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Insomnia is the most common sleep symptom presenting to a Sleep Physician. As our society has become increasingly fast paced, (a so to speak 24/7 society), we have become sleep deprived. Not only do we as a society obtain an inadequate amount of sleep, our sleep quality has declined as well. Our society on the whole has become rush, rush and pushing for the next best thing. One and done and onto the next thing quickly, this occuring in business and in our home life. Thus , we as a society are more stressed, and resulting in the inability to go to sleep (sleep initiation insomnia) or the inability to stay asleep (sleep maintence insomnia) .
Once insomnia begins, it tends to perpetuate itself, with less and less quality and quantity of sleep, resulting first in daytime fatigue. Other symptoms of chronic insomnia are inability to concentrate, memory loss, mood changes, irritability, short tempered, and eventually excessive daytime sleepiness and possibly even depression.. Although it is to note insomnia may be the first symptom of depression.
Insomnia may also be associated with obstructive sleep apnea, central sleep apnea, and restless leg syndrome/periodic limb movement disorder.
In most cases of insomnia there is usually an inciting event, ie illness or death in the immediate family, stressors in marriage or at work. Again ,once insomnia starts. the cycle may be self perpetuating and diffucult to break,called psychophysiologic insomnia. Even with the pre “bedtime ritual” ie watching TV, reading , brushing teeth, just the thought of laying down and trying to go to sleep results in anxiety and a “heightened tension” that is the predrome of insomnia each night.
Treatment may include cessation of caffeine, hot baths 2 hours before sleep, exercise 6 to 8 hours before bedtime, sleeping in a cool , dark, quiet environment, turning the alarm clock away, as not to ruminate on it, which perpetuates insomnia. Other treatment options include regular bedtimes and waketimes, small meals containing trytophan one hour before bedtime, relaxation techniques. Other proven and effective therapies include Sleep Restriction, Progressive Muscle Relaxation, and Cognitive Behavioral Therapy ( Please see A Sleep Physician for discussion and treatment concerning these techniques).
Other options include melatonin (for sleep initiation insomnia), or other hypnotics “sleeping pills” which include Ambien, Lunesta, Restoril etc. It is to note hypnotics should be used only short term for insomnia, as they can be associated with tolerance and potentially addictive. Also they may have serious side effects. You should discuss hypnotics (sleeping pills) with your primary care MD or Sleep physician before starting these medications or before any of above recommendations are tried or instituted. I use hypnotics (sleeping pills) short term only and as a last resort .
I would like to reiterate that insomnia may be the first symptom of depression and you should discuss your insomnia with your primary care physician and/or a Sleep Physician.

THANK YOU,

DR. JEFFREY

This entry was posted on Friday, January 15th, 2010 at 6:38 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.