Sleep Lab
//Insomia

Insomnia is characterized by an inability to sleep and/or to be incapable of remaining asleep for a reasonable period. Insomniacs typically complain of being unable to close their eyes or "rest their mind" for more than a few minutes at a time. Both organic and nonorganic insomnia constitute a sleep disorder. It is often caused by fear, stress, anxiety, medications, herbs or caffeine. An overactive mind or physical pain may also be causes. Finding the underlying cause of insomnia is usually necessary to cure it.

Types of insomnia

Three different types of insomnia exist. Insomnia may be classified as transient, acute (short-term), and chronic. Insomnia lasting from one night to a few weeks is referred to as transient. This is generally the case for most people, as one often suffers from jet lag or short-term anxiety. If this form of insomnia continues to occur from time to time, the insomnia is classified to be intermittent. Acute insomnia is the inability to consistently sleep well for a period of three weeks to six months. However, after this time, the person does not experience insomniatic episodes. Insomnia is considered to be chronic, the most serious, if it persists almost nightly for at least a month, and sometimes longer.

Common causes of insomnia

A person can have primary or secondary insomnia. Primary insomnia is sleeplessness that is not attributable to a medical or environmental cause. Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition, an example of which would be generalized anxiety disorder.

Some of the most common causes of insomnia are:

Pain can produce insomnia and finding effective ways to treat pain can provide relief. A common misperception is that the amount of sleep one requires decreases as he or she ages. The ability to sleep for long periods, rather than the need for sleep, appears to be lost as people get older. Some elderly insomniacs toss and turn in bed and occasionally fall off the bed at night, diminishing the amount of sleep they receive.

Insomnia is a common side-effect of some medications, and it can also be caused by stress, emotional upheaval, physical or mental illness, dietary allergy and poor sleep hygiene. Insomnia is a major symptom of mania in people with bipolar disorder, and it can also be a sign of hyper-thyroidism, depression, or other ailments with stimulating effects.

In addition, a rare genetic condition can cause a prion-based, permanent and eventually fatal form of insomnia called Fatal Familial Insomnia.

What do clinicians specifically look for, to diagnose insomnia?

Keeping a detailed sleep history or sleep diary can help a physician identify factors related to insomnia and whether other sleep disorders (such as sleep apnea, narcolepsy or restless legs syndrome) are the cause of the insomnia. To keep a sleep diary, keep track of the time you go to bed each night, when you wake up during the night, how long you are awake, and what time you arise in the morning. You should also note things that might be affecting your sleep, such as your mood, your diet, and your environment. It may be helpful to have a physical examination and a sleep test as well.

Usually, sleep specialists diagnose some form of insomnia if a person routinely:

• requires more than 30 minutes to fall asleep (which is onset insomnia), or is wakeful for a total of 30 minutes or more after initially falling asleep (which is maintenance insomnia), or
• if the person awakens too early in the morning with less than 61/2 hours of sleep (which is early morning awakening), or
• if the person complains of excessive " twilight zone " sleep (that is, feeling half awake and half asleep), or lastly,
• if the person reports daytime fatigue, concentration problems, irritability, anxiety, or depression.

Treatments For Insomnia

It is important to first determine if there is an underlying medical or psychiatric problem that may be causing your insomnia. Ask your doctor about what may be causing your insomnia and what treatment may be right for you. Your doctor may refer you to a psychologist for behavioral treatment or may consider using medications.

Currently, there are several prescription sleep aids available to treat insomnia. New drugs, known as hypnotics, show clear, measurable benefits with minimal risks. They can shorten the time it takes to fall asleep and reduce awakenings, which adds to total time spent asleep. There is widespread agreement that hypnotic medications are effective and safe for a few nights or a few weeks. Intermittent use over a longer period of time can also be effective. Possible side effects include feeling tired or drowsy the next day, memory loss and problems with performance.

Behavioral treatments, sometimes in combination with prescription medications, have also proven effective for many people, especially for those with long-term insomnia. These treatments are self-management strategies that are learned from a trained professional and then practiced by the patient.

Helpful advice:

• Avoid all stimulating substances/activities such as caffeine and exercise before bedtime.

• Do, however, engage in a regular exercise program, preferrably in the morning or around noon. Twenty to thirty minutes of aerobic activity which keeps your heart rate in the training range (60% to 80% of your max heart rate) is effective, particularly when interspersed with interval training, during which one pushes their workout into the anaerobic range for brief periods of time (20 to 60 seconds).

• Avoid distractions in the bedroom including excessive light and noise, television, alarm clocks, etc.

• If you find you cannot sleep, get out of bed and do an activity until you're tired again, so as to avoid associating sleeplessness with lying in bed.

• Avoid stressful thoughts and feelings before bedtime and while attempting to fall asleep.

• Combat worries and preoccupations about the day ahead by tending to plans and schedules before bedtime.

• Background noise, such as a fan or soft rhythmic music, can serve to ease some individuals into sleep.

• Purchase the most comfortable bed you can afford.

Alternative approaches

In the Buddhist tradition, people suffering from insomnia or nightmares may be advised to meditate on "loving-kindness", or metta. This practice of generating a feeling of love and goodwill is claimed to have a soothing and calming effect on the mind and body. This is claimed to stem partly from the creation of relaxing positive thoughts and feelings, and partly from the pacification of negative ones. In the Mettā Sutta, Siddhartha Gautama, the Buddha, tells the gathered monks that easeful sleep is one benefit of this form of meditation.

There are a number of alternative cures for this disorder that are currently marketed. Often, a combination of dietary and lifestyle changes is claimed to be the most helpful approach. However, it should be noted the reason they are considered "alternative" medical treatments is the lack of empirical evidence to back up such claims. There are always studies going on to either confirm or deny the effectiveness of such medicine, but in many cases even if no effect is shown to exist in a treatment, proponents will still believe in their effectiveness.

Statistics for insomnia

According to the U.S. Department of Health and Human Services, approximately 60 million Americans suffer from insomnia each year. ^[5]. Insomnia tends to increase with age and affects about 40 percent of women and 30 percent of men ^[6]. The average American get 7 hours of sleep, instead of the 8 to 10 hours recommended by doctors.

External links

• NHS Direct information on Insomnia
• NIH state of the science report on management of chronic insomnia in adults
• Insomnia from the NSF Sleeptionary
• American Academy of Sleep Medicine
• Find an accredited sleep center
• Sleep Research Society
• Sleeplessness Information
• Insomnia at University of Maryland Medical Center
• Insomnia Treatment Center