USF-COM
Department
of Family Medicine
Patient Education Information on...
Index of
Patient Education Topics
What is Insomnia and Who gets it?
Almost everyone has at one time suffered a loss of sleep. Often this is
only a minor irritation, but sometimes it becomes a major health problem.
"Having trouble falling asleep" or "having trouble
staying asleep" is known as insomnia, a problem which affects men and
women of all ages. In fact, 1 out of 2 people have suffered at least occasionally
from difficulty sleeping.
There are three basic types of insomnia: Transient, Short-term,
and Chronic.
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Transient insomnia is a brief disturbance of normal sleep patterns,
lasting only a few nights. It is usually caused by a change in sleep schedule,
excitement, stress, or an illness.
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Short-term insomnia can last as long as two to three weeks. Health
care providers look for ongoing causes, such as job changes, a divorce,
a serious illness, financial troubles, or a death of a relative or friend.
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Chronic or long-term insomnia lasts longer than a few weeks and
yields poor sleep every night, most nights, or several nights during each
month. About 10-15% of the people in the U.S. describe their sleep problems
as serious or chronic. Long-term insomnia often has medical causes. It
can also stem from poor conditioning or bad sleep habits.
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What are the symptoms of insomnia?
Besides difficulty sleeping, other symptoms of insomnia include:
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daytime fatigue
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irritability
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a feeling of not having rested well during the night
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What causes insomnia?
Personal Habits: Many "drugs" and behaviors
can result in or worsen sleeping problems. Drinking caffeine-containing
beverages and smoking are prime examples. Alcohol intake close to bedtime
also results in poor sleep. Varying bedtimes from night to night and changing
work shifts are other lifestyle factors that can undermine sleep quality.
Noise: Noise such as that from passing traffic,
airplanes, or a neighbor's television can disturb sleep. Too much light
in the room and extremes in room temperature can also interfere with sleep.
Medical Conditions: Primary sleep disorders, such
as disorders of breathing or periodic muscle contractions during sleep,
figure in more than half of all cases of chronic insomnia, according to
a nationwide study of 8,000 people conducted by the American Sleep Disorders
Association. Other physical factors such as arthritis, heartburn, menstruation,
headache, and hot flashes may also upset sleep.
Many disorders can stop you from sleeping well. Some are relatively
trivial, while others are
more serious. What's important is that most of them can be treated
and, even if the disorder
itself cannot be cured, your sleep can be improved. Below are some
of the most common
problems. If you are experiencing any of them, talk to your doctor.
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Anxiety: Anxiety and stress are among the most
common causes of sleeplessness. Sometimes it is possible to remove the
cause of the anxiety or stress. Do not try to "take on the world." Learn
to prioritize your life, separate your work from your leisure, and make
time for yourself. If this does not work, there are other ways to cope
with anxiety and stress, and with the sleep loss they may cause. Your doctor
will be able to give you more information.
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Depression: Clinical depression is more than
just feeling "blue," though depressed mood is an important symptom. Other
symptoms include irritability, loss of interest, loss of zest, feelings
of worthlessness, hopelessness, guilt, low energy, weight changes and sleep
disturbances. Depression is another common cause of sleeplessness
and, again, it can be treated. If you think you may be depressed, see your
doctor without delay.
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Snoring: Snoring happens when floppy tissue
in the back of your throat gets in the way of the air going in or out.
Snoring is more common in older adults, but should not be ignored just
because it is common. Regular snoring may also be a sign of sleep apnea,
which can be a serious condition. Snoring is a very treatable condition,
so if it keeps you or your partner awake, talk to your doctor.
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Sleep Apnea: Sleep apnea is a condition where
your breathing is temporarily interrupted while you sleep. A common sign
of sleep apnea is snoring followed by a period of silence, which ends with
a loud gasp as you start to breathe again. You may be unaware that this
is happening, but your sleep partner will be able to tell you. Sleep apnea
will not only interfere with your sleep, but may also be associated with
serious lung and heart problems.
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Pain: Almost any pain can keep you awake. Most
of the conditions that cause pain can be treated and, regardless of the
cause, almost any pain can be controlled. If pain is keeping you awake,
your doctor can help.
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Prostate trouble: If you are a man, you may develop
signs of prostate enlargement as you grow older. One of the first signs
of an enlarged prostate is the need to urinate more often, especially at
night. Frequent trips to the bathroom are very disruptive to sleep. Fortunately,
an enlarged prostate can be treated, both medically and surgically.
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Teeth grinding: Teeth grinding can interfere
with your sleep, but often you will only be aware that it is happening
because your sleep partner tells you so, or because you wake up with pain
in your jaws. If you think you are a teeth grinder, talk to your dentist.
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Sleepwalking: can be a sign of a significant psychological
problem and should never be ignored.
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Nightmares: Everyone has nightmares from time
to time. But frequent and terrifying nightmares that often interfere with
your sleep can also be a sign of an underlying medical or psychological
problem that might need treatment.
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Cramps: If you frequently wake up with muscle
cramps, especially in your legs, it may be a sign that you have a problem
with your circulation. This is often due to a hardening of your arteries
as you age. There are other possible medical causes of muscle cramping,
most of which are treatable; so, again tell your doctor about it.
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Restless leg syndrome: This is a condition that
causes your legs to twitch or jump spasmodically while you sleep.
Although it is not a serious condition in itself, it can interfere with
the quality of your sleep. Again, your partner may be the best person
to tell you if this is happening.
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Sweats: If you often wake at night because you
are drenched in sweat, it might be a sign that you are suffering from a
hormonal disorder. If you are a woman, it could be one of the signs of
menopause. However, frequent night sweats can also be a sign of diseases
such as diabetes, thyroid problems, or other medical conditions, so they
should not be ignored.
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How do you know if you have insomnia?
Consistent difficulty sleeping and daytime fatigue tell you that you have
insomnia.
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Now, what do I do about it?
Start by examining your own behavior. Keeping a detailed sleep diary for
a week or two often
reveals potential problems. Often, slight changes in your daily routine
can help you sleep better.
There are also proven sleep improvement methods developed by experts.
But you absolutely
must put into practice what you learn. Like repeating a golf stroke
or tennis backhand,
practicing the basics of good sleep is crucial to sleeping better.
Also remember that your
sleeplessness may have taken years to develop. So give yourself at
least two weeks with any of
these methods to see if it works for you. Make it fun!
Consider seeking medical advice if your sleep has been disturbed several
times during the past
month, or if lack of sleep interferes with how you feel or perform
the next day. Your doctor will examine your general health and evaluate
your sleep habits. If you can, make an appointment to talk about
your sleep difficulties only. This will ensure that your doctor is able
to devote enough time to the problem. If you have to combine this appointment
with a regular visit, be sure to explain that you want to leave enough
extra time to talk about your sleep concerns.
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Lifestyle modifications
For sleep complaints that are due to factors such as temporary stress or
poor sleep habits, most
sleep experts recommend lifestyle changes, sometimes in combinations
with short-term use of a
prescription sleep medication to help stop the cycle of poor sleep
quickly.
Pre-Sleep
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Exercise regularly. However, while regular physical activity is good, exercising
just before going to bed may actually make it harder to sleep.
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Avoid alcohol, caffeine and nicotine in the late afternoon and evening.
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If you have trouble sleeping at night, don't nap during the day, since
naps affect your ability to sleep at night.
Bedtime Customs
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Create a bedroom environment that is comfortable for sleeping; keep it
cool, dark, and free of noise.
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Use the bedroom for sleep and sexual relations only. Do not read, work,
or even watch television in bed.
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Establish a consistent sleep and wake schedule, as well as a regular bedtime
routine.
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Read a relaxing book or listen to soothing music before getting into bed.
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Take a warm bath.
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If stressful thoughts or problems are weighing on your mind, write them
down so you can put them aside for the night.
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If you are unable to fall asleep, get out of bed, leave the room, and do
something relaxing until you feel sleepy again.
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Medical Treatment
When supplemented by lifestyle changes, short-term use of sleep medications
may be a safe and effective therapy for individuals who have difficulty
falling or staying asleep. Discuss with your doctor whether use of a sleep
medication is appropriate for you.
In general, sleep medications can be divided into two categories: non-prescription
and prescription. Never drink alcoholic beverages while you are taking
any kind of sleep medication.
Over the counter medications:
Non-prescription sleep medications (those available without a prescription)
typically contain an antihistamine, which induces drowsiness. Although
many people use non-prescription sleep aids, they are not effective for
everyone. It is important to remember that, although they do not require
a prescription, they can -- like prescription medications -- cause side
effects, including dry mouth and dry eyes. Because they can also interact
with other medications that you may be taking, you may want to talk with
your doctor or pharmacist before using an non-prescription sleep aid.
Melatonin
Melatonin, a naturally occurring hormone that is available as a dietary
supplement in health food stores, also has been touted in the media as
a sleep aid. However, there currently are insufficient clinical data to
establish its safety and efficacy for this use. Melatonin works best
when given about 20 minutes before bedtime. Side effects may include
vivid dreams and morning tiredness.
Prescription drugs:
When used appropriately, prescription sleep medications can be both
effective and safe. However, as with all medications, drug interactions
and side effects can be experienced by some individuals. Some of the side
effects seen with prescription sleep medications include next-day drowsiness,
"rebound" insomnia (in which the insomnia gets worse for a short while
after the medication is discontinued), and temporary memory loss (involving
events occurring shortly after the drug is taken). In addition, some products
may cause dependence when used regularly for longer than a few weeks or
at high doses. Generally, prescription sleep medications are limited
to short-term use (7 to 10 days), and re-evaluation by a physician is recommended
if they are to be taken for a longer period.
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Complications of Insomnia
Being deprived of sleep can be both physically and emotionally agonizing.
Prolonged sleep loss
affects how we do our jobs or our happiness at home--it can even be
dangerous. Some
200,000 automobile accidents per year may be related to falling asleep
at the wheel. Sleep loss
has been a factor in major industrial accidents, such as the Exxon
Valdez oil spill and the Three
Mile Island nuclear plant accident.
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Web sites for more information on Insomnia
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Shuteye online: Online help for insomnia
and other sleep problems(http://www.shuteye.com/) (sponsored
by Searle laboratories) They have a sleep quiz, a sleep evaluation that
you can complete and show to your doctor at your first appointment, and
further information regarding insomnia.
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National Sleep Foundation Home
Page (http://www.sleepfoundation.org/) (sponsored by the National Sleep
Foundation) They have further information on all kinds of sleep disorders,
lists of publications about insomnia, and lists of community activities
promoting good sleep.
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Fatigue
Resource Directory: Scientific Information (http://www-afo.arc.nasa.gov/zteam/fredi/fredi.sec6.html)
(NASA’s fatigue resourse directory) This is a compilation of articles
and web sites with information on sleep disturbances.