Insomnia

Insomnia is a condition characterized by inadequate or poor quality sleep. The problem can be transient (lasts for a few nights), acute (lasts for a few weeks) or chronic (occurs at least three nights per week for a month or more).


Causes/associated factors
Insomnia is often related to:
depression
lack of exercise
stress or anxiety
environmental noise
extreme temperatures
change in environment
alterations in sleeping or waking patterns (as you may experience with jet lag)
medication side effects
caffeine
alcohol
smoking
sleeping during the day
chronic pain
Individual sleep needs vary and sleep patterns change with age. Most healthy adults need about six to nine hours of sleep each night to achieve what's considered "good" sleep. Children and adolescents need more, and older people tend to sleep less at night and may nap more often during the day.

As many as 30 to 40 percent of people experience insomnia at some point. About 10 to 15 percent of Americans indicate that their insomnia is chronic or severe. Insomnia is more common in women than men, and it's more likely to affect people over age 65 than younger adults.


Signs/symptoms
Complaints of insomnia often include difficulty falling asleep, waking up often with difficulty getting back to sleep, waking too early, and not feeling refreshed or rested in the morning. Other symptoms may include:
daytime drowsiness
difficulty concentrating
disturbed memory
irritability
lack of energy
chronic fatigue
feeling ill

Diagnosis
For many people, insomnia is merely bothersome. If you're concerned about the condition, consult your doctor. A diagnosis of insomnia can't be confirmed by any particular test. A primary goal is to determine what's causing the condition. The doctor will review your medical and sleep history and do a physical exam. You may also be given a thyroid test or electroencephalogram (EEG, a recording of the brain's electrical activity). If your doctor suspects a primary sleep disorder such as restless leg syndrome (a condition that causes uncontrollable leg twitching), sleep apnea (a group of serious sleeping disorders in which the person repeatedly stops breathing for a period of time during sleep) or narcolepsy (a chronic illness that causes a person to fall asleep uncontrollably for brief episodes at any time of the day), you may need specialized sleep studies. If your symptoms are severe or initial treatment is ineffective, you may be referred to a sleep specialist.

Treatment
Unless it interferes with daytime activities or work performance, transient and intermittent insomnia may not require treatment. To combat the condition, however, you may find the following suggestions helpful.
Establish a consistent sleeping/waking schedule every day and stick to it -- even if you didn't sleep well the night before. This includes weekends.

Create a dark, quiet bedroom. Wear earplugs to avoid noise and use a shade or eye mask to darken the room. Keep the room temperature comfortable.

After 20 to 30 minutes of lying awake in bed, leave the bedroom until you're too tired to do anything but sleep. Avoid watching the clock as you try to fall asleep.

Use the bedroom only for sleep and sex.

Try not to nap during the day.

Exercise regularly. Aerobic exercise increases slow wave sleep, the most restful and deepest sleep. Avoid working out within three hours of bedtime, however. You may be too energized to sleep.

Eat foods that contain tryptophan (a substance thought to induce sleepiness) before bedtime, such as turkey, warm milk or tuna.

Avoid smoking, large meals, hot showers, alcohol, caffeine and other stimulants, especially at bedtime.

Try relaxation techniques. Gentle stretching or deep, slow breathing are effective for some people.

Avoid over-the-counter sleeping pills. They can actually contribute to insomnia and cause drowsiness the next day.
Treatment of chronic insomnia may include a combination of therapies, including those mentioned above. Underlying physical or psychological disorders, as well as behaviors that contribute to insomnia, are common among people who have chronic insomnia. The most common problems are depression, anxiety and stress. If you have chronic insomnia, you may need to consult a doctor with expertise in sleep problems or a sleep specialist. To correct circadian rhythm disturbances (your body's natural 24-hour biological cycle), your doctor may recommend bright light therapy.

Medications are generally prescribed only on a short-term basis. Nearly all drugs used to treat insomnia have possible side effects, which should be discussed with your doctor ahead of time. Many of these medications have the potential for addiction. One of the newest medications used to treat insomnia is zaleplon (Sonata), a short-acting hypnotic. Barbiturates are used less often because of their greater potential for side effects and addiction. Other types of medications may also be used, depending on your symptoms and history.

Scientific studies on the use of melatonin (a naturally occurring hormone available without a prescription) do not offer conclusive information about its effectiveness and safety. There are also questions about the quality control of commercial processing. Melatonin is not approved by the U.S. Food and Drug Administration (FDA) for insomnia. Although melatonin may be helpful in preventing jet lag or adapting to shift rotations when working at night, concerns about side effects remain.


Complications
Insomnia can interfere with daily activities, and you may be more prone to accidents if you're deprived of sleep. Insomnia can also aggravate existing medical and psychological conditions.

Pregnancy-specific information
During pregnancy, brief periods of insomnia are often related to uncomfortable sleeping positions.

Senior-specific information
Sleep patterns often change with aging, and insomnia is especially common among people over age 65. Older adults tend to have more health conditions and take more medications that may contribute to insomnia. Again, older adults also tend to sleep less at night and may nap during the day.

Prevention
To prevent insomnia, try the suggestions listed above. It's especially important to avoid caffeine, smoking, alcohol and large meals before bedtime.