Insomnia

Insomnia is one of the most common sleep disorders. Insomnia is defined as a recurrent problem falling asleep, maintaining sleep, and/or waking up feeling un-refreshed, and is associated with problems functioning during the day. Daytime consequences of insomnia can include diminished sense of well-being, difficulties with concentration and memory, fatigue, and concerns and worries about sleep. A diagnosis of insomnia is made when the symptoms persist at least 1 month.

Consider these statistics provided by the National Sleep Foundation:

• Nearly 50% of Americans suffer from some form of insomnia a few nights per week
• 38% of people wake up not feeling refreshed
• 32% wake up often during the night
• 21% wake up too early, and are unable to return to sleep

It is important to realize that not everyone who has problems sleeping has insomnia. Symptoms that are persistent is emphasized because many people occasionally experience disturbed sleep at night but their problem is transient.

Types of Insomnia

Insomnia can be classified by duration:

• Transient Insomnia – Less than one month
• Short-Term Insomnia – Between one and six months
• Chronic Insomnia – More than six months

Insomnia can also be classified as:

• Primary Insomnia – Insomnia that is present with no other co-existing health conditions
• Co-Morbid Insomnia – When insomnia exists in conjunction with other medical or psychiatric conditions.

Causes of Insomnia

Approximately 75 percent of people with insomnia can identify a specific cause of their insomnia. One of the most common causes is stress related to home or work situations.

Biological Factors:

• Restless Legs Syndrome
• Conditions that cause chronic pain, such as arthritis
• Acid reflux disorder
• Conditions that are associated with difficulty breathing, such as COPD, asthma, congestive heart failure, and sleep apnea
• Depression, anxiety and other psychiatric disorders
• Conditions that cause increased urinary frequency, such as enlarged prostate, diabetes
• Abnormal thyroid function
• Dementia

Certain medications and commonly used substances can disrupt sleep:

• Caffeine, nicotine, and other stimulants
• Alcohol
• Some decongestants, allergy and cold medicines
• Some steroids, such as prednisone
• Beta blockers

Environmental Factors:

Conditioned Arousal: The bed and bedroom become linked with wakefulness, arousal or negative emotions. For example, many people say that they doze off while watching TV or reading in the living room, but become fully awake when they go to bed.

Trying too hard: Some people react to poor sleep by trying harder. They go to bed earlier, then toss and turn. Trying too hard causes frustration, increases arousal and can actually cause stress.

Worrying: After a period of not sleeping well, some start worrying about another struggle to fall asleep. Many begin to worry about how insufficient sleep will negatively affect them the next day. Such worries are counterproductive and end up making it even more difficult to fall asleep.

Who is at Risk for Insomnia?

Individuals who have irregular sleep-wake schedules are at risk for developing insomnia. These schedules weaken signals from the circadian clock regulating sleep and wakefulness. Individuals whose jobs involve frequent time zone changes or shift work are at risk. Others include:

• People who describe themselves as “worriers” 
• People who do not unwind from the day’s stresses 
• “Night owls” who do not have a regular wake time 
• Women are twice as likely to experience insomnia as men 
• Older adults are more likely to experience insomnia 
• People with other sleep disorders; such as sleep apnea or restless legs syndrome 
• People with a genetic predisposition are more likely to develop insomnia