INSOMNIA

What Is Insomnia? Insomnia describes difficulty sleeping; whether in falling asleep, staying asleep, or achieving restful sleep. Most often, insomnia is secondary to an underlying emotional or physical disturbance such as anxiety or pain. There are few physical causes of primary isolated insomnia.

What Causes Insomnia? Difficulty falling asleep, or initial insomnia, is most commonly due to an underlying emotional disorder such as stress, anxiety, or depression. Physical causes of initial insomnia include alcohol ingestion close to bedtime, pain (as in chronic arthritis or lower back pain) and drug use or withdrawal. Prescription drugs that may cause insomnia include antidepressants, blood pressure medications, and steroids. Over-the-counter drugs linked to wakefulness include certain brands of aspirin, decongestants, and weight loss drugs, all of which may contain caffeine or other stimulants. Rarely, insomnia is caused by one of several physical conditions, often unbeknownst to the patient. Sleep apnea is one such disorder in which the patient periodically stops breathing while sleeping, causing brief interruptions of sleep. Although the patient may be unaware of waking through the night, sleep is not satisfying or restful. (People who suspect this disorder in themselves or in their spouses should seek medical advice, as sleep apnea has recently been linked to high blood pressure.) A similar problem involves involuntary, erratic limb movements which cause intermittent awakening and inadequate rest; again, the patient is quite likely unaware of the problem. A third rare disorder called restless leg syndrome is another cause of insomnia; patients with this problem experience extreme discomfort and a strong urge to move their legs. Early morning wakening is a common symptom of mood disorders, and depression in particular; however, it is also a normal change of the sleep pattern with age. Long-standing insomnia without any obvious psychological or physical cause is often simply a normal part of aging; it is common for older people to spend more time awake and less time in deep sleep. In addition, a shift in the body's internal clock often occurs between the ages of fifty and sixty, such that people tend to go to sleep later and wake up earlier in the morning.

Non-Medical Treatment Of Insomnia: A number of methods of getting a good night's sleep should be attempted before resorting to medication; this is known as practicing good sleep hygiene. First, the bedroom environment should be dark, quiet, warm, and reserved for sleeping only. A regular bedtime and morning schedule should be established; it may also be helpful to start a regular bedtime routine of a warm bath, a relaxing walk, or a few minutes of reading, for example. Caffeine, alcohol, and nicotine intake should be avoided or at least reduced, particularly near bedtime. Fluid intake should be minimal before bed to avoid the need to use the bathroom at night. Regular exercise may prove helpful; however, vigorous activity should be avoided in the few hours preceding bedtime. Naps may worsen night-time insomnia and are not recommended. It is important, albeit difficult, to prevent "sleep anxiety"; that is, worrying about not falling asleep or consciously trying hard to get to sleep. Rather than tossing and turning, it is better to go to another room to read or relax before returning to bed.

When Should I See My Doctor About Insomnia? If you suspect that your sleeping problem is due to depression, anxiety, or drug use (prescription or otherwise), consultation with your doctor is warranted. Likewise, if lack of restful sleep interferes with your daily functioning and the above methods do not lead to any improvement in sleep, your doctor may be able to help.

What About Sleeping Pills? Sleeping pills, also called sedatives or hypnotics, should be viewed as a last resort, and a short-term solution only. It is always a good idea to check with your doctor before buying over-the-counter sleeping pills, or using antihistamines or anti-nausea drugs for the purpose of inducing sleep. Sleeping pills, whether over-the-counter or prescribed, should be used only to help reset a normal sleep schedule and to reduce sleep anxiety. Long term use of sedatives can lead to the problems of dependency on them for getting to sleep, withdrawal symptoms or "rebound insomnia," and decreased effectiveness. In the case of depression-related insomnia, sedatives should not be used as they may worsen the depression; instead, antidepressant medications (tricyclic antidepressants) have proven effective.

What About Melatonin? Melatonin is a hormone produced by a small gland in the brain (the pineal); it is now available alongside herbal medicines in the United States. Some studies have shown melatonin to play a role in inducing and regulating sleep, among a host of other health benefits. However, very little is currently known about its precise mechanisms, actions, or potential side effects. Because there are melatonin receptors on cells of the brain, blood vessels, ovaries, and digestive system, its effects could be far-reaching; suspected side effects include decreased sex drive, infertility, and damage to the retina in the eye. In short, neither the benefits nor risks of this drug are fully understood, thus it is best avoided at this time. (Melatonin is not legally sold in Canada; in the U.S.A., it is not recognized as a drug by the Food and Drug Administration and is thus not subject to drug regulations.)