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What is insomnia?

 

Insomnia is an inability to get the amount of sleep needed to function efficiently during the daytime. It is caused by difficulty falling asleep, difficulty staying asleep or waking up too early in the morning.  Insomnia is rarely a “primary disease” meaning an isolated medical or mental illness but rather a symptom of another illness.  It can create significant distress or impairment in daily functioning.  When this occurs, an individual may develop a preoccupation with sleep and become more and more distressed as a cycle of striving to sleep, being frustrated and distressed at the inability to do so, and then being less and less able to sleep.  Long-term insomnia can lead to deterioration of mood or motivation; decreased attention, energy and concentration; and increased fatigue, body weakness, and lethargy.

 

 

What things put a person at higher risk of experiencing insomnia?

 

Insomnia is a very common problem with over one-third of all Americans reporting difficulty sleeping and approximately one-fifth of Americans with significant sleep disturbances.  One in 20 Americans is prescribed a medication with the sole purpose of improving their sleep. However, it can be dangerous to take a medication to improve one’s sleep without further investigating the underlying cause of the symptom with one’s doctor.

 

Several variables could place a person at risk of experiencing insomnia.  Insomnia is more often a symptom or a presenting complaint, rather than an independent diagnosis,

 

  • Other mental health conditions could place one at higher risk of insomnia: depression, mania, anxiety to name a few;

  • The existence of a general medical condition, for example, pain, breathing problems, other neurological disorders;

  • Substance use or abuse;

  • Breathing-related problems such as sleep apnea.

 

 

Can insomnia be treatedHow?

 

Effective treatment of insomnia should be directed at the identifiable causes. Psychosocial, behavioral, and pharmacological approaches may be helpful.  Cognitive behavioral therapy as well as other therapies may be helpful. 

 

Improving “sleep hygiene” (or sleeping habits or routines) is a “first-line” treatment of choice for most people with insomnia.  Relaxation techniques may be useful in helping people to feel “ready to go to sleep” and in decreasing the anxiety experienced by many people with insomnia associated with falling asleep.  Medications may be effective, but one must be aware of side effects, tolerance, and addiction issues with many of these medications.  Melatonin may have a role in prevention and treatment of sleep disturbances, but your physician should be watchful and prudent about its use until its effectiveness is proven.

 

 

How does insomnia progress?

 

Insomnia typically begins in adolescence or early adulthood and has a fairly sudden onset at a time of psychological, social, or medical stress.  Its course may be limited to several months, but in 50% - 75% of the cases, chronic symptoms may last for more than 1 year.  In some cases, the course is episodic with periods of better or worse sleep occurring in response to life events such as vacations or stress.

 

 

Do people with insomnia get better?

 

The prognosis of insomnia is variable and depends on the duration and cause.  The prognosis for insomnia due to rapid travel across time zones (that is jet lag) is good and the symptoms usually go away within a few days. Outcomes of short term insomnia like insomnia caused due to stress are usually very good and related to improvement of the stressful condition.  Chronic insomnia can sometimes be difficult to treat. People with chronic insomnia usually need detailed evaluation for proper diagnosis and treatment. Prognosis or outcome of chronic insomnia can be influenced by other medical conditions, such as arthritis, mental health disorders, congestive heart failure, chronic obstructive pulmonary disease (COPD), and chronic pain syndromes.  Insomnia due to mental health disorder like depression or anxiety will need treatment of the underlying cause.

 

 

 

Sources and Links

 
  • American Psychiatric Association.  (2000).  Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision.  Arlington, VA:  American Psychiatric Association.
  • National Alliance on Mental Illnesshttp://www.nami.org/factsheets/Insomnia_factsheet.pdf
·         For a good listing of the diagnostic criteria of insomnia see  http://psychcentral.com/disorders/sleep/insomnia.htm
·         If you were in physical pain, you’d see a doctor to find out what’s wrong. Your mental health is just as important.  Learn more here about how to check yourself, from getting a mental health screening to visiting a counseling center. You can use the anonymous Self Evaluator to learn if a treatable mental health problem, including insomnia, could be affecting you or a friend. Be proactive about your mental health: it’s the first step to feeling better. http://www.ulifeline.org/COD/self_evaluator
·         The United States National Center for Complementary and Alternative Medicine (NCCAM) mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.  They do that by advancing the science and practice of symptom management; developing effective, practical, personalized strategies for promoting health and well-being; and enabling better evidence-based decision making regarding CAM use and its integration into health care and health promotion.  Information available there about complementary and alternative treatments for insomnia, for example, can be found at http://nccam.nih.gov/health/sleep.
 
 
 
 
02/25/2014