Insomnia

Insomnia is difficulty getting to sleep or staying asleep, or having nonrefreshing sleep for at least 1 month.

Causes

Primary insomnia refers to insomnia that is not caused by any known physical or mental condition.

Insomnia is caused by many different things. The most common causes of insomnia are:

• Alcohol
• Anxiety
• Coffee
• Stress

Secondary insomnia is caused by a medical condition. Depression is a very common cause of secondary insomnia. Often, insomnia is the symptom that causes people with depression to seek medical help.

Symptoms

• Difficulty falling asleep on most nights
• Feeling tired during the day or falling asleep during the day
• Not feeling refreshed when you wake up
• Waking up several times during sleep

People who have primary insomnia tend to keep thinking about getting enough sleep. The more they try to sleep, the greater their sense of frustration and distress, and the more difficult sleep becomes.

Exams and Tests

Your health care provider will do a physical exam and ask you questions about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia.

Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as sleep apnea).

Treatment

The following tips can help improve sleep. This is called sleep hygiene.

• Avoid caffeine, alcohol, or nicotine before bed.
• Don't take daytime naps.
• Eat at regular times each day (avoid large meals near bedtime).
• Exercise at least 2 hours before going to bed.
• Go to bed at the same time every night.
• Keep comfortable sleeping conditions.
• Remove the anxiety that comes with trying to sleep by reassuring yourself that you will sleep or by distracting yourself.
• Use the bed only for sleep and sex.

Do something relaxing just before bedtime (such as reading or taking a bath) so that you don't dwell on worrisome issues. Watching TV or using a computer may be stimulating to some people and interfere with their ability to fall asleep.

If you can't fall asleep within 30 minutes, get up and move to another room. Engage in a quiet activity until you feel sleepy.

One method of preventing worries from keeping you awake is to keep a journal before going to bed. List all issues that worry you. By this method, you transfer your worries from your thoughts to paper. This leaves your mind quieter and more ready to sleep.

If you follow these recommendations and still have insomnia, your doctor may prescribe medications such as benzodiazepines.

Outlook (Prognosis)

You should be able to sleep if you practice good sleep hygiene. See a doctor if you have chronic insomnia that does not improve.

It is important to remember that your health is not at risk if you do not get 6 - 8 hours of sleep every day. Different people have different sleep requirements. Some do fine on 4 hours of sleep a night, while others only thrive if they get 10 - 11 hours.

Sleep requirements also change with age. Listen to your body's sleep signals and don't try to sleep more or less than is refreshing for you.

Possible Complications

Daytime sleepiness is the most common complication, though there is some evidence that lack of sleep can also lower your immune system's ability to fight infections. Sleep deprivation is also a common cause of auto accidents -- if you are driving and feel sleepy, take a break.

When to Contact a Medical Professional

Call your doctor if chronic insomnia has become a problem.

Source: US. National Library of Medicine (MedlinePlus)

The Many Causes of Insomnia

Anxiety and stress are thought to be the most common causes of insomnia. About 35 percent of people with chronic insomnia suffer from depression or anxiety.

But sleeplessness can also be caused by a variety of medical conditions, medications and environmental factors. If you suffer from insomnia and have any of the following medical conditions, ask your doctor to discuss possible treatments.

Respiratory conditions

Allergies, asthma, bronchitis and emphysema can interfere with your breathing at night and can cause you to awaken frequently. In addition, many medications used to treat these conditions cause insomnia. Ask your doctor to give you a dosage schedule least likely to interfere with your bedtime.

Restless legs syndrome

Restless legs syndrome (RLS) is a disorder of the sensory nervous system. It causes an irresistible urge to move the legs because of an unpleasant feeling described as creeping, crawling, tingling or burning. Moving the legs temporarily eases the feelings. The unpleasant feelings may also occur in the arms. RLS can make it hard to fall asleep and stay asleep. Often the cause of RLS cannot be determined. It can occur as a result of a disease or condition such as: iron deficiency (with or without anemia), kidney failure, diabetes, Parkinson’s disease, rheumatoid arthritis and pregnancy. Some medications such as antidepressants, antinausea and antipsychotic medicines, and antihistamines can make symptoms worse.  

Simple self-care approaches and lifestyle changes can help relieve symptoms. These include avoiding tobacco, alcohol, caffeine; walking or stretching; taking a hot or cold bath; massage; and heat or ice packs.  Some prescribed medications may help. Levodopa can be used to treat mild cases. Dopamine agonists such as pergolide, pramipexole and ropinirole can be used for severe cases.

Heartburn

Heartburn can interfere with your sleep when stomach acid seeps into the esophagus, triggering a reflex that wakes you up. To reduce the incidence of heartburn: Avoid coffee, alcohol, chocolate and high-fat and highly acidic foods. Don't eat late at night. Raise the head of your bed six inches by placing blocks of wood under the bed frame. Stop smoking; tobacco smoke weakens the esophageal sphincter.

Arthritis

The pain and stiffness of arthritis often keep sufferers from sleeping well. Pain relievers and regular exercise that increase your joints' range of motion may provide relief. According to the National Sleep Foundation, up to 75 percent of people with rheumatic or arthritic disorders often suffer from sleep problems. 

Menopause

Many women experience restless sleep, night sweats and early morning awakenings when they reach menopause. Women on hormone therapy (HT) are less likely to experience sleeping problems. Because HT carries increased health risks, a woman should talk to her doctor about what is best for her.

Medications and sleep

Many prescription and nonprescription medications can cause insomnia. Ask your doctor if you can change to a related drug or alter the dosage or the time you take the medication if you have sleep problems and regularly take one or more of these drugs: Excedrin; Anacin; Triaminicin; prescription diet pills and other drugs that contain amphetamine; beta blockers; decongestants; antidepressants; anti-hypertensive medications; steroids; thyroid hormones; anti-metabolites; oral contraceptives; broncho-dilating drugs for asthma; and tranquilizers.

Nicotine and alcohol

Nicotine is a stimulant. Smokers experience nicotine withdrawal during sleep and can have difficulty falling asleep and problems waking up.

Alcohol may speed the beginning of sleep, but it increases the number of times you awaken in the later half of the night.

Source: Healthline.com - Connect to Better Health

Insomnia - Treatment options

How Is Insomnia Treated?

Lifestyle changes often can help relieve acute (short-term) insomnia. These changes may make it easier to fall asleep and stay asleep. 

A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia. 

Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it's important to treat the underlying cause (if possible). Your doctor also may prescribe medicine to help treat your insomnia.

Lifestyle Changes

If you have insomnia, avoid substances that make it worse, such as:

• Caffeine, tobacco, and other stimulants taken too close to bedtime. Their effects can last as long as 8 hours.
• Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk to your doctor about which medicines won't disrupt your sleep.
• Alcohol. An alcoholic drink before bedtime may make it easier for you to fall asleep. However, alcohol triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.

Try to adopt good bedtime habits that make it easier to fall asleep and stay asleep. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath.

Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don't eat heavy meals or drink a lot before bedtime.

Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet.

Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.

Cognitive-Behavioral Therapy

CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety. 

For example, relaxation training and biofeedback at bedtime are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood. 

CBT also works on replacing sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you're unable to fall asleep within a reasonable time. 

CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing. 

CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you're usually asleep. 

This schedule may make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.

For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone. 

For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.

Medicines

Prescription Medicines

Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use. 

Talk to your doctor about the benefits and side effects of insomnia medicines. For instance, insomnia medicines can help you fall asleep, but some people may feel groggy in the morning after taking them. 

Rare side effects may include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn't work well, tell your doctor. He or she may prescribe a different medicine.

Some insomnia medicines may be habit forming. Talk to your doctor about the benefits and risks of insomnia medicines.

Over-the-Counter Products

Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.

The Food and Drug Administration doesn't regulate “natural” products and some food supplements. Thus, the dose and purity of these products can vary. How well these products work and how safe they are isn't well understood.

Some OTC products that contain antihistamines are marketed as sleep aids. Although these products may make you sleepy, talk to your doctor before taking them. 

Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products can benefit you.

Source: National Heart Lung and Blood Institute

Sleep Disorders - Insomnia

Insomnia

Insomnia (in-SOM-ne-ah) is a common condition in which you have trouble falling or staying asleep. This condition can range from mild to severe, depending on how often it occurs and for how long. 

Insomnia can be chronic (ongoing) or acute (short-term). Chronic insomnia means having symptoms at least 3 nights a week for more than a month. Acute insomnia lasts for less time. 

Some people who have insomnia may have trouble falling asleep. Other people may fall asleep easily but wake up too soon. Others may have trouble with both falling asleep and staying asleep. 

As a result, insomnia may cause you to get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.

Overview

There are two types of insomnia. The most common type is called secondary or comorbid insomnia. This type of insomnia is a symptom or side effect of some other problem. 

More than 8 out of 10 people who have insomnia are believed to have secondary insomnia. Certain medical conditions, medicines, sleep disorders, and substances can cause secondary insomnia. 

In contrast, primary insomnia isn't due to a medical problem, medicines, or other substances. It is its own disorder. A number of life changes can trigger primary insomnia, including long-lasting stress and emotional upset. 

Insomnia can cause excessive daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. This can prevent you from doing your best at work or school. 

Insomnia also can cause other serious problems. For example, you may feel drowsy while driving, which could lead to an accident.

Outlook

Secondary insomnia often resolves or improves without treatment if you can stop its cause—especially if you can correct the problem soon after it starts. For example, if caffeine is causing your insomnia, stopping or limiting your intake of the substance may cause your insomnia to go away.

Lifestyle changes, including better sleep habits, often help relieve acute insomnia. For chronic insomnia, your doctor may recommend a type of counseling called cognitive-behavioral therapy or medicines.

Causes of Insomnia

Secondary Insomnia

Secondary insomnia is the symptom or side effect of another problem. This type of insomnia often is a symptom of an emotional, neurological, or other medical or sleep disorder.

Emotional disorders that can cause insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer's disease and Parkinson's disease are examples of common neurological disorders that can cause insomnia.

A number of other conditions also can cause insomnia, such as:

• Conditions that cause chronic pain, such as arthritis and headache disorders
• Conditions that make it hard to breathe, such as asthma and heart failure
• An overactive thyroid
• Gastrointestinal disorders, such as heartburn
• Stroke
• Sleep disorders, such as restless legs syndrome and sleep-related breathing problems
• Menopause and hot flashes

Secondary insomnia also may be a side effect of certain medicines. For example, certain asthma medicines, such as theophylline, and some allergy and cold medicines can cause insomnia. Beta blockers also may cause the condition. These medicines are used to treat heart conditions.

Commonly used substances also may cause insomnia. Examples include caffeine and other stimulants, tobacco or other nicotine products, and alcohol or other sedatives.

Primary Insomnia

Primary insomnia isn't a symptom or side effect of another medical condition. This type of insomnia usually occurs for periods of at least 1 month. 

A number of life changes can trigger primary insomnia. It may be due to major or long-lasting stress or emotional upset. Travel or other factors, such as work schedules that disrupt your sleep routine, also may trigger primary insomnia.

Even if these issues are resolved, the insomnia may not go away. Trouble sleeping may persist because of habits formed to deal with the lack of sleep. These habits may include taking naps, worrying about sleep, and going to bed early.

Researchers continue to try to find out whether some people are born with a greater chance of having primary insomnia.

Signs and Symptoms of Insomnia

The main symptom of insomnia is trouble falling and/or staying asleep, which leads to lack of sleep. If you have insomnia, you may:

• Lie awake for a long time before you fall asleep
• Sleep for only short periods
• Be awake for much of the night
• Feel as if you haven't slept at all
• Wake up too early

The lack of sleep also can cause other symptoms. You may wake up feeling tired or not well-rested, and you may feel tired during the day. You also may have trouble focusing on tasks. Insomnia can cause you to feel anxious, depressed, or irritable. 

Insomnia may affect your daily activities and cause serious problems. For example, you may feel drowsy while driving. Driving while sleepy leads to more than 100,000 car crashes each year. In older women, research shows that insomnia raises the risk of falling. 

If insomnia is affecting your daily activities, see your doctor. Treatment may help you avoid symptoms and problems related to the condition. Also, poor sleep may be a sign of other health problems. Finding and treating those problems could improve both your health and your sleep.

Source: National Heart Lung and Blood Institute