Insomnia

October 21, 2018

 "Though sleep is called our best friend, it is a friend who often keeps us waiting!"

                                                                                         - Jules Verne

 

 

 We've all experienced it— tossing and turning, looking at the alarm clock thinking about how long it will be before we have to get up, and wondering when will we ever get to sleep. Most people have occasional nights of sleeplessness but for far too many, sleepless nights are all too common. You can't get to sleep, you can't stay asleep, or you wake up much earlier then you want to and can’t get back to sleep. You’re tired all the time making it difficult for you to fully participate in activities with your family and friends, making you irritable, or interfering with your ability to function well at work. When this happens three or more times a week for at least a month, you're problems can be classified as the sleep disorder Insomnia. 

 

If this sounds like you, you're not alone. Insomnia is the most common sleep disorder we have. It’s estimated that about the third of all adults report some symptoms of insomnia, 10% to 15% of adults experience daytime impairments in their functioning because of their sleep problems, and 6% to 10% of adults meet full criteria for a clinical diagnosis of Insomnia Disorder. About one and a half times more women experience insomnia than men. If you have insomnia, you may have episodic bouts lasting from one to three months, you may have persistent symptoms lasting three months or longer, or you may experience recurrent periods of insomnia with two or more episodes occurring within a year.  

 

Insomnia can occur anytime throughout the night. For some, they have a hard time falling asleep. This is called Sleep Onset Insomnia or Initial Insomnia. For others, they can get to sleep but have difficulty maintaining sleep, waking in the middle of the night and not able to get back to sleep for an extended period of time. This is referred to as Sleep Maintenance Insomnia or Middle Insomnia. Late Insomnia involves waking up too early and then not being able to return to sleep. Although most of us think of difficulty falling asleep when we think of insomnia, Sleep Maintenance is actually the most common form of insomnia that people experience followed by Sleep Onset insomnia. While you may have one type of insomnia to begin with, over time you may develop the other forms of insomnia or experienced several types of insomnia at the same time.

 

Although it is more common among middle-aged and older adults, you can develop insomnia at any point during your lifetime. Often the first episode occurs in early adulthood. Insomnia may be brought on by a situation that's causing you to worry which interferes with your ability to sleep, but then even after the situation has been resolved and you are no longer worried, you may continue to have sleep problems to the point of developing a sleep disorder. You may develop insomnia because of a negative association you've developed with your bed. An example would be a person who had been bedridden for an extended period of time who then associates illness with his bed. This association may be so subtle that he doesn't even realize it.  Another example of this would be a woman who develops insomnia due to menopause-related problems, such as hot flashes during the night, who continues to experience insomnia after she no longer has hot flashes.

 

Other factors can to the development of sleep problems. You might have a medical condition contributing to your inability to sleep such as  chronic pain. Depression and anxiety can also keep you from gaining restful sleep. It could be caused by the medications you're taking or even the timing of when you take your medications. Because so many things can contribute to a person having sleep problems, a thorough evaluation is extremely important. If medical or emotional conditions are contributing to sleepless nights, addressing these issues may be all that is needed to treat the insomnia. Although they are sometimes helpful for the occasional sleepless night, both prescribed and over-the-counter medications are not recommended for the long-term treatment of insomnia. Always check with your physician before taking any sleep aide.

 

Some suffering from insomnia find the hormone melatonin to be helpful. However, a word of warning—melatonin is not regulated by the Food and Drug Administration (FDA) and often the amount of melatonin listed on the label and the actual amount in the product can vary widely. Also, many herbal supplements are touted on the Internet to be effective in the treatment of insomnia but there has been very little research regarding their effectiveness and safety. Caution should be used because many herbs can be damaging to the liver or have other potential serious side effects. Being “natural” does not mean being safe—various poisons are derived from plants commonly found in nature. And again, just like melatonin, they are not regulated by the FDA so purity and the actual amount of the ingredient in the product may vary significantly from what is reported on the label. When I’m considering taking a vitamin (also unregulated by the FDA) or any other unregulated supplement, I personally like to check with the Consumerlab.com whose stated mission is “to identify the best quality health and nutritional products through independent testing” for information. Another good resource is the Memorial Sloan Kettering Cancer Center’s About Herbs database (https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs). Just as with prescription and over-the-counter sleep aides, always check with your physician before taking any herbal supplement. 

 

When it comes to treatment options, the most recommended treatment for insomnia is the scientifically validated Cognitive Behavioral Therapy for Insomnia (CBT-I). It is recommended for the treatment of both short-term and long-term insomnia. Among those who endorsed CBT-I are the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the National Institutes of Health (NIH). After the initial sleep assessment, CBT-I is conducted in approximately 6  to 8 sessions incorporating methods that help remove factors conditioning your mind to resist sleep, reduce the worry about being able to get to sleep, incorporate relaxation techniques, and helps you developed fatigue at the right time so you can go to sleep. 

 

If you are having any of these sleep problems, there is help for you so keep hope alive. Feel free to contact me with if you have any questions.

 

We are such stuff as dreams are made on; and our little life is rounded with a sleep. 

                                                                                 - William Shakespeare

 

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