Insomnia
What is insomnia?
Insomnia is the most common of all sleep complaints. Almost everyone
has occasional sleepless nights, perhaps due to stress, heartburn or
drinking too much caffeine or alcohol. Insomnia is a lack of sleep that
occurs on a regular or frequent basis, often for no apparent reason.
How much sleep is enough varies. Although 7 1/2 hours of sleep is about
average, some people do fine on 4 or 5 hours of sleep. Other people need 9
or 10 hours a night.
Inability to get a good night's sleep can affect not only your energy
level and mood but your health as well because sleep helps bolster your
immune system. Fatigue, at any age, leads to diminished mental alertness
and concentration. Lack of sleep is linked to accidents both on the road
and on the job.
About one out of three people have insomnia sometime in their life.
Sleeplessness may be temporary or chronic. You don't necessarily have to
live with sleepless nights. Some simple changes in your daily routine and
habits may result in better sleep.
What are the different types of insomnia?
A person can have primary or secondary insomnia.
Primary insomnia means that a person is having sleep problems that are
not directly associated with any other health condition or problem.
Secondary insomnia means that a person is having sleep problems
because of something else, such as a health condition (like
depression,
heartburn, cancer,
asthma,
arthritis), pain, medication they are taking, or a substance
they are using (like alcohol). Insomnia can vary in how long it lasts
and how often it occurs. Insomnia can be short-term (called acute
insomnia) or last a long time (called chronic insomnia).
It can also come and go (or be intermittent), with periods of time when
a person has no sleep problems. Acute (short-term) insomnia can last
from one night to a few weeks.
What are the causes
of insomnia?
Common causes of insomnia include:
- Stress. Concerns about work,
school, health or family keep your mind too active and unable to relax
for sleep. Excessive boredom, such as after retirement or during a
long illness, also can create stress and keep you awake.
- Anxiety. Everyday anxieties
as well as severe anxiety disorders may keep your mind too alert to
fall asleep.
- Depression. You may either
sleep too much or have trouble sleeping if you're depressed. This may
be due to chemical imbalances in your brain or because worries that
accompany depression may keep you from relaxing enough to fall asleep
when you want to.
- Stimulants. Prescription
drugs, including some antidepressant, high blood pressure and steroid
medications, can interfere with sleep. Many over-the-counter (OTC)
medications, including some pain medication combinations,
decongestants and weight-loss products, contain caffeine and other
stimulants. Antihistamines may initially make you groggy, but they can
worsen urinary problems, causing you to get up more during the night.
- Change in your environment or work
schedule. Travel or working a late or early shift can disrupt
your body's circadian rhythms, making you unable to get to sleep when
you want to. The word circadian comes from two Latin words:
circa for "about" and dia for "day." Your circadian
rhythms act as internal clocks, guiding such things as your wake-sleep
cycle, metabolism and body temperature.
- Long-term use of sleep medications.
Doctors generally recommend using sleeping pills for only up to 4
weeks, or until you notice benefits from self-help measures. If you
need sleep medications for longer, take them no more than two to four
times a week, so they don't become habit-forming. Sleeping pills often
become less effective over time. If you're taking sleeping pills every
evening and they help, keep taking them. If they lose their
effectiveness, you might sleep better by slowly withdrawing from them.
- Medical conditions that cause pain.
These include arthritis, fibromyalgia and neuropathies, among other
conditions. Making sure that your medical conditions are well treated
may help with your insomnia.
- Behavioural
insomnia. This may occur when you worry excessively about not
being able to sleep well and try too hard to fall asleep. Most people
with this condition sleep better when they're away from their usual
sleep environment or when they don't try to sleep, such as when
they're watching TV or reading.
- Eating too much too late in the
evening. Having a light snack before bedtime is OK, but
eating too much may cause you to feel physically uncomfortable while
lying down, making it difficult to get to sleep. Many people also
experience heartburn, a backflow of food from the stomach to the
oesophagus after eating. This uncomfortable feeling may keep you awake.
- Inherited condition. Some
people have inherited poor sleep tendency. If that's your case, be
extremely careful not to overexcite yourself, especially in the
evening.
Insomnia becomes more prevalent with age. As you get older, three
changes often occur that may affect your sleep. You may experience:
- A change in sleep patterns.
After age 50, sleep often becomes less restful. You spend more time in
stages 1 and 2 of non-rapid eye movement (NREM) sleep and less time in
stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep,
and stages 3 and 4 are deep (delta) sleep, the most restful kind.
Because you’re sleeping lighter, you're also more likely to wake up.
With age, your internal clock often speeds up. You get tired earlier
in the evening and consequently wake up earlier in the morning.
- A change in activity. You may
be less physically or socially active. Activity helps promote a good
night's sleep. You may also have more free time and, because of that,
drink more caffeine or alcohol or take a daily nap. These things can
also interfere with sleep at night.
- A change in health. The
chronic pain of conditions such as arthritis or back problems as well
as depression, anxiety and stress can interfere with sleep. Older men
often develop non cancerous enlargement of
the prostate gland (benign prostatic hyperplasia), which can cause the
need to urinate frequently, interrupting sleep. In women, hot flashes
that accompany menopause can be equally disruptive. Other
sleep-related disorders, such as sleep apnea and restless legs
syndrome, also become more common with age. Sleep apnoea causes you to
stop breathing periodically throughout the night and then awaken.
Restless legs syndrome causes unpleasant aches in your legs and an
almost irresistible desire to move them, which may prevent you from
falling asleep.
Sleep problems can be a problem for children and teenagers, as well.
In addition to many of the same causes of insomnia as those of adults,
younger people may have trouble sleeping because of conditions such
sleepwalking, night terrors or bruxism — teeth grinding. In addition,
some children and teenagers simply have trouble getting to sleep or
resist a regular bedtime, often because their inherent (circadian) clock
is slow. When the clock on the wall says it's 10 p.m., their bodies may
feel like it's only 8 p.m., because of their slow clock.
How is insomnia treated?
Acute, or short-term insomnia may not require treatment. But if
your insomnia makes it hard to function during the day because you are
sleepy and tired, your health care provider may prescribe sleeping
pills for a limited time. The rapid onset, short-acting medications
now available avoid many of the earlier problems with continuing
effects (like feeling drowsy or groggy) the following day. Some
medications may be less effective after several weeks of nightly use,
however, and long-term safety and effectiveness has not yet been
established. Side effects of sleeping pills (and over-the-counter
sleep medicines) can be a problem, too. Mild insomnia often can be
prevented or cured by practicing good sleep habits.
Treatment for chronic (long-term) insomnia includes first treating
any underlying conditions or health problems that are causing the
insomnia. If insomnia continues, your health care provider may suggest
behavioural therapy or medication. Most medicines that are used for
sleep have side effects and must be used with caution. It is
not recommended to use over-the-counter sleeping pills for
insomnia. Behavioural approaches to treatment focus on changing
behaviours that may worsen insomnia and learning new behaviours to
promote sleep. Techniques such as relaxation exercises, sleep
restriction therapy, and reconditioning may be useful.
If self-help measures don't work or you feel that another condition,
such as depression, restless legs syndrome or anxiety, is causing your
insomnia, talk to your doctor. He or she may recommend that you take
medications to promote relaxation or sleep.
Often, taking prescription sleeping pills for a couple of weeks until
there's less stress in your life may help you get to sleep until you
notice benefits from behavioural self-help measures. Doctors generally
don't recommend prescription sleeping pills for the long term because
they can lead to dependence and other side effects.
In addition, sleeping pills can become less effective after a while.
OTC sleep aids contain antihistamines to induce drowsiness. They're OK
for occasional sleepless nights, but they, too, often lose their
effectiveness the more you take them. Many sleeping pills contain
diphenhydramine, which can cause difficulty urinating and a drowsy
feeling in the daytime.
Melatonin is a widely used OTC supplement that's marketed as a way to
help you overcome insomnia, prevent jet lag, battle cancer, rejuvenate
your sex life and slow aging. It helps some people, but no more than 10
percent of people with insomnia. To find out if you're one of those
people who benefit from melatonin, try it for 2 weeks, comparing your
sleep with the prior 2 weeks without melatonin.
Magnet therapy stimulates the pineal gland to
increase the production of melatonin naturally. Sleeping on a magnetic
pillow will help with insomnia.
Some people are helped by herbal preparations such as valerian. Try
herbal preparations to see if you benefit from them.
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