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Sleep Disorders

Insomnia, Circadian Rhythm Disorder, Restless Legs Syndrome, Narcolepsy, and Problem Sleepiness

Insomnia

What is Insomnia?Insomnia

Insomnia is the perception or complaint of inadequate or poor-quality sleep. Often those that suffer from insomnia report the following symptoms.

  • Difficulty falling asleep
  • Frequent waking during the night
  • Earlier than normal waking times

Typical conditions seem to make individuals more likely to experience insomnia:

  • Advanced age (insomnia occurs more frequently in those over age 60)
  • Female gender
  • A history of depression
  • Stress, anxiety
  • The use of certain medications

What Causes Insomnia?

Insomnia can be classified into three categories; transient (short term), intermittent (on and off), and chronic (constant). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more. There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • Stress
  • Environmental noise
  • Extreme temperatures
  • Change in the surrounding environment
  • Sleep/wake schedule problems such as those due to jet lag
  • Medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. A person with chronic insomnia should seek a medical evaluation by their physician, and may require the consultation of a specialist. Insomnia is a SYMPTOM of many disorders and not a disorder in itself.

How Is Insomnia Diagnosed?

Patients with insomnia are evaluated with the help of a medical history and a sleep history.  Sleep history may be obtained from a detailed sleep journal written by the patient themselves or through an interview with the patient’s bed partner concerning the quantity and quality of the patient’s sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea (OSA) or narcolepsy.

How Is Insomnia Treated?

Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. Treatment for chronic insomnia consists of:

  • Diagnosing and treating underlying medical or psychological problems
  • Identifying behaviors that may aggravate insomnia
  • Possibly using sleeping pills

A patient taking any sleeping medications should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two. Behavior modifying techniques such as Cognitive Behavioral Therapy (CBT) instead of medications to improve sleep, and relaxation therapy, sleep restriction therapy, and reconditioning are methods recommended to combat insomnia episode. Relaxation Therapy. Using specific and effective techniques that can reduce or eliminate anxiety and body tension, the result is the mind is able to stop “racing,” muscles can relax, and restful sleep can occur. It usually takes consistent practice to learn these techniques and to achieve effective relaxation. Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night’s sleep is achieved. Reconditioning. Another treatment that may help some people with insomnia is to recondition them 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. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person’s body will be conditioned to associate the bed and bedtime with sleep.

Where To Get More Information

  • Talk to your doctor if you are having trouble getting good, refreshing sleep each night. Together you can identify possible reasons for your sleeping difficulty and then try appropriate measure to correct the problem.
  • Obtain a referral from your family physician to have sleep testing done
  • Check out our Resources page for more informative books and websites