Information on Insomnia

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What is insomnia?

Insomnia is the inability to sleep, or to sleep satisfactorily, and is the most common sleep disorder. It may involve restless or interrupted sleep, a reduction in the usual time you spend sleeping or, in rare cases, complete wakefulness. Insomnia is a symptom rather than an illness in itself: in the majority of cases, sleeplessness has an underlying cause. When no underlying cause can be found, a person is said to be suffering from primary insomnia.

Insomniacs may experience loss of energy and enthusiasm, have problems with memory and concentration, and may feel ill, sleepy and frustrated. Poor sleep can be associated with accidents, lower work productivity and may worsen medical and psychological conditions. These consequences make insomnia an important health problem that deserves serious attention.

What causes insomnia?

Insomnia may be caused by the following:

  • Emotional distress, especially from internalized anger or anxiety.
  • Overusing substances such as caffeine (in coffee, colas and some “energy drinks” like Red Bull), nicotine, certain medications and herbal remedies, and alcohol. Alcohol consumption may cause initial drowsiness, but this is usually followed by sudden wakefulness once the alcohol is metabolized. Paradoxically, insomnia may result from sedatives prescribed to relieve it. Some people, especially the elderly, develop an inverted sleep rhythm: drowsiness in the morning, sleep during the day and wakefulness at night.
  • Disturbances in your body clock or circadian rhythm. This may be the result of an irregular sleep schedule due to, for example, excessive daytime napping or late-night partying. Disturbance of sleep timing is common in people traveling by plane to different time zones, night shift workers and high school and university students doing “all-nighters” when cramming for tests.
  • Environmental factors – such as noise, extreme temperatures, bright lights and sleeping in unfamiliar surroundings – can cause transient and intermittent insomnia.
  • Medical conditions. Many illnesses, such as ulcers, depression, diabetes, kidney disease, heart failure, Parkinson’s disease and hyperthyroidism, may lead to chronic insomnia. Shortness of breath from asthma or other medical problems, heartburn, frequent urination and chronic pain, say from arthritis or leg cramps, can also cause sleep problems. Insomnia may be associated with an underlying psychiatric condition, such as depression or schizophrenia. Early morning waking is common in some acutely depressed people. Other sleep disorders may also lead to chronic insomnia. Sleep apnea (snoring with numerous or prolonged breathing pauses during sleep), narcolepsy (inability to control staying awake or falling asleep), periodic leg and arm movements during sleep (the muscles twitch or jerk excessively), or restless legs syndrome (an overwhelming need to move the legs) can all interfere with sleep onset and maintenance.
  • Eating large meals close to bedtime.
  • Vigorous exercise close to bedtime.

Who gets insomnia and who is at risk?

Over 90% of people will experience insomnia at some point in their lives, and for the vast majority, this will be transient insomnia. Approximately 30% of the population suffers from chronic insomnia.

Those at risk of increased insomnia are:

  • Women. Women appear to be more prone to insomnia than men. The following factors may also contribute to the condition:
    • The menstrual cycle. Studies have found that 50% of menstruating women reported bloating that disturbed their sleep for two to three days each cycle. Women who suffer from Pre-Menstrual Syndrome may have symptoms of anxiety, irritability or depression, which may lead to insomnia.
    • Menopause. Sleep patterns tend to change with menopause, and insomnia becomes more common.
    • Pregnancy. Sleeplessness is common during pregnancy, especially in the later weeks.
  • Elderly people. Aging brings a change in sleeping patterns, resulting in typically lighter, more fitful sleep.
  • People with a history of depression.

Symptoms and signs of insomnia

Insomnia typically involves the following symptoms:

  • Difficulty falling asleep and maintaining sleep, or waking up too early.
  • Waking up feeling unrefreshed or drowsy. In more severe cases of insomnia, people may feel fatigued, depressed, anxious or irritable.
  • People with insomnia often suffer from daytime sleepiness.
  • Forgetfulness and trouble concentrating.

How is insomnia diagnosed?

To diagnose the cause of insomnia, your doctor will perform a complete physical exam and take a medical history, which will include your lifelong sleep patterns, previous experiences of insomnia and recent life stresses. Be sure to tell your doctor about any prescription or non-prescription medications you might be taking, as well as stimulants such as coffee. He or she may also want to interview your sleeping partner about your sleep patterns, as your partner may observe aspects of your behavior during sleep of which you are unaware. Your doctor may also ask you and your partner to keep diaries of your sleep patterns for a few weeks.

Diagnostic tests

In most cases, the cause will become apparent through the medical history and physical examination. If there is evidence of an additional sleep disorder, such as sleep apnea, your doctor may recommend a sleep study, or “nocturnal polysomnography”. These studies are usually done in a sleep laboratory in a medical center, where you spend the night in a hospital-type room while specialized machines monitor your heart, lung, brain and muscle activity.

Can insomnia be prevented?

Insomnia can often be prevented if you identify and deal with problems that could cause or exacerbate insomnia, such as underlying medical problems, like depression, or behaviors such as caffeine consumption.

However, when treatment of medical or behavioral factors does not improve insomnia or when there is no apparent underlying cause (as in primary insomnia), your doctor may recommend other treatment methods.

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