What is Insomnia?

Insomnia is the perception of inadequate or poor-quality sleep because of one or more of the following: difficulty falling asleep, waking up during the night with difficulty returning to sleep, and/or waking up too early in the morning. Insomnia may cause problems during the day, including tiredness, difficulty concentrating, and irritability.

Insomnia can be classified as transient (less than one month) and chronic. Chronic insomnia occurs most nights and lasts a month or more. If episodes of insomnia occur from time to time, the insomnia is said to be intermittent.

What Causes It?

Certain factors seem to make individuals more likely to experience insomnia. It is more common in the elderly, women, and those with a history of depression or anxiety. Stress, anxiety, and other medical conditions may contribute to insomnia. Transient or intermittent insomnia may occur in people who are experiencing one or more of the following: stress, environmental noise or extreme temperatures, jet lag or similar problems, and, medication side effects.

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One common causes of chronic insomnia is depression. Other underlying causes include heart failure, asthma, sleep apnea, narcolepsy, and restless legs syndrome. It may also be due to behavioral factors ( including the misuse of caffeine, alcohol, or other substances), shift work or other night time activity schedules, and chronic stress.

Some of the behaviors that perpetuate insomnia are:

• anticipating and worrying about insomnia;
• ingesting excessive amounts of caffeine;
• drinking alcohol before bedtime;
• excessive napping in the afternoon or evening;
• irregular sleep/wake schedules.

How is it Diagnosed?

Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained with the aid of a sleep diary filled out by the patient, and an interview with the patient’s bed partner.

How is it Treated?

Transient and intermittent insomnia may not require treatment, since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person’s biological clock will often revert to normal on its own. The occasional use of short-acting sleeping pills may improve sleep and daytime alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia. Recommended treatments for chronic insomnia include:

• Diagnosing and treating underlying medical or psychological problems;
• Reducing behaviors that may worsen insomnia;
• Transient or intermittent use of sleeping pills, under the careful supervision of a physician.
• The long-term use of sleeping pills for chronic insomnia is not recommended, as it can lead to dependence and side effects;
• Behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning;

Relaxation Therapy

There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the insomniac’s mind is able to stop "racing," muscles relax, and restful sleep can occur. It usually takes practice to learn these techniques and to achieve relaxation.

Sleep Restriction

Most chronic insomniacs spend too much time in bed unsuccessfully trying to sleep. Most benefit from a sleep restriction program that at first allows only a few hours in bed per night The time in bed is gradually increased as sleep improves.

Reconditioning

Another helpful treatment for most chronic insomniacs is reconditioning, i.e., learning to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. The insomniac is advised to go to bed only when sleepy. If unable to fall asleep, one should get up, relax and read, and return to bed when sleepy. Throughout this process, avoid naps and wake up and go to bed at the same time each day. Eventually one is conditioned to associate the bed and bedtime with sleep, instead of with anxiety and frustration over insomnia.