Insomnia includes a wide variety of sleep complaints
usually involving insufficient quality or duration of sleep. Typically,
people with insomnia complain of at least two of these symptoms:
- problems with falling asleep at bedtime (which
we call onset insomnia), or
- waking at in the middle of the night and having
difficulty falling back asleep (which we call maintenance insomnia),
or
- having a final arise time that's too early
in the morning (which we call early morning awakening), or
- excessively light sleep or restless sleep during
the night, or
- daytime fatigue, which can get in the way of
memory, concentration, and work efficiency and which can cause
restlessness, irritability, anxiety, or a sense of helplessness
during the day.
Onset and maintenance insomnia are often associated
with anxiety, and maintenance insomnia and early morning awakening
are often associated with depression.
Who will have insomnia?
The most common predictors of insomnia are age and
gender. More than 25% of people aged 65 or older have difficulty
sleeping. Twice as many women complaint of insomnia as men.
The
diagnosis of insomnia
The amount of time spent sleeping varies from individual
to individual and may not be a good indicator of whether one may
have insomnia.
According to the national Health
Organization:
- 71/2 hours is the average amount of time
for normal sleep
- 6% of the population require 6 hours of
sleep or less to feel rested
- 4% of the population need 9 hours of sleep
Insomnia is diagnosed by sleep specialists if
a person often:
- requires more than 30 minutes to fall asleep
- if they awaken for a total of 30 minutes or
more after they have been sleeping
- if the person awakens too early in the morning
with less than six hours of sleep
- if the person complains of feeling "FOGGY" sleep
(that is, feeling half awake and half asleep)
- if the person reports daytime fatigue, concentration
problems, irritability, anxiety, or depression.
A reliable predictor of insomnia is the sleep
efficiency rating. To find your rating:
Divide your time asleep (5hours).
By the total time you spend in bed (7 hours).
7h/5h = 0.71
If your sleep efficiency is significantly below
85%, you are likely to be diagnosed with an insomnia problem.
Frequently, especially if medical causes of insomnia
are suspected, polysomnography, which is an overnight sleep study,
is conducted to find out what specific body processes are operating
effectively during sleep and wakefulness. Throughout the night,
precise measurements are taken of your brain waves, blood oxygen
level, eye movements, muscle tension and movements, breathing through
the mouth and nose, chest and abdomen movement while breathing,
and heart activity.
How does insomnia
differ from occasional sleepless nights? It's
normal to experience occasional sleepless nights resulting
from worry about home, business and family.
What are some medical issues involved
with insomnia? Frequently, but not always, insomnia
can be caused by anxiety or depression, which often requires
medication from a physician. In turn, anxiety and depression
are often a result of insomnia. Some examples:
- Obstructive sleep apnea
- Leg or arm movements during sleep
- Heartburn
- Acute physical pain
- Circadian rhythm disorder
- And many more
When medical factors have been ruled out or dealt
with, then insomnia is sometimes treated by a mental health provider.
Chronic insomnia
Psychological insomnia. In the field of sleep
medicine, chronic insomnia is referred to psycho-physiological
insomnia, referring to a person's conditioned anxiety about the
sleep experience and body tension when trying to fall asleep.
Chronic Insomnia can be
learned. When we initially experience a medical or psychological
stressor which causes us to lose sleep, we may begin to associate
certain behaviors with the stress, such as...
- our bedtime,
- our bed and bedroom, and
- our bedtime rituals (like brushing teeth)
...causing our brains to interpret these
behaviors as signals to interfere sleep.
Bedtime "Cues". After awhile,
these bedtime signals start to acquire a powerful, negative meaning.
Whereas, before the stress began, they had been normal signals
for going to sleep and staying asleep, they now transform, after
repeated nights of poor sleep, into signals for stopping sleep.
It's almost as if our bedtime, our bed and bedroom, our bedtime
rituals are the cues that now tell us to stop! don't think about
going to sleep and staying asleep it's impossible.
In the presence or those powerful negative cues,
- our minds become alert, awake, and vigilant,
focusing intensely on the prospect of not sleeping and rapidly
reviewing our options, or action plans, for correcting the problem,
or compensating for it tomorrow
- we experience anxiety and frustration
- adrenaline and glucose are released into the
bloodstream
- our hearts begin to pump vigorously, and our
blood pressure increases, to provide emergency supplies of oxygen
and glucose to our tissues
- we experience hypersensitivity to sounds and
light
- we try fruitlessly to make ourselves sleep
- our thoughts race about our predicament, or
our thoughts race about nothing in particular
- we worry about unchangeable things in our lives
not yet accepted and changeable things not yet changed
- our blood is diverted away from our digestive
tract to the skeletal muscles, which have become tense and taut,
ready to spring into action
- and the cycle continues night after night
We're especially concerned that the signs will
indicate that tonight will be another sleepless night. Because
of this behavior that we repeat nightly, we learn to associate
the sleep experience, with feeling anxious, guarded, and uncomfortable
about the prospect of having trouble failing asleep and staying
asleep. This learned pattern becomes more and more ingrained in
our nighttime functioning, and we move more and more into the vicious
cycle of chronic insomnia. We feel out of control, and try vainly
to regain that control. As the sleep becomes more difficult to
achieve the insomnia becomes a self-fulfilling prophecy. The insomnia
becomes chronic, if undiagnosed and untreated by a sleep medicine
specialist.
Mental
Health and the Treatment of Insomnia
Psycho-behavioral Intervention. Coaching
patients in behavioral strategies and psychological strategies
for improving sleep.
Behavioral Strategies. Behaviorally, work
in regularizing the sleep regimen, relaxing before bedtime, eliminating
daytime napping, reducing- caffeine intake, etc.
Psychological Strategies. Psychologically
eliminating the conditioned anxiety about the sleep experience,
and the body tension that interferes with sleep.
Absence of Bedroom Cues Helps Sleep. Insomniacs
report good sleep when they are not in the presence of their regular
negative bedroom cues and when they are not trying to sleep; such
as on a vacation, watching television, reading, or riding as a
passenger in a car.
THIS INFORMATION IS NOT TO BE
USED AS A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE.
SEEK THE
ADVICE OF YOUR PHYSICIAN BEFORE STARTING ANY NEW TREATMENT OR
WITH ANY QUESTIONS YOU MAY HAVE REGARDING A MEDICAL CONDITION.
