Lying awake at night staring at the ceiling is never fun. But we all experience this insomnia at some points in our lives. When sleeplessness becomes chronic, it can cause other health and lifestyle problems. Dr. Audrey Liu, a sleep specialist at Mercy Medical Center, talks about how to treat insomnia.
What are the different symptoms of insomnia?
Nighttime symptoms of insomnia include difficulty falling asleep, recurrent awakenings throughout the night and early awakenings. Poor quality or nonrestorative sleep is another common complaint. Daytime symptoms include fatigue, irritability, decreased concentration or memory and anxiety about inadequate or poor sleep.
What are the different types of insomnia?
Almost all individuals experience insomnia in their lifetime. Acute stress from illness, work or family can trigger periods of poor sleep or inability to sleep. This type of insomnia can be short-lived or intermittent.
However, transient or intermittent insomnia can evolve into a more pervasive debilitating condition. Chronic insomnia lasts for at least 6 months and is often due to multiple factors including medical illness, persistent stress, coping behaviors that actually worsen insomnia, and development of thoughts and beliefs that worsen the condition.
How is insomnia treated? What are some of the newest treatments?
First, the cause of the insomnia should be determined, and serious medical problems should be ruled out. Obstructive sleep apnea, restless-legs syndrome and depression are a few common treatable conditions that cause insomnia.
There are many measures one can take to help promote good sleep. Establishing a good sleep environment with comfortable bedding and room temperature and low levels of noise and light is a simple first step. Avoid caffeine, nicotine and light from electronic devices close to bedtime. All promote wakefulness and disrupt nighttime sleep. Do not drink alcohol to help sleep. It may promote sleep onset but increases awakenings during the night. Cut out or avoid naps, which can make falling asleep harder.
When insomnia is severe or persistent, cognitive behavior therapy by a sleep specialist may be indicated. This therapy consists of various treatments directed at changing behaviors and anxiety that may contribute to insomnia. Cognitive behavior therapy techniques include restricting sleep, relaxation techniques and therapy directed at thought patterns that perpetuate insomnia. Cognitive behavior therapy can be as effective as medications and can be used in combination with medications.
Many prescription and over-the-counter medications are used to increase sleepiness and prolong sleep. Sedative-hypnotic medications that stimulate GABA receptors in the brain to increase sleepiness and are the main medications used for insomnia. They include the benzodiazepines (such as estazolam and flurazepam) and the newer nonbenzodiazepines (zolpidem, zaleplon and eszoplicone). More recent medications approved for use in insomnia include ramelteon which works on melatonin receptors in the brain and doxepin, an antidepressant that is now FDA approved to treat insomnia.
Other antidepressants, antihistamines and antipsychotic medications may be sedating, but are not primarily designed to treat insomnia, and should be used with caution.
When would a doctor prescribe medication for insomnia?
A sleep medication may be prescribed if symptoms persist and are interfering with daily activities despite non-pharmacologic therapy and diagnosis and treatment of other medical conditions that may cause insomnia.
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Chronic insomnia, by definition, includes associated daytime symptoms such as low energy, anxiety, impaired concentration, irritability and sleepiness, which result in a poor quality of life. Insomnia has also been associated with accidents, poor work performance and increased risk for substance abuse and mental health disorders, such as depression and anxiety.
Who gets insomnia?
Insomnia is more common in individuals with depression, anxiety and chronic medical conditions such as arthritis, cancer, diabetes, chronic pain and heart disease. Increasing age and female gender are associated with higher rates of insomnia. Shift workers often develop insomnia due to frequently changing sleep and work schedules. Frequent travelers may develop insomnia related to jet lag.