Insomnia
What is it?
Insomnia—difficulty in falling or staying asleep, or waking up too early—is the most common sleep disorder. It may affect people of any age, but prevalence increases with advancing years. Sleep requirements vary greatly: Some people need nine hours of sleep a night; others do fine with five. Many who complain of insomnia sleep more than they think they do. Although persistent insomnia may be frustrating and even debilitating, self-treatment is often successful.
What Causes It?
- Psychological distress—due to emotional upset, a different or noisy sleeping environment, or worrying about the next day—is the most common cause of insomnia. Anxiety, depression, and mania cause more persistent sleep disturbances.
- Caffeine and other stimulants are common causes. Even a single cup of coffee or tea during the day can lead to insomnia in susceptible people.
- Diuretic medications taken later in the day can cause frequent awakenings to urinate.
- Alcoholic beverages disrupt the sleep cycle and cause frequent awakenings. Chronic alcoholism may cause sleeping problems that persist for years, even after drinking is discontinued.
- Paradoxically, sleeping pills cause insomnia. They tend to lose their effectiveness after a few weeks, and withdrawal may cause rebound insomnia.
- Physical disorders—heart and lung diseases, hyperthyroidism, gastroesophageal reflux, arthritis, and many more—cause insomnia. Prostate disorders, kidney disease, and diabetes may cause frequent awakenings throughout the night to urinate.
- Other causes include a sedentary lifestyle, exercising vigorously late in the day, recent surgery, and pregnancy (especially the last month).
Prevention
- Avoid or minimize caffeinated beverages.
- Within three hours of going to bed, do not drink alcoholic beverages, smoke, or eat a large meal (although a small bedtime snack may be advised).
- Avoid amphetamines or other stimulants (unless directed otherwise by your doctor).
- Exercise moderately during the day; this should help you feel tired at night.
- If possible, go to bed and get up at set times each day and resist the temptation to take long naps.
- Prior to bedtime, restrict reading and television watching. Try to avoid worrying (it may help to set aside a regular time during the day to think about problems and possible solutions.) Take a warm bath or drink a glass of warm milk to relax.
- Use your bed only for sleeping and intimacy; don't watch television, talk on the phone, or do paperwork in bed.
Diagnosis
- In cases with no obvious cause, the doctor may advise an overnight stay at a sleep-study laboratory to monitor brain-wave patterns, breathing, muscle activity, and other body functions.
How to Treat It
- Follow preventive tips.
- If you are unable to fall asleep or if you wake up and cannot get back to sleep, get out of bed and stay up until you feel tired and drowsy.
- Psychological counseling may help relieve the anxiety or depression that prevents sleep.
- Your doctor may ask you to keep a log of sleeping patterns to identify causes of sleeplessness.
- When a short-term stressor such as an upcoming event or a recent grief is present, your doctor may prescribe a sedative tranquilizer (such as zolpidem, lorazepam, or alprazolam) to be taken on a shortterm basis under his or her supervision.
When to Call a Doctor
- Make an appointment with a doctor if insomnia persists, is associated with depression, or interferes with normal activities.
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Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.