INSOMNIA

The following discussion is for general informational purposes only and is not meant to provide the reader with specific medical advice. Please consult with your personal physician, or with a neurologist, for specific advice, guidance and information regarding your particular circumstances.

DESCRIPTION

Insomnia is the sensation of insufficient amounts of sleep. This problem may result from problems with sleep onset and sleep maintenance difficulties. In addition, insomnia patients may complain of disturbed or non restorative sleep.

Insomnia is underreported and undertreated. A National Sleep Foundation survey found that 70% of patients who have difficulty sleeping never discuss the issue with their physician. Only 6% of patients made an appointment to specifically discuss their sleep difficulties. The most common sleep complaints are waking up during the night and waking up feeling drowsy and tired in the morning.

The consequences of insomnia can be great. One third of chronic insomniacs have difficulty concentrating as compared to 7% of the general population, despite age and gender controls. Thirty six percent of chronic insomnia patients complained of an inability to enjoy family and social relationships. Fifty three percent of chronic insomnia patients also complained of memory disturbances. Patients with insomnia had a 250% increase in the frequency of motor vehicle accidents due to falling asleep behind the wheel. This is a MAJOR public health concern.

SYMPTOMS

Insomnia patients can be classified by the duration of their sleep problem. A patient may have insomnia lasting several days, termed transient insomnia. Short term or transient insomnia is applied to patients who have insomnia that last from days to up to 4 weeks. Chronic insomnia lasts for greater than one month. Insomnia can also be classified by causes, such as primary causes (chronic pyschophysiologic insomnia, sleep state misperception, inadequate sleep hygiene, altitudinal insomnia) or secondary causes (due to psychiatric conditions such as affective disorders, anxiety conditions, PTSD, schizophrenia or medical conditions such as neurodegenerative conditions, congestive heart failure, GERD, thyroid disease, hepatic disease, chronic renal disease, diabetes or pulmonary issues).

TREATMENT

Treatment for insomnia may include behavioral techniques or pharmacologic interventions. The following review will focus on the behavioral treatments of insomnia. One of the most common behavioral techniques includes stimulus control instructions. It targets the maladaptive association between sleep settings and sleeplessness. The following are step by step instructions:

1. Lie down only when sleepy
2. Do not use the bedroom for anything other than sleep (or intercourse)
3. If sleep does not occur in 20 minutes, get out of bed and do a relaxing activity
4. Lie down when sleepy again
5. If sleep does not occur repeat step 3
6. Get out of bed at your set wake time no matter how much sleep occurred.

Another common technique includes sleep restriction, which utilizes sleep deprivation. The patient is advised to set the amount able to be in bed the same as the total sleep time of the preceeding 2 week period. The patient is advised to get out of bed the time in the morning, no matter the amount of sleep obtained. When the sleep efficiency reaches 90%, the patient is allowed to sleep for 15-20 minutes longer.

Progressive Muscle Relaxation may also be very helpful. This entails reducing muscle tension by sequential tensing and relaxing of the main muscles groups. Patients are instructed to lie down, close their eyes and get comfortable. Then they should tense a particular muscle group and note the feeling. They should release the tension and note the feeling. Then they should repeat the same procedure for different muscle groups. In addition for some patients Biofeedback may also be very helpful.

A final important issue is to focus on improvements in sleep hygiene. Daytime habits to avoid include excessive caffeine consumption, smoking, alcohol consumption, napping during the day, exercising in the late evening, insufficient wind down period, late evening meals or watching television or reading before lights out. Nighttime habits that interfere with sleep include an irregular sleep-wake schedule, spending too much time in bed, falling asleep with T.V. or radio on, bed partner disrupting sleep, clock watching at night or staying in bed during awakenings. Morning habits that interfere with sleep include lingering in bed while awake in the morning, extra sleep during the weekends, outdoor light exposure in the morning causing a phase shift in circadian rhythms.