INSOMNIAN

Insomnia is a complex problem affecting tens of millions of people all over the world and can cause a variety of effects and even disability that have serious consequences for both the insomniac and others. Despite its high prevalence, insomnia is often misunderstood and not well managed.

There are four major types of Insomnia:

How much sleep does a person need?

There is no “normal” amount of sleep time. Each person has different needs. A good rule of thumb to know if you have enough sleep is feeling alert and refresh upon waking up.

What can cause Insomnia?

Many things can cause insomnia. Insomnia usually is not a primary disorder; it is frequently a complaint or symptom secondary to another illness (e.g. anxiety disorder). The goal is to find the underlying problem causing the complaint. Almost any sleep disorder can present as insomnia including circadian sleep disorders, sleep apnea, restless leg syndrome, etc. 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 different people react to medications differently. Life events can cause insomnia but it is usually temporary. Anxiety about falling (or not falling) asleep can also be responsible, however, if the anxiety is associated with a long history of insomnia, further evaluation regarding other possible cause is warranted. 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. This problem can be treated using many different techniques.

Types of insomnia based on duration of symptom:

1. ransient insomnia - lasting for a few nights
2. Short-term insomnia - two or four weeks of poor sleep
3. 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:

Treatment

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 the sleep/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.

Chronic insomnia treatment

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.

Try behavioral 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.

If insomnia is affecting your quality of life, talking to your physician is strongly advised. For chromic insomnia, a sleep specialist may be needed.

References:

1. Sleepnet Insomnia
2. Medscape Sleep Resource