Insomnia: Not Something to Lose Sleep Over by Dr. James Pearce, M.D.

ImageWe all dream of the perfect night sleep and waking up fully restored and ready to face the following day. Sleep is as important to your health as a balanced diet and regular exercise. It can affect you both physically and mentally. However, as many as 40% of adults experience insomnia each year with the direct cost of treatment as well as indirect cost (including lost productivity) adding up to $30-$35 billion annually. One in ten American adults experience chronic or persistent insomnia.

Insomnia is defined as a subjective experience of inadequate or poor quality sleep. It may include difficulty falling asleep, difficulty maintaining sleep, waking up too early, or waking up feeling unrefreshed. It may be classified as transient, short term, or chronic depending on the duration of symptoms.

Causes of insomnia may include stress, medication side effects, anxiety, depression, changes in environment or work schedules, and a variety of medical problems. Other behaviors may exacerbate the problem: excessive caffeine, alcohol, or smoking before bedtime, worrying, napping during the day, or irregular sleep/wake schedules. It is found in males and females of all age groups, although it seems to be more common in females and the elderly.

A variety of treatments are available including behavioral modifications and medications. Keeping a sleep diary can greatly help you and your doctor determine the best treatment for you. The sleep diary will help track when you go to bed, estimate time to fall asleep, estimated number of awakenings during the night, what time you wake in the morning, and to rate the quality of your sleep and how rested you feel.

General sleep hygiene measures include:

  • Avoid caffeine after lunchtime (coffee, colas, teas, and yes even chocolate!)
  • Avoid tobacco and alcohol prior to bed
  • Physical exercise everyday, but not 3-4 hours prior to bedtime
  • Use your bed for sleep and sexual activity only
  • Establish a set bedtime and wake-up time including on weekends
  • Avoid or limit napping during the day
  • Leave the bed after 20 minutes if unable to sleep and do something relaxing and non-stimulating. Return back to bed only when you begin to feel sleepy.
  • Keep your bedroom dark, cool and quiet
  • Try to relax and unwind before your retire and not take your problems with you to bed

If these general sleep hygiene measures don’t help enough, you may be tempted to try over-the-counter (OTC) medications such as Benadryl ( Tylenol PM) but these medications should be avoided in people over the age of 65 or for people with certain health conditions secondary to their side effects and safety. Other supplements available include melatonin or valerian, but their results are mixed and additional research is needed and under investigation to better assess their safety and whether they are effective sleep aids.

If you continue to have persistent problems with sleep you should visit your doctor and discuss your concerns and treatment options. Your doctor may recommend keeping a sleep diary to chronicle and track your seep regimen and habits. They should also review your medical history and medications and discuss potential underlying and treatable medical or psychological problems that may be interfering wit your getting a good night’s sleep.

There are also a variety of prescription sleeping polls that may be very helpful in some cases. They are best used for temporary relief as regular use can lead to rebound insomnia, but newer medications are now available which have the indication for chronic and long-term use. Cognitive Behavioral Therapy (CBT) should also be included in the management of chronic insomnia. Another option may be to order specialized sleep studies if a primary sleep disorder is suspected such as Obstructive Sleep Apnea (OSA), Restless Leg Syndrome (RLS), or another Periodic Limb Movement Disorder.

Insomnia is a very prevalent and widespread problem. It can be successfully managed in conjunction with your doctor after assessing your medical and sleep history. Many behavioral and pharmacological therapies are available for both acute and chronic insomnia. If your insomnia interferes with your daily activities, you should discuss this issue with your primary care physician.

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