Insomnia
Insomnia – the inability to fall asleep at night or to sleep soundly throughout the night – can be temporary or persistent and can have many causes.
Causes, Types and Diagnosis
Insomnia that is temporary is frequently classified as transient. If insomnia lasts longer than a few days or even a few weeks, it usually will be classified as permanent.
Women suffer the effects of insomnia more than men do, probably due to the many hormonal changes women experience. In addition, because of other factors such as a sedentary lifestyle or an underlying medical condition or as a side effect of prescription medication, insomnia can increase with age.
Insomnia that is not considered persistent can result from too much stress, from crossing into different time zones, or from environmental factors such as an increase in noise levels or temperature variations of more than a few degrees. Exposure to excessive light or loud and/or persistent noise including nearby traffic and even closer second-hand snoring can create an environment in which sleep is elusive. Insomnia can even be the result of learned behavior.
Medical treatment for intermittent or transient insomnia generally is not prescribed. That's because the condition typically remedies itself once the affected individual takes control of his or her situation and corrects the problem(s) causing the insomnia.
Permanent or chronic insomnia, on the other hand, can be more serious. The degree of severity will have a lot to do with what is found to be the underlying cause. Therefore, the first step that those suffering from chronic insomnia need to take is to meet with their health care providers. An in-person meeting is the only way to begin narrowing down the reasons behind the chronic insomnia.
This type of insomnia could be caused by an abuse of narcotics or even caffeine or by shift work. Or it could be due to any number of physical or mental disorders including depression, anxiety, kidney disease, heart trouble, restless leg syndrome, asthma, Parkinson's disease or a condition called sleep apnea. And there are even more reasons why someone might regularly have trouble getting a good night's sleep.
The process of determining the underlying cause could be long and might require numerous tests and evaluations, but it has to happen. Once the cause is known, it will be easier to identify whether medical treatments are necessary or whether the underlying cause of insomnia can be treated by making one or more behavioral changes. Alleviating insomnia could be as easy as eliminating caffeine several hours before bedtime.
Diagnosing insomnia can be ever trickier than diagnosing an underlying condition because sleep in general is subjective. What is an ample amount for one person isn't necessarily right for someone else. In general, those who have difficulty remaining alert, focused and able to concentrate during the day may be suffering insomnia. Keeping a sleep journal, answering a number of sleep-related questions and evaluating the answers and/or seeing a sleep specialist are some of the tools that can help diagnose insomnia.
Insomnia Cures and Treatments
If you are diagnosed with insomnia and the insomnia is not a symptom of an underlying problem, it can most often be 'cured' or 'treated' by incorporating one or more changes into your life. If on the other hand your insomnia is the result of a mental disorder, a breathing disorder or some other type of physical disorder, making more than a behavioral or lifestyle change likely will be required.
Hanging curtains to help block out light and sleeping in a room separate from someone who snores are both things you can do to treat your insomnia. So is practicing one or more forms of cognitive behavioral therapy. The goal of cognitive behavioral therapy is twofold. It helps you change your thoughts at bedtime and it helps you develop more favorable sleeping habits.
Stimulus control involves retraining yourself to think of bed only as a place for sleep or for intercourse. If you want to watch television or read you need to do those activities elsewhere. Once you start associating bed with sleep (or sex), the tossing and turning should cease, making it easier to fall asleep.
Progressive muscle relaxation helps many people who have trouble sleeping because they are not able to relax. While in bed their minds work in overdrive, thinking about the situations they should have handled differently during the day or worrying about all the tasks they have to complete tomorrow. With so much looking backwards and forwards, it's difficult to focus on the present task which is getting to sleep. Learning muscle relaxation and deep breathing techniques can help lower the stress, anxiety and tension that can keep you from falling asleep.
Besides (or in addition to) muscle relaxation, psychotherapy sessions can help you work out times during the day for worrying or for planning the next day's activities so you stop doing this when you're supposed to be sleeping.
Visual imagery is another effective relaxation technique that can help you fall asleep. Rather than focusing on your task list, picture yourself in what you consider to be a calm, serene environment. Imagining yourself repeatedly doing something that calms rather than stimulates (like counting sheep) can also help you fall asleep.
Sleep hygiene training consists of changing all those bad habits that keep you from falling asleep at night. Just like dental hygiene can help keep your teeth healthy, sleep hygiene can help keep your sleep healthy.
Developing regular and consistent sleep and waking times, eliminating alcohol, nicotine and heavy meals 6 hours before going to bed, avoiding daytime naps, incorporating bedtime rituals such as a hot bath or light reading or other tasks designed to help you relax, making sure your bedroom is cool and dark and incorporating moderate evening exercise together can help you fall asleep faster and sleep deeper. Remember though, it's an all-or-nothing treatment package!
These non-medical treatments are proving to be extremely effective at reducing or eliminating insomnia. What's even better is that they're safe and have no side effects!
Sleep Aids and Medications
There are many instances in which behavioral and environmental changes aren't effective at treating or curing insomnia. There are also times when insomnia sufferers simply don't wish to try these other types of treatments and cures. Fortunately for those individuals, several effective sleep aids and medications are available.
If taken correctly and only as needed for short periods of time, prescription medications need not cause any problems with addiction. That's good news especially since sleep medications are the most common treatment for insomnia.
Medications to treat insomnia are available by prescription and over-the counter. To obtain a prescription, you of course need to be under the care of a physician. This is actually wise since effective treatment begins with a firm diagnosis and an identification of any underlying causes for the insomnia. For example, if insomnia turns out to be a symptom of depression or anxiety, the patient will fare better when given a prescription designed to treat depression or anxiety rather than the sleep disorder.
When insomnia is identified as purely a sleep issue, the most effective sleep aids for promoting sleep are called hypnotics. The two main goals of hypnotics are to induce sleep faster and then maintain it for a longer period, resulting in better quality sleep.
There are half-life hypnotics and full-life. Half-life hypnotics are designed to stay in the system only half the amount of the time as full-life so they won't interfere with daytime activities. Hypnotics vary by dosage, too. They're most effective when taken for short durations and when their use is decreased over a period of time rather than all at once.
Antihistamines are the most common form of over-the-counter (OTC) sleeping aid. Although antihistamines are designed to block the chemicals that the body releases during an allergic outbreak, they have the ability to calm which makes them effective at encouraging sleep. However, this is a point of considerable debate. Some OTC sleep aids contain pain relievers and even if they don't, OTC sleep aids should never be taken with alcohol. Even though they're available without a prescription, it's advisable to consult with a medical professional before taking any type of sleep aid.
Melatonin supplements are another sleep aid that can help in dealing with insomnia. Melatonin is a naturally-occurring hormone the body produces as day turns into night. Melatonin helps the body prepare for sleep by lowering body temperature and triggering other changes inside the body.
Care must be taken when supplementing melatonin because there is always a risk of over-supplementation (ingesting more than the body needs to work effectively). In addition, nutritional supplements such as melatonin lack the stringent testing and reporting requirements that govern prescription medications so side effects and long-term effects may not be fully understood.
Some claim that herbal remedies including St. John's Wort, valerian root, chamomile and lemon balm are effective at reducing instances of insomnia, but like nutritional supplements, there are no regulations requiring the generation of reports and/or studies to back up these claims or document the benefits or disadvantages of long-term usage.