Insomnia

Definition

Insomnia includes having trouble falling or staying asleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can affect not only your energy level and mood, but also your health, work performance and quality of life.

Insomnia signs and symptoms may include

• Difficulty falling asleep at night
• Awakening during the night
• Awakening too early
• Not feeling well rested after a night's sleep
• Daytime fatigue or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention or focusing on tasks
• Increased errors or accidents
• Tension headaches
• Gastrointestinal symptoms
• Ongoing worries about sleep

Causes of Insomnia

• Stress
• Anxiety/Depression
• Caffeine, nicotine and alcohol
• Poor sleep hygiene. This includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of your bed for activities other than sleep or sex.

• 'Learned' insomnia. This may occur when you worry excessively about not being able to sleep well and try too hard to fall asleep.

• Other sleep-related disorders, such as sleep apnea and restless legs syndrome, also become more common with age. Sleep apnea causes you to stop breathing periodically throughout the night and then awaken. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.

Your risk of insomnia is greater if

• You're a woman
• You're over age 60
• You have a mental health disorder
• You're under a lot of stress
• You work night or changing shifts
• You travel long distances
• Increased use of medications. Older people use more prescription drugs than younger people do, which increases the chance of insomnia caused by a medication.

Complications of insomnia

• Lower performance on the job or at school
• Slowed reaction time while driving and higher risk of accidents
• Psychiatric problems, such as depression or an anxiety disorder
• Overweight or obesity
• Poor immune system function
• Increased risk and severity of long-term diseases, such as high blood pressure, heart disease and diabetes.

Tests and diagnosis

This may involve a complete sleep wake schedule evaluation, blood test to rule out thyroid function, and If you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome. Also, you may need to spend a night at a sleep center.

Treatment and drugs

1. Behavioral therapies include the following depending on the cause of insomnia

• Education about good sleep habits
• Relaxation techniques
• Cognitive therapy
• Stimulus control
• Sleep restriction
• Light therapy

2. Medications

Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep.

Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use.