Insomnia

Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30-50% of the general population is affected by insomnia, and 10% have chronic insomnia (lasting more than 4-6 weeks). Insomnia is a symptom, not a stand-alone diagnosis. By definition, insomnia is “difficulty to initiate or maintain sleep, or both.” Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia.

Insomnia affects all age groups. However, certain groups of people are more likely to be affected by sleeplessness, including:

  • Older Adults: Among older adults, insomnia affects women more than men and the incidence increases with age.
  • Adolescents or young adult students, primarily due to irregular sleeping habits
  • Pregnant women and those experiencing menopause
  • People with medical or psychiatric conditions.
  • People who travel frequently or shift workers
  • Stress most commonly triggers short-term or acute insomnia. However, if this is not addressed soon, it may develop into chronic insomnia.
  • Misuse or overuse of sleeping pills

If you are experiencing sleep problems, there are solutions available and it would be best to seek medical advice rather than attempt self-medication.

How do you know if you or someone you love suffers from insomnia? Some of the common night time symptoms include inability to fall asleep or stay asleep, waking too early in the morning and/or having difficulty falling asleep after waking. However, most often the resultant daytime symptoms are more likely to make the patient seek medical attention. These symptoms include lack of energy, irritability, frequent napping, daytime sleepiness, difficulty concentrating and inattentiveness.

Insomnia may result from either psychological or physical causes.

  • The most common psychological problems include anxiety, stress, and depression. In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness or while receiving treatment for the same.
  • Some common medical conditions that trigger insomnia include chronic pain due to any cause, diabetes mellitus (particularly if it is not well controlled), congestive heart failure, chronic lung disease which is particularly common in smokers, and neurological disorders including stroke, dementia and Parkinson’s disease. Disrupted breathing during sleep (Obstructive Sleep Apnea) which usually manifests with snoring and excessive daytime sleepiness may also lead to insomnia.
  • Certain medications have been associated with insomnia. Amongst them are certain over-the-counter cold remedies. Medications for high blood pressure also have been associated with poor sleep.
  • Common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine use in the hours immediately before bedtime but also limiting your total daily intake.
  • People often use alcohol to help induce sleep. However, it has been shown that alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning.
  • A disruptive bed partner with loud snoring or leg movements also may impair your ability to get a good night’s sleep.

As mentioned earlier, most of us experience short-term insomnia sometime during our life span, which may not need medical attention. However it would be wise to seek a doctor’s attention if it lasts longer than 4 weeks or interferes with your daytime activities and ability to function.

Following are some suggestions to help anticipate and modify situations likely to be associated with insomnia. They are not foolproof, nor will they safeguard you from the consequences of sleep deprivation once it has occurred.

Insomnia from jet lag

  • Avoid Caffeine and alcohol during long flights.
  • If you can anticipate your trip, begin to shift your bedtime to coincide with the time schedule in your destination.
  • Short-acting tranquilizers have been shown to be useful. Melatonin, a hormone that regulates our sleep-wake cycles, is currently being studied.

Insomnia from shift changes

  • Behavioral therapy has been useful in modifying the insomnia and symptoms of sleep deprivation in shift workers.
  • You should shift your schedules forward in a clockwise direction-from days to evening to night shift-and allow sufficient time to adapt (at least 1 week) between shift changes.
  • Bright light is a potent stimulus to regulate your body’s internal sleep rhythm and this may be used at the advice of a sleep specialist.
  • General recommendations (Sleep Hygiene)
  • Establish bedtime routines and improve your sleep habits. Learn to relax and control your sleep environment. Avoid using the bed for anything other than sleep and sex.
  • Avoid large meals and strenuous exercise before bedtime and reduce use of stimulants including caffeine and nicotine.
  • Avoid daytime naps to better consolidate your night’s sleep.

Recovery from insomnia can vary. If you have insomnia caused by jet lag, your symptoms will generally clear up within a few days. If you are depressed or have underlying physical problems leading to insomnia for many months, it is unlikely that your symptoms will go away on their own. You will need further evaluation and treatment. Never underestimate the importance of a good night’s sleep!