Insomnia is trouble sleeping. It’s very common. About 80 million American adults have sleep problems.
Primary insomnia can involve less sleep, less restful sleep, interrupted sleep, and delay in falling sleep. Secondary insomnia is usually related to a psychiatric disorder (depression, anxiety), medical condition, or using alcohol, caffeine, or illicit drugs (amphetamines, cocaine).
Nightmares often occur early in sleep and are usually remembered. Night terrors, which children often have, occur later and aren’t remembered. Other conditions affecting sleep include enuresis (bedwetting) and sleepwalking.
Insomnia is most common in elderly people. It may be related to a crisis, a medical condition, such as heart disease, or an emotional or psychiatric problem, such as depression, anxiety, and schizophrenia. Medicines, cigarette smoking, and poor sleep habits lead to insomnia. Working at night or in shifts and traveling through different time zones may also cause insomnia.
Symptoms include trouble falling asleep or staying asleep, waking early in the morning, and daytime tiredness.
The health care provider can identify insomnia by hearing about symptoms. If the diagnosis is unclear, a sleep study may be done to look at brain waves and sleeping pattern and to rule out disorders such as sleep apnea and restless leg syndrome. Measuring the total amount of sleep is not enough to diagnose insomnia. The quality of sleep is also important.
Treatments include reducing stress, by learning and practicing relaxation. For example, a warm bath, soft music, relaxation tapes, earplugs, eyeshades, and electric blanket may help. The health care provider may prescribe medicine, usually used for a short time or just on certain nights. Sometimes, long-term treatment is needed. Prescription medicines include sedative and hypnotic drugs. They include zolpidem and benzodiazepines such as temazepam. They should be used temporarily because of the chance of addiction.
Herbal (melatonin and valerian root) and over-the-counter medicines are also used. Several over-the-counter drugs are available. Over-the-counter sleep aids and some herbal agents may have serious interactions with other drugs. The most commonly used sleep inducer is alcohol, but alcohol makes sleeping problems worse.
Diet is important. Caffeine or other stimulants shouldn’t be taken late in the evening. If the problem is secondary insomnia or comorbid insomnia, the associated disorders must be treated in addition to focusing on insomnia.
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