Trouble falling asleep or staying asleep (usually called insomnia) is a problem for one out of every three American adults. If you have ever suffered from insomnia, you know how it can disturb your day and your night. It can make you feel fatigued during the day. It may cause you to have trouble focusing on tasks.
What Are Some Types Of Insomnia?
Insomnia can occur in people of all ages. Most people have insomnia for a night or two, but sometimes it can last for weeks, months, or even years. Insomnia is most common among women and older adults.
Adjustment insomnia is a problem with falling asleep or staying asleep that lasts for a few nights. Adjustment insomnia lasts less than three months. This type of insomnia is usually brought on by excitement or stress. Children, for example, may toss and turn just before school starts in the fall. Insomnia can happen the night before an important exam or sports event. Adults often sleep poorly before an important business meeting or after an argument with a family member or close friend. People are more likely to have trouble sleeping when they are away from home. Travel across time zones can cause adjustment insomnia. Exercising too close to bedtime (within four hours) or being sick can also cause this type of insomnia. When the stressful situation eases up, or when the sleeper adjusts to it, sleep returns to normal.
More than 20 million Americans complain of chronic insomnia. Chronic insomnia lasts at least one month. Most insomniacs worry about their sleep. But it is wrong to blame all troubled sleep on worrying. A study by the American Academy of Sleep Medicine showed that patients with insomnia may have problems with breathing or abnormal muscle activity during sleep. A sleep specialist can help to sort out the causes of insomnia and recommend effective treatments.
Tendency to Insomnia
Some people seem more likely than others to have insomnia during times of stress. Other people respond to stress by getting a headache or stomach ache. Knowing that you are likely to get insomnia and that it will not last too long can be helpful in dealing with it when it happens.
Relationship problems, a child with a serious illness or an unrewarding job may contribute to sleep problems. Learning to deal with stress may help treat your insomnia.
Psychophysiological (Learned) Insomnia
If you sleep poorly during times of stress, you may worry about not being able to function well during the day. You may decide to try harder to sleep at night. This usually makes things worse. After a few nights, some of the things you’re doing to get ready for bed may remind you of your trouble sleeping. Changing into your night clothes, turning off the lights and pulling up the blankets suddenly make you wide awake. Some people with psychophysiological insomnia may fall asleep quickly when they are not in bed. They may drift off on the couch, while reading the newspaper, watching TV, or driving. Even a few nights of poor sleep during a month can trigger psychophysiological insomnia. Treatment includes “unlearning” the reminders of poor sleep and learning new sleep habits.
Caffeine keeps people awake. If you have coffee in the evening your sleep will be less restful, even if it does not keep you from falling asleep. Nicotine also keeps people awake, and smokers may take longer to fall asleep than non-smokers. Many medications have stimulants in them. These include weight loss, anti-allergy and asthma medications. Some cold remedies also have stimulants in them.
You may think that having a glass of wine at bedtime will help you sleep. But alcohol, while it may help you fall asleep quickly, is likely to make you wake up briefly throughout the night.
If you are a shift worker you are more likely to experience sleep problems. This includes workers who have changing shifts. It also includes people who work nights or early mornings. Keeping the same schedule, even on weekends, is important. It can help program your body to sleep at certain times and to stay awake at others. Waking up at the same time every morning is one way to stabilize your sleep pattern. Having a routine is important.
You may think that resting and having a quiet lifestyle helps prevent insomnia. In fact, people who get little or no exercise may find it hard to sleep at night. Regular exercise helps people sleep better. The best time to exercise is the afternoon. Do not exercise close to bedtime. Leave at least two hours before bedtime for your heart rate to slow down after exercise.
Sleeping pills should be used as directed by your doctor. Some sleeping pills stop working after a few weeks if they are used every night. If you stop using them suddenly, however, your sleep may be worse for a time. This problem can be reduced by cutting back slowly on the use of sleeping pills. Your healthcare professional will help you with this. Studies have recently found that after slowly stopping sleep medication, a person’s sleep may be no worse than when the individual was taking sleeping pills.
Many medical problems can disrupt sleep and lead people to complain that they have insomnia. Psychiatric problems, other sleep disorders and physical illnesses may change sleep in ways that can easily be mistaken for insomnia. Treating the medical disorder may treat the insomnia.
One kind of insomnia – waking up very early – is one of the most common complaints of people with depression. If you have a psychiatric disorder you may sleep poorly. Treatment of the underlying disorder can help improve your sleep. Some of the medications used to treat psychiatric disorders may also cause insomnia.
Sleep Related Breathing Disorders
People with sleep apnea stop breathing during sleep. This can wake a sleeper dozens or even hundreds of times a night. The time when breathing stops can be as short as 10 seconds. Most people do not remember waking up. People with sleep apnea usually breathe normally when they are awake. A sleep study is needed to diagnose sleep apnea. Sleep related breathing problems are most common in men, overweight people, and older adults. People with sleep apnea often benefit from a treatment known as positive airway pressure (PAP). This treatment keeps the breathing passages open with a steady stream of air flowing through a mask worn over the nose during sleep.
Periodic Limb Movements
Periodic limb movements are brief muscle contractions. The contractions may cause leg jerks that last a second or two. The contractions occur every 30 seconds or so, often for an hour or longer. Some people have leg jerks every night. These movements can cause hundreds of brief interruptions of sleep each night, resulting in restless sleep. Periodic limb movements become more frequent and severe as we grow older. Treatment can include medication, evening exercise, a warm bath, or a combination of these. Iron replacement may be helpful if your iron level is low.
What Are Some Behavioral Treatments?
There are four suggested behavioral treatments that have been well tested with insomnia. These are usually given by sleep specialists.
Sleep Restriction: Insomniacs may stay in bed for a long time hoping this will result in more sleep time. Instead, too much time in bed spreads sleep over a longer period, breaks up sleep, and increases frustration. Sleep restriction therapy limits the time spent in bed and helps to make sleep more efficient.
Stimulus Control: Stimulus control aims to make the bedroom an inviting setting for sleep. For some, the bedroom becomes a place where things such as paper work and worrying take place. These activities and thoughts often prevent sleep. At bedtime, the link between these activities and your bedroom keeps you awake. Stimulus control procedures reduce wake-related activities in the bedroom, including lying awake in bed. This is done in order to improve the chances of falling asleep quickly.
Follow these instructions for stimulus control management of your sleep problem:
- Try to sleep only when you are drowsy.
- If you are not drowsy and are unable to fall asleep for about 20 minutes, leave your bedroom and start a quiet activity somewhere else. Do not let yourself fall asleep outside the bedroom. Return to bed when, and only when, you are sleepy. Repeat this process as often as necessary throughout the night.
- Maintain a regular wake time, even on days off work and on weekends.
- Use your bedroom only for sleep, illness, and sex.
- Avoid napping during the daytime. If you cannot resist taking a nap, limit nap time to a single nap of less than one hour. Do not nap later than 3 pm.
Relaxation Therapy: Relaxation therapy is a group of activities that try to produce a feeling of calm. These include trying to focus on pleasant thoughts in a quiet setting. Using relaxation therapy helps to increase the chances of falling asleep.
Cognitive Therapy: Many people have mistaken beliefs and attitudes about sleep. Some people think that bad things will happen to them if they get less than eight hours of sleep. Cognitive therapy uses methods of reasoning to correct these faulty ideas and thoughts. This helps to promote sleep and relieve daytime worrying and bedtime wakefulness.
No More Sleepless Nights, Revised Edition, by Peter Hauri PhD, and Shirley Linde PhD (John Wiley and Sons, New York, 1996)
Say Goodnight to Insomnia, by G.D. Jacobs and H. Benson (Owl Books, 1999)