Restless Leg Syndrome (RLS) | Sleep Apnea | Insomnia | Pediatric Sleep Apnea
What is Insomnia?
Insomnia is the most common sleep disorder, affecting around 70 million U.S. citizens. There are three types of insomnia:
- Difficulty going to sleep
- Difficulty staying asleep
- Difficulty going to sleep and staying asleep
Who has insomnia?
Nearly everybody experiences insomnia at some point in his or her life. These acute episodes are typically experienced during times of great stress. Insomnia is considered chronic when it lasts for over a month. Chronic insomnia may be secondary to psychiatric or medical disorders. However, most commonly insomnia is psycho physiologic. In psycho physiologic insomnia, patients often find that they “can’t turn their mind off” at their desired bedtime.
What are the effects of insomnia?
Insomnia puts people in a situation where they cannot get an adequate amount of sleep. Additionally, people with psycho physiologic insomnia frequently have poor quality sleep. These factors result in symptoms of daytime sleepiness, fatigue, depressed mood, as well as decreased ability to concentrate, problem-solve and make decisions.
How is insomnia treated?
Options available for the treatment of insomnia include behavioral modifications, pharmaceutical therapy or some combination of the two.
Behavioral modification:
- Stimulus control trains people to use their bed and bedroom for sleep and relations only. Instead of lying in bed awake, persons with insomnia are encouraged to go to another room and engage in a low light, relaxing activity until they are sleepy and ready to return to bed.
- Sleep restriction involves the use of a sleep diary or actigraph to determine the amount of sleep someone with insomnia is getting. Then that person must limit his or her time in bed based on that determination to improve sleep efficiency. Gradually, time in bed is increased while sleep efficiency is maintained. This is the best treatment for insomnia but has the side effect of incurring additional sleepiness during the initial weeks of therapy.
- Relaxation training includes several methods to reduce mental and physical tension.
- Cognitive restructuring addresses individual concerns regarding sleep and its role in restoration and well being.
Pharmaceutical Therapy
Prescription medications that promote sleep are called hypnotics. Medications differ by dose and duration of action.
Most individuals take hypnotics a few nights or a few weeks at a time. Some may benefit from long-term use. Older medications were associated with development of tolerance and rebound insomnia when medications were stopped. The outcome was leaving patients in a worse situation than they started. However, some of the newer medications can be safely used for extended periods of time while maintaining their effectiveness. The most common side effects include morning sedation, memory problems, and a night or two of poor sleep after stopping the medication.