Insomnia

Insomnia

What is insomnia?

Insomnia is difficulty falling asleep or staying asleep that results in daytime problems. It can be either a long-term or a short-term problem.

1 in 3 adults will have a complaint of chronic insomnia at some point in their lives. It occurs more often in older adults, half of whom have some difficulty going to sleep, staying asleep, or both.

Problems with sleep often point to poor sleeping habits, but can be a sign of underlying physical or mental problems.

Not only is insomnia more common among older adults, but other sleep disorders such as restless leg syndrome, periodic limb movements, and sleep apnea are also more prevalent among the elderly. Most healthy older people don't usually have difficulties related to these changes, but people with medical and psychological disorders are more likely to develop sleep problems.

How does it occur?

Causes include:

• acute stress such as being in the hospital or having a sick relative
• depression, anxiety, and other emotional problems
• use of caffeine or other stimulants
• use of alcohol and medications which can relax you but lead to shallow, fragmented sleep, especially if used long term
• pain, shortness of breath, and other discomfort caused by an illness such as arthritis or heart failure
• poor sleep habits, including going to bed at different times at night, noisy surroundings, or eating or working in bed before sleeping
• changes in sleep patterns because of different work hours or travel.

Chronic illness or pain can cause insomnia. These include:

• Diabetes may result in frequent urination that interferes with sleep.
• Urinary incontinence or frequency, caused by drugs, prostate enlargement, or loss of bladder control, can interrupt sleep.
• Chronic lung diseases can cause frequent arousal due to decreased oxygen and the feeling of air hunger.
• Arthritis causes joint pain and stiffness, making it hard to sleep.
• Alzheimer's patients have decreased total sleep time and more frequent awakenings.
• Sleep apnea is a disorder where breathing stops periodically throughout the night. Most cases are due to partial airway blockage, and obesity is a contributing factor. Loud snoring and a characteristic arousal snort are signs of sleep apnea.
• Periodic movements in sleep is a condition where there is powerful flexing of the lower leg muscles many times throughout the night.
• Restless leg syndrome is a creepy, crawly, uncomfortable sensation in the leg muscles throughout the night. It can make falling asleep and staying asleep hard.

Certain medications can also interfere with sleep. You should ask your health care provider whether any of your medications may cause problems with sleep.

Also, studies have shown that there is a change in the quantity and quality of sleep for most people over age 65. These changes are due both to normal aging and existing illness.

Normal aging includes a general trend toward more time in bed but the same or less time asleep. Older people tend to go to sleep earlier in the evening and wake up for the day earlier in the morning. People also are more likely to take daytime naps as they grow older. Older men generally take longer to fall asleep and awaken more frequently than older women. Both sexes awaken briefly more often during the night, with an increase in the lightest and least restful sleep and a decrease in the deepest and most refreshing sleep.

What are the symptoms?

Symptoms include:

• difficulty falling asleep
• waking frequently in the night
• waking early in the morning and being unable to return to sleep
• not feeling rested in the morning or feeling tired during the day
• restlessness or anxiety as bedtime approaches.

Insomnia may be situational, which is temporary, or chronic, which is ongoing.

Situational insomnia occurs with a stressful life event. It involves difficulty falling asleep or staying asleep and lasts 3 weeks or less. This kind of insomnia generally goes away when the stress or life event is past. Sleeping medication may be needed for a time to help you through this period.

Chronic insomnia can be caused by irregular sleep-wake patterns resulting from shift work, drug dependency, stress, illness, or psychiatric problems. It lasts longer than 3 weeks and must be treated by addressing the underlying problem. Medication is only used for the most severe cases and only when it is really needed. Developing good sleep habits is also very important.

How is it diagnosed?

Your health care provider will ask you about:

• your sleep patterns
• use of any medications
• eating habits
• your mental and physical condition
• your medical and psychiatric history, and your family's history
• your job and travel patterns.

Your provider may ask your spouse, bed partner, or other family member about your sleep habits. You may also have a physical exam and blood tests.

You may be asked to write down the following when you get up each morning:

• how long you were in bed
• how much time you think you actually slept
• how many times and what times you awoke
• what time you woke up in the morning
• your thoughts about the quality of your sleep.

Your health care provider may suggest that you spend a night in a sleep center where you might have a continuous recording of your breathing, eye movements, muscle tone, blood oxygen levels, heart rate and rhythm, and brain waves during sleep.

How is it treated?

If a medical disorder is causing your insomnia, you provider will treat you for that. If drug or alcohol abuse is the cause of your insomnia, you will need to stop using these substances.

Your provider may recommend relaxation techniques, changes in diet, and a generally healthy lifestyle that includes exercise. Your provider also will probably recommend a regular sleep routine. In some situations, a medication may be prescribed to help you sleep. Other times, counseling is recommended to help resolve psychological problems or reduce stress that may cause or contribute to your insomnia.

How long will the effects last?

Often, insomnia lasts for just a few nights. If you have chronic complaints of insomnia, talk to your doctor.

How can I take care of myself?

• Use the bedroom only for sleep and sex, not for reading or watching TV.
• Keep the room dark and the temperature comfortable.
• Massage or a warm bath before bed may relax you.
• Soft music may help.
• Consider using white noise, such as a fan blowing.
• Keep active during the day. Exercise and get some fresh air.
• Establish a regular bedtime and wake-up time and stick to them even on weekends.
• Avoid daytime napping, especially in the late afternoon and early evening.
• Avoid caffeine late in the day.
• Avoid excessive fluid intake prior to bed.
• If you spend more than 30 minutes in bed and cannot fall asleep, get out of bed, read, or watch TV until you are sleepy.
• Maintain a reasonable weight. Excessive weight may cause daytime fatigue and may worsen sleep apnea.
• Stop smoking.
• Arrange your medication schedule with your provider so that you take any drugs that might sedate you in the evening and drugs that may interfere with sleep during the day.
• Avoid daily use of sleep medications. You may become dependent on them or build up your tolerance to them so that they no longer work as well.
• Don't use alcohol as a "nightcap."