Are You Struggling With Insomnia?

Karla Robinson, MD

Trouble Sleeping At Night?

With so much debate surrounding the trial of Dr. Conrad Murray, and the death of Michael Jackson, it has really brought to light a common problem affecting many people each night-insomnia.  Insomnia is defined as difficulty falling asleep or staying asleep as evidenced by either frequent or early awakenings.  The sleep disruption has to occur despite having adequate time and opportunities to sleep to qualify as insomnia.  This condition is by no means rare, as it is estimated that almost 50% of Americans report having experienced insomnia at some point in their lives.  Approximately 20% of people report it as chronic or ongoing.

Insomnia can be classified as either primary or secondary.  Primary insomnia is an inability to sleep due to an actual sleep disorder.  This can be caused by prolonged stress or an imbalance in the sleep-wake cycle.  Primary insomnia actually accounts for very few cases of the inability to maintain a good night’s rest.  Over 80% of insomnia cases are secondary, in which the sleep disturbance is the result of another condition or illness and is not a sleep disorder on its own.  Most often this form of insomnia is caused by chronic medical problems, mental health disorders, medicines, drugs, and stimulants.

The effects of insomnia are not only a poor quality sleep leading to fatigue, poor attention, lack of concentration, motivation, and decreased functioning during the daytime or waking hours, but also significant physical effects.  Studies have shown a link between insomnia and high blood pressure, depression, anxiety, and heart disease.

Treatment of insomnia is dependent on the type and severity of symptoms.  Secondary insomnia can often time resolve on its own after correcting the cause.  In the instance of medication induced insomnia, once the offending medication is either discontinued or switched, the symptoms of insomnia disappear and a normal sleep pattern can resume.  If medical problems such as a thyroid disorder or bipolar disorder are responsible for the sleepless nights, once the conditions are treated, the symptoms of insomnia improve.

A good place to start with treating the symptoms of insomnia is addressing sleep hygiene.  Sleep hygiene often refers to the habits and conditions surrounding the sleep environment
that contribute to the overall sleep experience.  It is vitally important to make sure that the
conditions are ripe for a full night’s sleep.  Bedtime distractions can often be blamed for losing quality sleeping hours.  Eating, doing work, reading, or watching television in bed can all detract from a peaceful sleeping environment.  It is best to limit the bedroom to sleeping, in an effort to “train” your body to want to go to sleep when entering the room.  It is also important to maintain a regular sleep schedule throughout the week.  Even if the weekend schedule permits for “sleeping in” or frequent napping, resist the urge and maintain a regular routine for sleeping and waking. 

Avoiding things that are known to stimulate the body such as vigorous exercise, caffeine, and alcohol right before bed can also help promote good sleep hygiene.  While often used by those experiencing insomnia as a sleep aid, alcohol use at night leads to frequent awakenings at night and prolongs the symptoms of insomnia.  In addition to the type of beverage being a factor, it is best to avoid food and beverages just prior to bed in general, as to limit the need for nighttime arousal due to bathroom breaks.

There are times where medication may be needed to help in the treatment of insomnia, particularly in cases of primary insomnia.  Treatment is typically short-term as to limit
the abuse potential of the sleep aids and to maximize effectiveness.  As with any medications, the risk of side effects such as residual impairment, amnesia, and respiratory depression may limit their use.  Goals for medication use generally range from 2-4 weeks, although each case is assessed individually.

Insomnia is a problem preventing many people from experiencing a restorative sleep each night.  It can unfortunately lead to a significant decrease in overall productivity, lost wages, preventable accidents, and a decreased quality of life.  If you are experiencing difficulty achieving a restful sleep, speak with your physician to discuss ways to improve the amount and the quality of sleep you are getting each night.