In the year 2007, the United States Department of Health and Human Services reported that approximately 64 million Americans suffered regularly from insomnia each year. Women suffer 1.4 times more often than men. Insomnia is not a disease in and of itself, but a symptom of a sleep disorder. Insomnia is characterized as an inability to fall asleep, or stay asleep through the night, or both.

TYPES OF INSOMNIA

There are three types of insomnia: transient, acute and chronic. Transient insomnia can last days, or weeks. It may be caused by the timing of sleep, severe depression, changes in the environment, or stress. Its effects on the body are like those of sleep deprivation.

Transient insomnia lasts for days to weeks. Its effects are similar to sleep deprivation.

Acute insomnia is insomnia that continues consistently for a period of three weeks to six months.

Chronic insomnia can go on for years at a time.

PATTERNS OF INSOMNIA

There are four patterns of insomnia: onset (difficulty falling asleep), middle-of-the-night (difficulty falling back to sleep after awakening in the night), middle (difficulty maintaining sleep), and terminal, or late insomnia (waking too early).

Patterns of insomnia are related to its causes.

Onset insomnia, characterized as difficulty falling asleep upon first retiring, is often associated with anxiety disorders.

Middle-of-the-night insomnia, sometimes referred to as nocturnal awakenings, occurs when a person falls asleep readily upon going to bed, but awakens in the night, or too early in the morning, then has difficulty getting back to sleep. This category includes middle and terminal insomnia.

Middle insomnia is characterized by waking in the middle of the night. Pain syndromes and medical illnesses are often associated with this pattern.

Terminal or late insomnia means waking too early in the morning. It is often associated with clinical depression.3 Considerable research indicates a strong connection between insomnia and depression.

DIAGNOSES

Insomnia may be difficult to diagnose. It is sometimes confused with delayed sleep phase syndrome.

CAUSES

Causes of insomnia include: diet, lack of exercise, obesity, illness, drugs, medications, caffeine, ephedrine, stimulants, psychoactive drugs, hormones and hormone shifts, problems of life (stress, fear, etc.), mental afflictions, shift work, among other causes. Excessive alcohol intake can cause middle-of-the-night insomnia and other side effects such as hangovers, headaches and morning grogginess.

COMPLICATIONS

Physical complications include possible obesity, risk of heart disease and/or diabetes, high blood pressure, and circadian rhythm disorder.

Some of the psychological complications of insomnia are: lower performance, risk of depression, slowed reaction time, and risk of anxiety disorder.

LENGTH OF SLEEP

How much you sleep can even affect your mortality. It appears that the optimum amount of sleep is about seven hours. Those who slept about seven hours per night had the lowest mortality rates. More sleep – eight hours or more each night increased the mortality rate by 15%. That rate of loss was also found in those who slept three and a half hours or less per night. A loss in mortality was also found in those who took sleeping pills.1

SLEEP QUALITY

Poor sleep quality can also be a complication of insomnia. Sleep apnea (interrupted breathing during sleep) may be the cause, or clinical depression can contribute to poor sleep quality as well. Persons experiencing poor sleep quality do not reach delta, or stage 4 sleep, also known as REM (rapid eye movement) sleep, the most restorative of the sleep stages. Sleepers do not always remember waking up frequently in the night, but they may experience increased sleepiness during the day. Poor sleep quality can also be a result of excessive cortisol in the body. Having to get up in the night to urinate will certainly disturb sleep, and noise and light also disturb sleep.

It is important to rule out psychological and medical problems before treating insomnia, and to determine whether poor sleep hygiene may be a factor.

TREATMENT

Using drugs to treat insomnia is not the best modality. Dependence may result, with rebound withdrawal effects if the drugs are stopped. Tolerance to the effects of a hypnotic drug may also occur; these drugs are best used on a temporary basis, and only when absolutely necessary as diagnosed and prescribed by a doctor. Non-pharmacological strategies such as dietary supplements, stimulus control, sleep-restriction therapy, behavioral interventions such as cognitive behavior therapy, patient education, and relaxation therapy are recommended over prescription sleeping drugs. Chronic users of prescription sleeping drugs had no better results than chronic users who did not use drugs.

Many who suffer from insomnia use sleeping medication or other sedatives as an aid. One of the problems with these medications is that they have a risk of psychological dependence: the person cannot accept the idea that they do not need drugs to sleep. A physical dependence may also develop with these drugs. Many drugs have side effects such as vehicle accidents, fractures, problems thinking, and falls, especially in the elderly.

Many dietary supplements have been studied and used to help improve the quality of sleep. Melatonin, a hormone available in supplements, can help reduce insomnia. Tryptophan also has a beneficial effect, probably because it is converted in the body to serotonin and melatonin.

Some people use herbs such as lavender, hops, passion-flower, chamomile and valerian. These have been featured in several studies and have been effective in many cases when taken properly and in the right combinations.

Supplements of magnesium may also help, as well as calcium, Vitamin D, and zinc, to name a few.