Insomnia and Other Related Sleep Problems

Insomnia - the inability to sleep, or to sleep satisfactorily - is the most common sleep disorder. It varies from restless or disturbed sleep to difficulty in falling asleep, to a reduction in the usual time spent sleeping. In the extreme, it may involve complete wakefulness.

Requirements for sleep vary widely. Most adults need the traditional seven or eight hours of sleep a night, but some adults are "short sleepers" and function well on only three or four hours. Many people overestimate the amount of sleep they need and underestimate the amount they actually get during a restless night. Generally there is no need for concern, even if an unbroken night's sleep is rare. However if loss of sleep impairs a person's ability to function well during the day, it might indicate a problem.

The mechanism that induces sleep is not known. In the dark, the pineal gland in the brain secretes a hormone called melatonin, which is thought to induce sleep. Exactly why sleep is necessary for good health and efficient mental functioning is unknown. We do know that sleep consists of two very different states: rapid-eye movement (REM) sleep and non-REM sleep. In REM sleep, the eyes move under the closed lids, the heartbeat quickens and all body processes speed up. Dreams occur during REM sleep and sexual arousal is common, even if the dreams themselves are not sexual in content. Periods of REM sleep last about 20 minutes and occur four or five times during the night. They alternate with longer periods of non-REM sleep, when body functions slow. Non-REM sleep has four stages. During the deepest stages (3 and 4) it is hard to arouse a sleeper. As the night goes on, the periods of non-REM sleep become progressively lighter. Stage 4 sleep is felt to be restorative. During this time the body repairs itself, utilizing a hormone called somatostatin. Lack of stage 4 sleep is believed to be important in chronically painful conditions such as fibromyalgia.

Insomnia can take various forms: difficulty falling asleep (sleep onset insomnia), difficulty staying asleep, and early wakening. Sleeplessness is common during pregnancy, especially in the later weeks. The elderly typically sleep lightly and fitfully.

Physical situations can complicate sleep patterns: the need to urinate frequently, leg cramps, painful conditions such as arthritis, symptomatic asthma or other medical problems and restless legs syndrome can all interfere with both sleep onset and sleep maintenance. Social situations can disturb sleep, too. Arguing, watching exciting programs on television late at night, consuming excessive caffeine or alcohol or eating a large meal close to bedtime, vigorous exercise less than six hours before retiring may disturb sleep patterns.

In the majority of insomnia cases, however, the core problem is emotional. Anxiety and internalized, unexpressed anger are common causes of sleeplessness. Depression is also implicated in insomnia, waking in the early morning is common in some depressed individuals. People may clock many hours of sleep time, yet continue to feel fatigued due to poor sleep quality.

Paradoxically, insomnia may result from the use of a sedative prescribed to relieve it. Some people, especially the elderly or people with certain occupations, develop an inverted sleep rhythm: drowsiness in the morning, sleep during the day, and wakefulness at night.

There are a number of ways to help yourself fall asleep more easily.

  • Establish a bedtime "ritual" composed of environmental cues which tell your body that it is now time to rest: go for a stroll an hour or so before bedtime, take a warm bath or drink a glass of warm milk (milk contains an amino acid that is converted to a sleep-enhancing compound in the brain).

  • Sexual intercourse has a relaxing effect for many people.

  • Relaxation techniques, including muscle-relaxation exercises and meditation, may be useful.

If insomnia is persistent, consult a doctor. Often, reassurance that the problem results from normal anxieties or from a treatable physical disorder relieves distress and helps restore a normal sleeping pattern. Treatment of underlying stressors or alteration of living habits is necessary if one or the other is causing insomnia. Above all, it is important to create a situation that is appropriate for sound sleep.

Many sleep problems can be overcome by simple, common sense measures. These include:

  • Cut back on coffee, tea, and other sources of caffeine, especially in the evening.

  • Avoid alcoholic drinks in the late evening. Alcohol may help sleep onset, but cause early morning wakefulness.

  • Avoid eating a large, late-evening meal - and heavy, fatty foods before going to bed.

  • Take a walk or perform mild exercise such as yoga or Qi Gung before going to bed.

  • Don't use your bedroom as a place to work.

  • Have a warm milk drink before going to bed. Milk products contain an amino acid precursor that boosts serotonin in the brain.

  • Take a warm (NOT HOT) bath (not a shower) before going to bed.

  • Avoid naps if they interfere with your normal sleep pattern.

  • If unable to fall asleep within 20-30 minutes of lying down, get up and do something else until you feel sleepy. This way your body does not associate your bed with wakefulness.

  • Exercise during the day.

Drugs may be prescribed when the cause of insomnia includes a particularly stressful situation (i.e., bereavement or the loss of a job) or a pain from some physical condition, or if a person's efficiency and sense of well-being are seriously impaired by sleeplessness. Hypnotic (sleep-inducing) drugs should never be combined with even a small amount of alcohol, a sedative that enhances gastrointestinal absorption of the drugs and compounds their effects. Always follow your doctor's specific instructions for treating insomnia. Alcohol consumption may cause initial drowsiness, but this is usually followed by sudden wakefulness after the alcohol is metabolized. It may be more difficult to get back to sleep than it was beforehand.

Nearly half of all Americans have some kind of sleep disorder, with insomnia being the most common. Worry, anxiety, unconscious tensions, and major or minor health problems can all affect the quality of sleep.  Simple tension-reducing measures, such as a warm bath or moderate exercise, often help restore normal sleeping patterns. If they do not, and insomnia becomes a chronic problem, seek medical help. Sleep-inducing medications should be considered a temporary solution when great emotional stress, considerable physical pain, or prolonged sleeplessness seriously affect the quality of a person's life.

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