Can't Sleep? Learn about Insomnia

It's three o'clock in the morning, and you can't sleep. You stare at the clock, aware that the alarm will go off in a few hours, but you can't sleep. You know you have a busy day ahead and need to be rested, but you can't sleep. No matter how hard you try, you can't sleep. You have insomnia.

For a long time, doctors were taught, "insomnia is a symptom, not a disease (or disorder)." However, new evidence is beginning to suggest insomnia may not simply be a symptom of other conditions, but rather, may be a disorder in its own right.

Regardless of whether it occurs with other medical conditions or by itself, insomnia tends to have a consistent set of nighttime and daytime symptoms. Moreover, treatment of associated conditions without specific attention to sleep does not consistently improve insomnia. Insomnia and other conditions may follow different time courses, and in many cases, insomnia is associated with worse outcomes of other conditions.

According to the National Institutes of Health, insomnia affects more than 70 million Americans. Direct costs of insomnia, which include dollars spent on insomnia treatment, healthcare services, hospital and nursing home care, are estimated at nearly $14 billion annually. Indirect costs such as work loss, property damage from accidents and transportation to and from healthcare providers, are estimated to be $28 billion.

What is this condition that affects so many of us and costs so much? The word "insomnia" comes from the Latin in ("no") and somnus ("sleep"), so it literally means "no sleep" or the inability to sleep.

Insomnia is an experience of inadequate or poor quality sleep as characterized by one or more of the following sleep complaints:

• difficulty initiating sleep;
• difficulty maintaining sleep;
• waking too early in the morning.

NSF's 2002 Sleep in America poll shows that 58% of adults in the U.S. experience symptoms of insomnia a few nights a week or more. Although insomnia is the most common sleep problem among about one half of older adults (48%), they are less likely to experience frequent symptoms of insomnia than their younger counterparts (45% vs. 62%), and their symptoms are more likely to be associated with medical conditions, according to the 2003 poll of adults between the ages of 55 and 84.

Sleep specialists classify insomnia in two primary categories: acute and chronic. Short term or acute insomnia, which is often due to a temporary situation such as stress, jet lag, change or loss in a job or relationship, can last up to one month and is treatable. It is important to address the underlying cause. Effective and safe prescription medications can help.

Long-term, or chronic, insomnia, which is experienced for a month or longer, can be secondary to causes such as medical, physical or psychological conditions, another sleep disorder, or medications and substances. It is essential to get a medical diagnosis. In addition to appropriate use of medications, education on behavioral and other techniques are well as good sleep practices can improve sleep.

In addition, chronic insomnia may be "primary," which means that it is not caused by other medical, psychiatric, sleep, or medication factors. Primary insomnia may be caused by factors such as increased body temperature, metabolic rate, or brain metabolism . Poor sleep habits may also contribute to primary and other forms of insomnia.

Insomnia is a risk factor for the onset of depression and can significantly affect your quality of life. Consequences of not getting enough good sleep can include daytime fatigue, impaired mood, depression and psychological distress, and decreased ability to concentrate, problem-solve and make decisions, as well as being at risk for injury, driving drowsy, and illness.

Fortunately, there are treatment options available, ranging from behavioral therapy to the use of prescription medicines, or a combination of the two.

Behavioral therapy is offered typically by a psychologist, psychiatrist or other health practitioner or counselor with specialized training. Several visits to the therapist are usually required to learn and implement the techniques of specific behavioral therapies. Some of the more common behavioral approaches include:

Stimulus control, which trains people to use their bed and bedroom for sleep and sex only. Persons with insomnia are encouraged to go another room and engage in a relaxing activity until they are sleepy and ready to return to bed.

Cognitive therapy, which is conducted with a therapist who helps the patient with attitudes and beliefs that may contribute to poor sleep.

Relaxation training, which often involves reducing tension and muscular relaxation techniques.

Prescription medications that promote sleep are called hypnotics. Medications differ by dose and duration of action. Most individuals take hypnotics a few nights or a few weeks at a time. Some may benefit from long-term use. Research indicates that when used nightly, hypnotics remain effective for at least several weeks and probably longer, and a recent study found that long-term use of a hypnotic medication was both safe and efficacious. The most common side effects include morning sedation, memory problems, headaches and a night or two of poor sleep after stopping the medication. Some hypnotic side effects can be minimized by using short-acting drugs.

Although the specific causes of insomnia differ from one person to the next, there are some general habits you can adopt that may help you sleep better. Not each of these practices may apply to everyone with insomnia, so you may want to focus on one or two that seem particularly relevant to your situation. Sleep experts recommend the following tips for good sleep:

At night:

• Establish a regular bedtime routine and a regular sleep-wake schedule. That means getting up at the same time every day of the week, no matter how much you've slept the night before, and going to bed at about the same time.
• Don't spend too much time in bed. Your time in bed should be about the same as the amount of time you can actually sleep during the night. You can't force yourself to sleep by spending more time in bed.
• Do not eat or drink too much before bedtime.
• Create a sleep-promoting environment that is quiet, dark, cool and comfortable.

During the day:

• Consume less or no caffeine, particularly late in the day.
• Avoid alcohol and nicotine, especially close to bedtime.
• Exercise, but not within three hours before bedtime.
• Avoid naps, particularly in the late afternoon or evening.
• Establish a regular bedtime and get up at the same time every day. Do not stay in bed to make- up for lost sleep or beyond your regular rise time.
• Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor.

Over-the-Counter (OTC)Medications:

Non-prescription, over-the-counter sleep aids are often antihistamines prescribed for allergies. They are readily available and may be useful for some individuals in some situations, but you should be aware of side effects such as prolonged sleepiness or the possibility of interactions with other medications. It is best to consult a physician for advice on treating your sleep problem.