Insomnia. sleep disorder, sleep disruption

Insomnia is the inability to fall asleep easily, or remain asleep throughout the night, or waking too early in the morning.  There is controversy surrounding the average number of hours of sleep that an adult requires.  It was thought that adults require 7 – 8 hours nightly, but that number is presently under review.   Researchers purport that people require less sleep with age and suggest the number may be as low as 6 hours for the older adult.  

A disruption of the body’s circadian rhythm may lead to insomnia.  The circadian rhythm is the regular recurrence of certain phenomena such as body temperature, hormone production and release, sleep, etc. in cycles of approximately 24 hours.  The biological processes occur at about the same time each day or night. 

Most individuals have occasional nights of restlessness, which is normal. However, prolonged restlessness may lead to diminished memory, depression, headaches, impaired concentration, and an increase in risk of substance abuse. 

Signs and Symptoms

Common symptoms of insomnia include:

• Anxiety as bedtime approaches
• Daytime drowsiness, fatigue, irritability, difficulty concentrating, and impaired ability to perform normal activities
• Inability to sleep despite being tired
• Not feeling refreshed after sleep

Causes, Conditions, or Situations Leading to Insomnia:

• 50% of cases have no identifiable cause
• Certain prescription medications such as decongestants, bronchodilators, and beta-blockers
• Excessive computer work
• Hormonal changes during menstrual cycle with insomnia occurring during menstruation and sleep improving mid-cycle around ovulation
• Lifestyle choices such as consuming coffee, alcohol, cola drinks, recreational drugs, smoking, heavy meals, and drinking large quantities of fluids causing uncomfortable bladder distention.
• Menopausal women (30%-40%) due to hot flashes, night sweats, anxiety, and/or changes in hormones
• Occasionally a symptom of an underlying medical conditions such as chronic sleep-induced respiratory problems, nocturnal myoclonus which causes painful cramping of the legs, gastroesophageal reflux causing heartburn, chronic pain syndromes, heart disease, arthristis, ADD, etc.
• Partners who snore or are restless throughout the night
• Shift work, travel across time zones, and loss of vision as circadian rhythms are partially regulated by the release of melatonin from the brain in response to sunlight
• Smoking cessation may lead to short-term insomnia
• Stress from family, school, work, events
• Type of bedding may affect sleep and may improve with changing to a firmer or softer mattress, lighter or heavier blankets, a device to support bedding at the foot of the bed, different pillow, etc.
• Underlying psychological, psychiatric, and neurological conditions such as anxiety, depression, bipolar disorder, dementia, Parkinson’s disease, restless leg syndrome, post-traumatic stress disorder, etc.

Diagnosis

If you report symptoms of insomnia or sleep disorders to your physician, he or she will first obtain a detailed sleep history by asking questions about your sleep patterns and sleep quality. He or she will also ask questions to determine whether you snore, have any underlying medical conditions, take medications, or have recently undergone any significant life changes. Keeping a sleep diary (recording all sleep-related information) may help the physician determine the type of insomnia and how best to treat it. The primary care physician may recommend a sleep specialist or a sleep disorders center where brain waves, body movements, breathing, and heartbeats may be electronically monitored during sleep.

Preventive Care

The following lifestyle changes can help prevent insomnia:

• Avoid caffeine (especially after noon) and nicotine
• Early treatment of insomnia may also help prevent psychiatric disorders such as depression
• Exercise regularly.  However, exercise can stimulate arousal so it should be done in the morning or afternoon.
• Get regular exposure to late afternoon sun to stimulate the release of melatonin which helps regulate the circadian rhythm
• Practice stress reduction techniques such as yoga, meditation, or deep relaxation
• Seek anxiety disorder help and support