your internal clock often advances, which means you get tired earlier in the evening and consequently wake up earlier in the morning.
  • A change in activity. You may be less physically or socially active. Activity helps promote a good night's sleep. You may also have more free time and, because of this, drink more caffeine or alcohol or take a daily nap. These things can also interfere with sleep at night.
  • A change in health. The chronic pain of conditions such as arthritis or back problems as well as depression, anxiety and stress can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, hot flashes that accompany menopause can be equally disruptive.

    Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night and then awaken. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

Sleep problems may be a concern for children and teenagers as well. In addition to many of the same causes of insomnia as those of adults, some children and teenagers simply have trouble getting to sleep or resist a regular bedtime because their inherent (circadian) clocks are more delayed. When the clock on the wall says it's 10 p.m., their bodies may feel like it's only 8 p.m.

When to seek medical advice :
If insomnia has been interfering with your daytime functioning for a month or longer, see your doctor to determine what might be the cause of your sleep problem and how it might be treated.

Symptoms :
Insomnia symptoms may include :

  • Difficulty falling asleep at night
  • Waking up during the night
  • Waking up too early
  • Daytime fatigue or sleepiness
  • Daytime irritability

Diagnosis:
Insomnia can be difficult to diagnose because the kind of sleep patterns and degree of daytime fatigue that some people consider indications of insomnia other people consider normal.

Your doctor may ask you questions about your sleep patterns, such as how long you've experienced your symptoms and whether they occur every night. Your doctor may also ask about whether you snore, how well you function during the day, whether you take any medications and whether you have other health disorders. You may be asked to complete a questionnaire to determine your wake-sleep pattern and your level of daytime sleepiness.

It's possible that your doctor may suggest you spend a night at a sleep disorders center. These centers are accredited by the American Academy of Sleep Medicine. A team of people at the center can monitor and record a variety of body activities during the night, including brain waves, breathing, heartbeat, eye movements and body movements. But for most people whose main complaint is insomnia, polysomnography does not provide useful information.

Complications :
Sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically.

The impact can be cumulative. People with chronic insomnia are more likely than others to develop psychiatric problems, such as depression or an anxiety disorder. Additionally, lack of sleep slows your problem-solving skills and may make you take unnecessary risks. Long-term sleep deprivation may increase the severity of chronic diseases, such as high blood pressure and diabetes.

Insufficient sleep can also lead to serious or even fatal accidents. According to the National Highway Traffic Safety Administration, more than 100,000 crashes each year are due to drivers falling asleep at the wheel.

Treatment:
If self-help measures don't work or you believe that another condition, such as depression, restless legs syndrome or anxiety, is causing your insomnia, talk to your doctor.He or she may recommend insomnia treatments that may include behavioral therapies or medications to promote relaxation and sleep.

Behavioral therapies
Behavioral treatments teach you new sleep behaviors and ways to make your sleeping environment more conducive to sleep. Some studies have shown behavioral therapies are equally or more effective than sleep medications. They can also be used in combination with prescription sleeping medications.

Medications
Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), until there's less stress in your life may help you get to sleep until you notice benefits from behavioral treatments. Ramelteon is the newest sleep medication, and it doesn't appear to have the same risk of dependency and rebound insomnia that the other sleep medications do. However, all of these medications may cause severe allergic reaction, facial swelling and complex sleep-related behaviors such as sleep-driving and preparing and eating food while asleep.

Doctors generally don't recommend relying on prescription sleeping pills for more than a few days because they may cause side effects, and developing your ability to sleep without the help of medication is the goal. In addition, sleeping pills can, rarely, be habit-forming and become less effective after a while.

The antidepressant trazodone (Desyrel) also may help with insomnia. Over-the-counter sleep aids contain antihistamines that can induce drowsiness. They're OK for occasional sleepless nights, but they, too, often lose their effectiveness the more you take them. Many sleeping pills contain diphenhydramine, which can cause difficulty urinating and a drowsy feeling in the daytime.

 
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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