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WHAT
CAUSES INSOMNIA?
Certain
conditions seem to make individuals more likely to experience
insomnia. Examples of these conditions include:
*
advanced age (insomnia occurs more frequently in those over age
60)
*
female gender
*
a history of depression
If
other conditions (such as stress, anxiety, a medical problem, or
the use of certain medications) occur along with the above
conditions, insomnia is more likely.
There
are many causes of insomnia. Transient and intermittent insomnia
generally occur in people who are temporarily experiencing one
or more of the following:
*
stress
*
environmental noise
*
extreme temperatures
*
change in the surrounding environment
*
sleep/wake schedule problems such as those due to jet lag
*
medication side effects
Chronic
insomnia is more complex and often results from a combination of
factors, including underlying physical or mental disorders. One
of the most common causes of chronic insomnia is depression.
Other underlying causes include arthritis, kidney disease, heart
failure, asthma, sleep apnea, narcolepsy, restless legs
syndrome, Parkinson's disease, and hyperthyroidism. However,
chronic insomnia may also be due to behavioral factors,
including the misuse of caffeine, alcohol, or other substances;
disrupted sleep/wake cycles as may occur with shift work or
other nighttime activity schedules; and chronic stress.
In
addition, the following behaviors have been shown to perpetuate
insomnia in some people:
*
expecting to have difficulty sleeping and worrying about it
*
ingesting excessive amounts of caffeine
*
drinking alcohol before bedtime
*
smoking cigarettes before bedtime
*
excessive napping in the afternoon or evening
*
irregular or continually disrupted sleep/wake schedules
These
behaviors may prolong existing insomnia, and they can also be
responsible for causing the sleeping problem in the first place.
Stopping these behaviors may eliminate the insomnia altogether.
WHO
GETS INSOMNIA?
Insomnia
is found in males and females of all age groups, although it
seems to be more common in females (especially after menopause)
and in the elderly. The ability to sleep, rather than the need
for sleep, appears to decrease with advancing age.
HOW
IS IT DIAGNOSED?
Patients
with insomnia are evaluated with the help of a medical history
and a sleep history. The sleep history may be obtained from a
sleep diary filled out by the patient or by an interview with
the patient's bed partner concerning the quantity and quality of
the patient's sleep. Specialized sleep studies may be
recommended, but only if there is suspicion that the patient may
have a primary sleep disorder such as sleep apnea or narcolepsy.
HOW
IS IT TREATED?
Transient
and intermittent insomnia may not require treatment since
episodes last only a few days at a time. For example, if
insomnia is due to a temporary change in the sleep/wake
schedule, as with jet lag, the person's biological clock will
often get back to normal on its own. However, for some people
who experience daytime sleepiness and impaired performance as a
result of transient insomnia, the use of short-acting sleeping
medications may improve sleep and next-day alertness. However,
while many doctors prescribe sleeping pills, as with all drugs,
there are potential damaging side effects and the risk of
addiction. The use of over-the-counter sleep medicines is not
usually recommended for the treatment of insomnia.
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