Insomnia is a sleep disorder that involves difficulty falling asleep or staying asleep, sometimes both. Although most people suffer an occasional sleepless night, patients with insomnia have difficulty sleeping on a regular basis. This condition affects approximately 1 in 10 people in the United States and can lead to other troubling symptoms, such as fatigue, low energy level, and a weakened immune system. While insomnia is not normally considered a serious medical disorder, it can make life difficult, or even unmanageable.
Types of Insomnia
There are two types of insomnia, differentiated by cause. Either type may be acute or chronic. Acute cases typically last from one night to a few weeks, while chronic insomnia is diagnosed if the problem continues for a month or longer.
Women, because of their hormonal cycles, are more at risk for the disorder.
Primary insomnia occurs without any other medical condition. Patients with this type of insomnia may be as frustrated by a lack of explanation of their problem as by its disturbing symptoms. In many cases, however, with a bit of investigation, psychological or environmental causes of the condition can be deciphered. These causes may include:
- Stress at home, school or in the workplace
- Traumatic loss through divorce, illness or death
- Anxiety or post-traumatic stress (PTSD)
- Changes in schedule
- Caffeine, nicotine, alcohol
- Overeating before bed
- Poor sleep habits
- Aging, due to changes in activity levels and general health
Working odd hours, changing work shifts or experiencing jet lag may also be causes of insomnia.
Secondary insomnia is caused by another medical disorder or by medication. Medical conditions that may result in secondary insomnia include chronic pain from arthritis, cancer or respiratory illness, hyperthyroidism, and gastroesophageal reflux disease (GERD). The need to urinate frequently may also interfere with normal sleep patterns.
Medications that may interfere with sleep include prescription drugs like blood pressure medications, stimulants and corticosteroids and over-the-counter preparations like decongestants and weight-loss products.
Symptoms of Insomnia
Obviously, the clearest symptom of insomnia is the inability to fall asleep or the inability to remain asleep for the appropriate number of hours. Patients may awaken during the night and have trouble falling back to sleep or may awaken too early in the morning. Other symptoms of insomnia include:
- Daytime fatigue or sleepiness
- Irritability or depression
- Difficulty concentrating
- Memory loss
- Increased mistakes or accidents
- Gastrointestinal discomfort
While the number of hours of sleep necessary varies among individuals, most people require 7 or 8 hours to function at full capacity. Patients with insomnia often complain of sleeping fewer than 6 hours per night either sporadically or for a number of consecutive days or weeks.
Diagnosis of Insomnia
In order to diagnose whether a patient has primary or secondary insomnia, a complete physical examination must be performed and a full medical history taken. Sometimes blood tests are necessary to rule out underlying disease, such as hyperthyroidism. The doctor may ask the patient to keep a sleep diary, including pertinent information about activities and diet.
In some cases, especially where the patient is troubled by other sleep disorders, like sleep apnea, the doctor may recommend evaluation in a sleep clinic where various bodily functions, including respiration, brain waves, eye movements and heartbeat are measured and recorded.
Treatment of Insomnia
Treatment of insomnia depends on its cause. In secondary insomnia, the underlying cause of the condition must be addressed. This may include changing a medication or altering the time that it is administered, or treating a disease or condition.
In the case of primary insomnia, behavioral changes or medications to combat anxiety or depression, or sleep medications, either prescription or over-the-counter, can work wonders. It is usually recommended that patients rely on sleeping pills, like zolpidem (Ambien) for only a few weeks, but some medications can be used long-term. Some patients are helped by taking nutritional supplements such as L-tryptophan.
Primary insomnia is typically treated by one or more of the following:
- Relaxation techniques
- Cognitive behavioral therapy
- Changing sleep patterns and environment
- Sleep restriction
- Light therapy
For a number of patients, small changes may make a big difference. Patients are often advised to limit bedroom activities to sleep and sex or simply to refrain from watching television in bed.