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Insomnia

Insomnia – Overview and Facts

Insomnia is the most common sleep complaint. It occurs when you have
trouble falling asleep or staying asleep even though you had the
opportunity to get a full night of sleep. The causes, symptoms and
severity of insomnia vary from person to person. Insomnia may include:

Difficulty falling asleep
Difficulty staying asleep throughout the night
Waking up too early in the morning

Insomnia involves both a sleep disturbance and daytime symptoms. The
effects of insomnia can impact nearly every aspect of your life. Studies
show that insomnia negatively affects work performance, impairs
decision-making and can damage relationships. In most cases, people with
insomnia report a worse overall quality of life.

As many as 30 to 35 percent of adults complain of insomnia.Everyone has
the occasional night of poor sleep. In many cases this is due to staying
up too late or waking up too early. This does not mean you have
insomnia, it means you didn’t get enough sleep.

As many as 30 to 35 percent of adults complain of insomnia. It is more
common in groups such as older adults, women, people under stress and
people with certain medical and mental health problems such as
depression.

There are two types of insomnia based on the regularity and duration of
the sleep disturbance and daytime symptoms:

Short-term insomnia: This type of brief insomnia lasts for up to
three months. It occurs in 15 to 20 percent of people.

Chronic insomnia: This type of insomnia occurs at least three times
per week and lasts for at least three months. About 10 percent of people
have chronic insomnia.

A board certified sleep medicine physician diagnoses chronic insomnia.
The sleep team at an accredited sleep center can provide ongoing care.

Insomnia – Symptoms & Causes
Symptoms and causes of insomnia are different for every patient. Insomnia symptoms may include:
• Fatigue
• Problems with attention, concentration or memory (cognitive impairment)
• Poor performance at school or work
• Moodiness or irritability
• Daytime sleepiness
• Impulsiveness or aggression
• Lack of energy or motivation
• Errors or accidents
• Concern or frustration about your sleep
Insomnia is most often associated with another problem. Insomnia that is not caused or worsened by other factors is rare. These factors may include:
Stress
This varies from relatively minor things like work or personal stress, to more severe changes such as death, divorce or job loss.
Other sleep disorders
Some sleep disorders can cause insomnia or make it worse. For instance, people with restless legs syndrome may have a hard time falling asleep.
Medical conditions
Many physical illnesses can cause insomnia. People who experience pain, discomfort or limited mobility from medical problems may have difficulty falling asleep or staying asleep. Insomnia due to medical conditions is most common in older adults because people tend to have more chronic health problems as they age. Conditions such as pregnancy, particularly the third trimester, and menopause can cause sleep problems. The severity and duration of insomnia often varies with the related health condition.
Mental disorders
The relationship between sleep and mental health is complex. Insomnia is sometimes caused by a mental health disorder. Often a mental health disorder will be found after a complaint of insomnia. Depression is one of the most common mental illnesses in the United States and a frequent cause of insomnia. People with depression often have trouble falling asleep or staying asleep. Difficulty falling asleep is also common in people with anxiety disorders. Other mood disorders such as bipolar disorder may also cause sleep problems.
Medication or substance use or abuse
Insomnia can be an unwanted side effect of many prescription or over-the-counter medications. Common cold and allergy medicines contain pseudoephedrine and can make it difficult to fall asleep. Antidepressants and medications to treat ADHD, high blood pressure or Parkinson’s disease can also cause insomnia.
Drinking alcohol before bedtime can cause frequent awakenings during the night. Insomnia also can occur if you suddenly stop using a sleeping pill.
Caffeine and other stimulants can prevent you from falling asleep. Stimulants also cause frequent awakenings during the night.
Some people are sensitive to certain foods and may be allergic to them. This can result in insomnia and disrupted sleep.
Environmental factors
The environment where you sleep can cause insomnia. Disruptive factors such as noise, light or extreme temperatures can interfere with sleep. Sleeping with a bed partner who snores also can cause sleep disruption. Extended exposure to environmental toxins and chemicals may prevent you from being able to fall asleep or stay asleep.
Habits or lifestyles
Irregular sleep schedules (see shift work disorder) can cause insomnia in workers who try to sleep during the day.

Insomnia – Diagnosis & Self-Tests
If you think you may have insomnia, ask yourself the following questions:
• Does it take you more than 30 minutes to fall asleep, or do you wake up during the night and have trouble returning to sleep, or do you wake up earlier than desired?
• Do you have daytime symptoms such as fatigue, moodiness, sleepiness or reduced energy?
• Do you give yourself enough time in bed to get at least 7 hours of sleep each night?
• Do you go to bed in a safe, dark and quiet environment that should allow you to sleep well?
If you answered “yes” to all of these questions, then you may have insomnia.
If you’ve had insomnia for at least three months (chronic insomnia), consider booking an appointment with a board certified sleep physician at an AASM accredited sleep center. If you have had insomnia for fewer than three months, you may have short-term insomnia. Try to follow good sleep hygiene, and if the problem does not go away in three months, talk to a sleep physician.
A board-certified sleep physician can diagnose insomnia and work with the sleep team to treat it. Before your appointment, the doctor will ask you to keep a sleep diary for two weeks. By recording when you go to sleep and when you wake up, along with how long you were awake during the night, a sleep diary will help your sleep medicine physician see your habits. This may give your physicians clues about what is causing your insomnia and what course of treatment to take.
The board-certified sleep physician will need to know your medical history and whether you are taking any medications, including over-the-counter drugs. He will also want to know whether anything else has happened in your life, such as any event that is causing stress or trauma. The physician may give you a written test to analyze your mental and emotional well being. You may also receive a blood test if the physician suspects a related medical problem is causing insomnia.
You will not need an overnight sleep study unless the board-certified sleep medicine physician suspects you have sleep apnea or another sleep disorder.
Insomnia – Treatment
The treatment for insomnia depends on its underlying cause. For chronic insomnia a board certified sleep medicine physician may recommend any combination of the following treatments:
Sleep Hygiene
In many chronic insomnia cases, by practicing good hygiene and changing your sleep habits you can improve your sleep. Sleep hygiene is a set of bedtime habits and rituals you can do every night to improve how you sleep.
Cognitive Behavioral Therapy for Insomnia
Cognitive behavioral therapy for insomnia, or CBT-I, addresses the thoughts and behaviors that keep you from sleeping well. It also helps you learn new strategies to sleep better. CBT-I can include techniques for stress reduction, relaxation and sleep schedule management. The Society of Behavioral Sleep Medicine has a directory of behavioral sleep specialists who provide CBT-I.
Medications
Your board certified sleep medicine physician may prescribe medication to treat your insomnia. Sleeping pills that are specifically approved to treat insomnia are called hypnotics. You may build a tolerance to these medications over time. Some medications that treat other problems also may help you sleep. Your doctor can decide which medication is best for you. You should only take a medication when supervised by a doctor.
In cases where the insomnia is caused by a medical condition, the doctor may refer you to a specialist who can treat the underlying condition. The course of insomnia is likely to change as your medical condition improves. Your board-certified sleep medicine physician may also want to change any medications that you currently take if he suspects the drugs are related to your insomnia.
Although insomnia is common, most people can find a treatment that works for them with the help of a board-certified sleep medicine physician at an accredited sleep center.
Find an accredited sleep disorders center.