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Sleeping Disorders - Insomnia

Insomnia

There are four major types of Insomnia.

Difficulty falling asleep
No problem falling asleep but difficulty staying asleep, keep getting up in the night.
Waking up in the early hours of the morning
Sleep State Misperception

How much sleep does a person need?

Enough to feel alert during the day. Typically 7 to 9 hours (varies from person to person) of good quality sleep.

What can cause Insomnia?

Many things can cause insomnia. Insomnia is not a disorder it is a complaint. The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present themselves as insomnia including circadian disorders, sleep apnea, restless legs, and the list goes on. So ruling out a sleep disorder can be important. Medications, herbs and caffeine can cause insomnia. Most medications will report the possible side effect of insomnia and sleepiness. The same medication can cause both since we all react to medications differently. Life events can cause insomnia but it is usually temporary. Anxiety about falling asleep can also be responsible, however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and you need to find out what is the underlying cause. Once sleep is restored to normal the anxiety will usually go away. Physical problems such as pain can be the underlying cause. There is also the possibility of mental problems, and a good sleep doctor that works with insomnia can rule this in or out sometimes without an all night sleep study.

Three basic types of Insomnia

Transient insomnia - lasting for a few nights
Short-term insomnia - two or four weeks of poor sleep
Chronic insomnia - poor sleep that happens most nights and last a month or longer

Transient and short-term 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. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioural factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other night time activity schedules; and chronic stress.

In addition, the following behaviours have been shown to perpetuate insomnia in some people:

• poor sleep hygiene in general
• expecting to have difficulty sleeping and worrying about it
• drinking excessive amounts of caffeine
• drinking alcohol before bedtime
• smoking cigarettes before bedtime
• excessive napping in the afternoon or evening
• irregular or continually disrupted sleep/wake schedule

Difficulty sleeping is only one of the symptoms. Daytime symptoms include:

Sleepiness

· Anxiety

· Impaired concentration

· Impaired memory

· Irritability

Treatment or transient and short-term insomnia

Transient and short-term 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 thesleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day 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.

Treatment for chronic insomnia consists of:

First, diagnosing and treating underlying medical or psychological problems.
Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial.

A patient taking any sleeping pill 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.

Trying behavioural techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, reconditioning, and bright light.

Relaxation Therapy.

There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much 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 (some experts even say using the bed for sex call cause performance anxiety which could lead to insomnia). 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.

Bright Light.

If you are having trouble getting to sleep early enough at night it will help to wake up at the same time every morning and try to get as much bright light in the morning as possible. This will help reset the internal clock to an earlier time at night for sleep. If you are having trouble staying awake in the evening and waking up too early in the morning then try to get bright light in the evening. This will help rest the internal clock to go to sleep later and wake up later. You may want to avoid early morning light using this method until you have stabilized your sleeping pattern.

Sleep State Misperception

Many people will sleep most of the night and believe they didn't sleep at all. Sleep State Misperception can cause anxiety which increases the symptoms. All night sleep recordings show normal sleep, but the next morning the patient will report not sleeping. Seeing their sleep data and education can help with this problem.

If you feel you are not sleeping at all during the night but are not sleepy the next day you may have this complaint.