Everyone has a sleepless night from time to time. Lying awake night after night is another matter. With this condition, called insomnia, you do not get enough sleep to wake refreshed and able to function well during the day. Insomnia affects 25 million Americans all the time and millions of others some of the time. It strikes people of all ages.
Patterns of insomnia
Insomnia has different forms. Some people have trouble falling asleep. Others fall asleep easily but wake during the night and have trouble falling back asleep. Some people wake too early in the morning and cannot fall asleep again.
Of course not everyone needs the same amount of sleep. Sleep requirements normally decrease with age. Newborn babies sleep 18 hours a day, while teens need only 8 or 9 hours, and elderly people just 5 to 6 hours.
There are three types of insomnia:
- Transient insomnia lasts for several nights.
- Short-term insomnia lasts for 2 to 3 weeks.
- Chronic insomnia lasts for months or years.
Irregular sleep patterns are usually not a problem unless they are chronic and interfere with your daily life. If you are so tired during the day that you cannot concentrate, you may be prone to accidents. If you dread going to bed because you are afraid you will not fall asleep, your anxiety will keep you from sleeping.
Related symptoms
People with insomnia often complain of anxiety, depression, and irritability. Other symptoms may include mental confusion {dementia) and problems in concentrating and decision making. Insomnia also contributes to traffic and other accidents. Insomnia may also be associated with other sleep-related disorders such as sleepwalking, sleep terrors, nightmares, and bed-wetting.
Associations
Insomnia is almost always a sign of another problem either physical or emotional. Anxiety and depression are common causes of sleep loss. Stressful situations, such as losing a loved one, encountering money problems or job loss, travel, taking an exam, or giving a speech, can all lead to transient insomnia. Long-term insomnia is one of the main symptoms of serious depressive illness, including clinical depression and bipolar disorder.
The body cannot adjust quickly to abrupt changes in sleep schedules. These occur more often in a modern industrial society than they did in the hunting or agricultural societies of the past. A change in work shift from working days to working nights, for example is often a cause of insomnia. Jet lag is an- other source of sleep loss. In jet lag the internal body rhythms of those who fly long trips from west to east are upset. This upset often produces sleep disturbances.
Common physical causes of transitory sleep loss include heartburn and restless leg syndrome. Restless leg syndrome produces a crawling feeling inside the legs. These odd sensations force the affected person to get up and walk around until the feeling stops.
Insomnia in women sometimes appears during pregnancy or menopause, which is the life stage when a woman stops menstruating.
Two serious sleep-related disorders are sometimes related to insomnia: sleep apnea and narcolepsy. Sleep apnea is the sudden stoppage of breath during sleep. This seldom causes the person to awaken but disrupts normal sleep patterns, producing restless and unfulfilling sleep. Narcolepsy is a condition in which a person falls asleep several times a day for short periods. A per- son with narcolepsy may suddenly fall asleep even while talking, eating, or driving a car. Although this is quite the opposite of insomnia, any temporary insomnia from another source makes the narcoleptic attacks more frequent and prolonged.
Some other conditions, particularly asthma, ulcers, and the pain of arthritis, migraine, or angina, may cause interrupted sleep.
Prevention and possible actions
If insomnia leaves you feeling sleepy, tired, depressed, or anxious for three or more weeks, you should see your doctor for diagnosis and treatment
Sleeping pills may help provide sounder sleep and improve alertness the following day. This relief is only temporary, since sleeping pills do not cure insomnia. For some types of insomnia, sleeping pills may be dangerous. The sleep that drugs pro- duce is not natural or restful. After taking sleeping pills for a few days, you may feel more tired than ever and think that you need more of the drug. The more you use, the more disturbed your sleep. This creates a vicious cycle called drug-dependent insomnia. In one recent study, 40% of the people who complained of insomnia were dependent on the drugs they were taking to treat their insomnia. To prevent this, physicians seldom prescribe sleeping pills for more than three weeks. Nightly use is seldom advised. For stress-related insomnia, sleeping pills may be prescribed for only a few nights. In severe cases, a sleeping pill may be prescribed for a few weeks until psychotherapy takes effect.
Physicians do not recommend repeated use of over-the- counter sleeping pills because the long-term effects of their active ingredients are not known. Some may be habit forming for some people. Many drugs intended to induce sleep lose their effectiveness within two weeks if used regularly.
While alcohol relaxes some people enough to sleep, it leads to a shallow sleep with many awakenings. It is not a good idea to become dependent on alcohol to induce sleep. For one thing, regular use of alcohol at the same time each day is thought by some to contribute to the development of alcoholism. Furthermore, when alcohol is combined with sleeping pills, as often happens because of the shallow, unsatisfactory sleep induced by alcohol use, the result may be fatal.
Relief of symptoms: Remedies for insomnia include the following:
- Regular exercise during the day, not at bedtime
- No caffeine-containing beverages after noon
- No smoking, since nicotine is a stimulant
- A hot bath or whirlpool before bed
- A glass of warm milk at bedtime
- No daytime naps
- Reading a light book (no work-related material)
- A comfortable bed in a room that is neither too hot nor too cold
- Counting sheep
Some sleep researchers recommend delaying bedtime for an hour or two if you cannot sleep. If you do not fall asleep within 20 minutes after trying this, get up and do some quiet activity, such as reading or working on a hobby. Do not smoke or eat. The next day, whether sleep came easily or not, get up at your regular time and try to get through the day without falling asleep. Do not let your days and nights get turned around.
