Definition and Overview

Insomnia is a medical disorder wherein the person has difficulty sleeping. This means that the individual has problems initiating or maintaining sleep or both. Also known as sleeplessness, insomnia has also been defined as a condition that results in poor quality of sleep with an associated functional impairment experienced during the day. A clinical diagnosis of insomnia is usually given when this medical problem happens at least three times in a week. According to the National Institute of Health, approximately 30% of the population experience symptoms of this sleep disorder, however, it is more common in women than in men, largely because of hormonal changes. It is also more common in the older age group, usually above 60 years old, due to changes in the sleeping cycle and the development of other medical diseases as a person ages.

Cause of Condition

Insomnia can be primary or secondary. Primary insomnia occurs when there is no other inciting factor for the condition. Secondary insomnia, meanwhile, occurs in association with another medical condition. Insomnia may also be transient, which lasts less than one week; acute, which lasts less than one month and is usually related to stress; or chronic, which symptoms last for over a month.

Numerous psychological and environmental factors can result in insomnia. Significant stress in a person’s life, such as death of a family member or unemployment, can lead to this condition. Co-morbid conditions, such as bronchial asthma, acid reflux disease, and chronic pain syndromes producing constant physical discomfort, may also be the underlying reasons. Your lifestyle may also be a factor, such as in nightshift workers and in frequent travelers who experience jet lag. Distractions in one’s surroundings, such as extreme noise or varying temperature, as well as certain medications, such as steroids, may also cause this sleep disorder. Chronic insomnia may also be due to psychological causes, such as chronic life stresses, anxiety, depression, or bipolar disorder.

Key Symptoms

Insomnia is a disorder that affects not only the quantity, but more importantly, the quality of your sleep. Patients with insomnia are unable to fall asleep during the night and are typically restless and anxious during the day. They may also wake up several times throughout the night and have difficulty returning to sleep once they have been awakened. Some patients also wake up in the wee hours of the morning and do not feel rested when they wake up. Headaches are common. Some patients rely on substances, such as alcohol or sleeping pills, in order to fall asleep. Patients who have insomnia generally feel tired and fatigued during the day and may develop mood disturbances, such as irritability. Patients also usually notice a decline in their work performance or functionality and may develop problems with memory and concentration. This can result in more errors at work or in school and may be dangerous for the individual.

Who to See and Types of Treatments Available

If you are experiencing sleep disturbances, especially when the symptoms interfere with your usual activities or if they happen for longer than a month, it is best to consult a general practitioner or GP. You will be evaluated completely, which will include a review of your medical history and a physical examination. You will also be asked about your sleep history, and you may be requested to construct a sleep diary, which will include details of your sleeping patterns. In addition, you may be requested to undergo a sleep examination, known as polysomnography, in order to monitor your brain activity while you sleep.

The management of insomnia is targeted at identifying and treating the cause of the disorder. Successful treatment usually involves a combination of pharmacological and the use of behavioral techniques. Establishing good sleeping habits are important in the management of insomnia, whether it be primary or secondary. These habits include avoidance of nicotine, caffeine and alcohol, not taking naps in the middle of the day and eating a light snack prior to sleeping, among others. Controlling the sleeping environment by minimizing bright lights during nighttime and eliminating distractions like watching television may also be done.

Behavioral therapy with relaxation exercises is also helpful. If you are discovered to have insomnia, you may be referred to a sleep specialist or a psychiatrist for further evaluation and treatment. You may be prescribed certain medications, such as antihistamines, sleeping pills or benzodiazepines, in order to help you sleep. These medications are usually given for only a short period of time and in small doses, and if possible, completely avoided, especially in the elderly population. Support groups and specialized sleep centers, such as the National Sleep Foundation, can also provide you with useful information, tips, and assistance.

Resources:

  • Sleep Foundation Org. http://sleepfoundation.org/insomnia/content/treatment
  • National Institute of Health. www.nih.gov/
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