Can’t Sleep?

By Brigit C. Britton, MD – MIPC Physicianinsomnia

There are few things more frustrating than lying awake at night, watching the clock tick away until your next work day. Insomnia is an increasing problem in the US, with approximately 30% of adults reporting sleep difficulty and 10% experiencing chronic insomnia.  Not only is this a source of anxiety for many, but lack of sleep can have significant emotional, mental and physical consequences.  So why is sleep so crucial, what exactly is insomnia, and what are some ways to help manage this condition?

Sleep is a necessity, not a luxury, but as our days become busier and our schedules more hectic many people forget this fact. It is important to remember that inadequate sleep can have a detrimental effect on all areas of life and health. Sleep loss can cause metabolic and endocrine alterations that lead to obesity, and inadequate sleep duration (<6hrs) can increase risk of cardiovascular disease and even mortality. There is also an association between insomnia and psychiatric illnesses, mainly depression and anxiety.  Further, in terms of public health, patients suffering from insomnia are generally less productive at work and more likely to be involved in workplace or motor vehicle accidents.  One thing is clear, adequate sleep is crucial to not only personal health but also the well-being of society.

Insomnia is defined as the inability to fall asleep, stay asleep, or waking too early in the morning.  It is usually transient and associated with an acute situational stress such as a job change, project deadline, death of a family member or other emotional event.  Environmental conditions, such as an overly bright room, an uncomfortable mattress or even a subtle temperature change, can also disrupt your sleep temporarily. Chronic insomnia, on the other hand, is diagnosed when a patient experiences sleep difficulties for a longer period of time (at least a month) associated with significant daytime impairment.  Chronic insomnia tends to occur more often in females, those with comorbid medical or psychiatric illnesses, the elderly, unemployed, and patients with impaired social relationships.

There are several treatment options available for insomnia. If your symptoms are persisting despite environmental and behavioral changes, your doctor may suggest Cognitive Behavioral Therapy (CBT) and/or start medications. CBT is a strategy that combines several approaches to help regulate your sleep cycle. It does not require medications and is proven to be beneficial, but must be done by a trained professional. There are also various prescription medications available to help treat insomnia.  These include benzodiazepines, nonbenzodiazepine sedatives, antipsychotics, melatonin agonists and antidepressants. Treatment must be tailored to each person as all medications have side effects and every patient is different.  You are likely to see several over-the-counter sleep remedies on the market today. Most contain an antihistamine (such as diphenhydramine) which can cause daytime drowsiness, sedation, dry mouth and other adverse effects. Routine use of these to treat insomnia is not recommended. Other available products contain various herbal remedies (most often Valerian) and melatonin (which is actually a hormone). The herbal therapies are not regulated by the FDA and may contain undesirable substances or produce liver toxicity in certain patients. Melatonin is widely marketed; however, it appears to only have a beneficial effect in a very small subset of patients. In addition to medication, there are some other non-pharmacologic therapies worth mentioning. Acupressure has been found beneficial in some patient as are phototherapy and chronotherapy.

If you are suffering from insomnia, don’t despair! It is important to visit your doctor for a full evaluation and to assess for other causes such as hyperthyroidism or sleep apnea.  Behavioral changes and proper sleep hygiene are of utmost importance and in many cases may improve your symptoms.  Try the following sleep tips:

  • Avoid naps during the daytime
  • Exercise daily and make sure you stop exercising at least 6 hours before bedtime
  • Avoid alcohol in the evening (alcohol should not be used to treat insomnia and can actually disrupt sleep)
  • Avoid heavy meals at night, especially if you have problems with reflux/heartburn
  • Avoid smoking and other nicotine products at night
  • Relax before getting into bed:  try a warm bath, journaling, massage or prayer to settle you mind
  • Sleep at the same time each night, regardless of work/shift schedule
  • Reserve your bedroom for sleep and sexual activity,  avoid other activities while lying in bed such as working on your computer or playing games on your phone
  • Make your bedroom conducive for sleep: turn off the TV, try room darkening curtains to decrease ambient light and change your mattress as needed

For more information about insomnia, visit one of our clinics today.

 

References:

  1. Roth, T. Insomnia: Definition, Prevelance, Etiology and Consequences. J Clin Sleep Med. Aug 15, 2007;3(5Suppl):S7-S10[PubMed]
  2. Chawla, J. et al. (2014, June 2). Insomnia. Retrieved from http://emedicine.medscape.com/article/1187829-overview
  3. Beccuti G, Pannain S. Sleep and obesity. See comment in PubMed Commons belowCurr Opin Clin Nutr Metab Care. 2011 Jul;14(4):402-12[PubMed]
  4. Grandner M, Sands-Lincoln M, Pak V, Garland S. Sleep duration, cardiovascular disease, and proinflammatory biomarkers. Nat Sci Sleep 2013; 5:93-107 [PubMed].
  5. Bonnet MH, et al. Treatment of insomnia. http://www.uptodate.com/home. Accessed Aug. 3, 2014.