Insomnia

• Insomnia is the symptom of difficulty falling asleep or staying asleep.

• Insomnia is habitual sleeplessness.

• Background:
There are two distinct types of sleep.
1. REM sleep is the dreaming sleep known as Rapid Eye Movement(REM)) sleep
2. Non-REM sleep is the deep restful stage of sleep which is divided into 4 distinct stages.

• Overview:
Insomnia is very common and affects up to 40% of the population.
Insomnia is more common in the elderly and in women.
Insomnia is defined by a complaint of the quality or amount of sleep for at least three times per week for at least one month.
Chronic insomnia is sleeplessness lasting longer than 3 weeks
Although the human body requires sleep for normal function, the exact amount of sleep is not known.
Although the human body requires sleep for normal function, the exact amount of sleep is not known.
Eight hours of sleep per night is average.

• Symptoms:
Sleeplessness
Multiple awakenings while trying to sleep
Nonrestorative sleep, not feeling refreshed after sleep
Anxiety

• Causes:
Insomnia is common and more than 80% of all cases of insomnia are the result of:
· medications (decongestants, amphetamines, anti depressants)
· caffeine (coffee, tea, soda, chocolate)
· tobacco
· alcohol
· pain
· anxiety
· depression

• Complications:
Sleep-related motor vehicle accidents
Hypertension
Depression
Anxiety disorder

• Treatment:
1. Practice good sleep hygiene:
Avoid all napping
Get regular exercise
Reduce noise in the room while sleeping
Eat dinner at a reasonable time
Avoid caffeine, alcohol, cold medications
Avoid excessive fluid intake before bed
Avoid non-sleep activities while in bed such as eating, reading, or watching television
Avoid clock watching while trying to sleep (take the clock out of the bedroom)
If not asleep within 15 minutes after going to bed, get up and return to bed when you feel sleepy
If you still want to lie down, do so in another room

2. Sedatives.  Sleep with medication is better than no sleep

• Insomnia that persists or recurs should be evaluated by your doctor.

References
Principles and Practice of Sleep Medicine, 4th ed. Philadelphia, Saunders, 2005
Hypothalamic regulation of sleep and circadian rhythms. Nature 437:1257, 2005 [PMID: 16251950]
Insights from studying human sleep disorders. Nature 437:1279, 2005 [PMID: 16251953]

Posted on June 13, 2010

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