Insomnia

Alternative names

Sleeping difficulty; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness

Definition

Sleeping problems, called insomnia, can take several forms:

• Difficulty falling asleep when you first go to bed at night
• Waking up too early in the morning
• Waking up frequently throughout the night

All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning.

Considerations

Everyone has an occasional sleepless night, and this is not a problem for most people. However, as many as 25% of Americans report occasional sleeping problems, and insomnia is a chronic problem for about 10% of the population. In these cases, the lack of restful sleep impairs the person's ability to carry out daily responsibilities because they are too tired or they have trouble concentrating.

Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be adequate. Even though the elderly need less sleep, almost one half of people over 60 experience some degree of insomnia.

The best measure of the amount of sleep needed is how you feel. If you awaken feeling refreshed, you are getting enough sleep. For some people, this may take only 4 hours. Others can need up to 10 hours to feel rested.

Using long-acting or high-dose sedatives as a "cure" for insomnia can make the problem worse, not better, over time. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to similar difficulties. Using antihistamines over time may also lead to reversible memory impairment.

Strong, prescription sedatives do not produce a natural, restful sleep. In addition, you can develop tolerance or dependence on these drugs. In this case, the same dose of the drug no longer produces sleep, which may lead you to try a higher dose. The circular situation becomes worse. Higher doses worsen the chance of dependence, tolerance, and side effects. Stopping these medications can cause a rebound insomnia and withdrawal.

A life-threatening disease is rarely the cause of problems with sleep. For many people, poor sleep habits are the cause. However, because insomnia is a key symptom of depression, you should be evaluated for depression if you are having sleeping difficulties.

Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes, and fatigue.

It may help to consult a psychiatrist, another physician, or another mental health practitioner for evaluating psychiatric disorders that can lead to insomnia. If you are depressed, antidepressants can help both the sleeping problem and the depression. These medications do not carry the same concerns about tolerance and dependence as sedatives.