Insomnia: the body's sleep thief
by Michelle Badash, MS
Which of the following people would you characterize as having insomnia?
Diane McNamara*, 52, was grappling with some difficult family decisions. She began waking every night between 2:00 and 3:00 a.m. and was unable to fall asleep again. After two weeks, her family situation resolved and her sleep pattern returned to normal.
John Chu* occasionally has "rocky" sleep—he falls asleep, awakens, and falls asleep again several times a night. But he figures it's a natural part of aging, since he's just celebrated his 70th birthday.
Ever since her late 30s, Jenna Samuels* has had trouble falling asleep. Now that she's in her mid-40s, she often feels tired, but has resigned herself to this sleep pattern, believing it's just how her own body "clock" functions.
*Names have been changed.
Despite their different situations, all three of these people experienced insomnia.
What is insomnia? Some surprising facts
If you're among the 87 million Americans who have trouble sleeping, you may be surprised to learn that the definition of insomnia is subjective; it is your personal perception of poor-quality sleep, caused by any of the following:
- Difficulty falling asleep
- Frequent awakenings and difficulty falling back to sleep
- Waking too early
Insomnia is not related to the number of hours you sleep, since each person's need for sleep varies. Although most people need about seven to nine hours of sleep, the main criteria are whether you feel rested and alert after sleep.
Symptoms of insomnia
Common symptoms of insomnia include:
- Persistent fatigue
- Difficulty concentrating
- Irritability
- Daytime sleepiness
Types and causes of insomnia
Although Diane, John and Jenna all have insomnia, their sleep disturbances fall into three categories based on their different symptoms:
Transient (short-term) insomnia
Diane's family problems resulted in transient insomnia, which can last from one night to three weeks. This type of insomnia is usually associated with temporary life changes, including:
- stress
- environmental noise
- extreme temperature changes
- jet lag
- medication side effects
Intermittent insomnia
John's periodic bouts of interrupted sleeping and waking are characteristic of intermittent insomnia. It can be short-term or persist in the same off-and-on pattern for months or longer.
The belief that we need less sleep as we age is not true. However, sleep disturbances may be more common in older people due to medical conditions, such as restless leg syndrome, arthritis, heart or lung disease, and the effects of multiple medications.
Chronic insomnia
Jenna's insomnia is chronic; it is a constant pattern, and has lasted well over one month. This type of insomnia is the most complex and may be caused by a variety of factors, including:
- Physical or mental conditions
- Depression and/or anxiety
- Arthritis and other sources of chronic pain
- Asthma
- Kidney disease
- Sleep apnea
- Restless leg syndrome
- Hyperthyroidism
- Parkinson's disease
- Constant changing of sleep schedule (e.g., shift work)
- Chronic stress
Chronic insomnia may also be behavior-based. Activities such as drinking caffeine or alcohol at night, smoking cigarettes before bedtime, watching television in bed, or worrying about the inability to fall asleep can contribute to chronic insomnia.
Treatment
Most short-term cases of insomnia resolve naturally. If you experience daytime sleepiness or impaired performance because of insomnia, using sleeping pills for the short-term may alleviate symptoms. But both over-the-counter and prescription sleep aids may cause side effects, so talk to your doctor or pharmacist about possible side effects before taking any sleep aid.
Chronic insomnia, which sleep experts believe results from an underlying physical or mental condition, is treated in the following steps:
- Diagnosing and treating the physical or emotional causes
- Changing or eliminating behavior that may worsen insomnia
- Prescribing medication (as a last resort; however, long-term use of sleep medication is highly controversial.)
Ten ways to get to sleep without pills
Follow these tips and you may be able to enjoy regular, restful sleep without having to take medication:
- Establish a regular sleep routine. Go to sleep and wake at consistent times every day.
- Try doing deep breathing exercises while in bed, visualizing the details of a relaxing scenario, or progressively tightening and relaxing muscles from head to toe.
- Use your bedroom only for sleep and sex—not as an office or TV room.
- Get regular exercise, but be sure to finish your exercise at least three hours before going to bed.
- Don't nap during the day, even if you have trouble sleeping at night.
- Avoid caffeine, nicotine and alcohol in the late afternoon and evening.
- Keep lighting dim. Avoid exposure to bright lights before going to bed. Also, keep your bedroom as dark and restful at night as possible.
- Try taking a warm bath before bedtime.
- Leave your bed if you can't sleep. If you're wide awake for a long time, get out of bed and do something else that may make you sleepy. This helps your body associate the bed only with sleeping.
- Try eating certain foods and using herbs that may produce drowsiness, including foods rich in the amino acid tryptophan (such as milk and turkey), the herbal remedy valerian, and aromatherapy using the herb lavender.
Resources
National Center on Sleep Disorders Research
http://www.nhlbi.nih.gov/about/ncsdr/
National Center for Complementary and Alternative Medicine
http://nccam.nih.gov
"Cognitive Behavioral Therapy for Treatment of Chronic Primary Insomnia," by J.D. Edinger, et al. Journal of American Medical Association, April 11, 2001.
Last reviewed August 2001 by Medical Review Board
