A number of sleep disorders can disrupt your sleep quality and leave you with excessive daytime sleepiness, even if enough time was spent in bed to be well rested. More than 70 sleep disorders affect at least 40 million Americans and account for an estimated $16 billion in medical costs each year, not counting costs due to lost work time and other factors. The four most common sleep disorders are insomnia due to temperature regulation, obstructive sleep apnea (sleep-disordered breathing), restless legs syndrome (RLS), and narcolepsy. Additional sleep problems include sleep walking, sleep paralysis, night terrors, and other “parasomnias” that cause abnormal arousals.
Insomnia is defined as having trouble falling asleep or staying asleep, or as having unrefreshing sleep despite having ample opportunity to sleep. Life is filled with events that occasionally cause insomnia for a short time. Such temporary insomnia is common and is often brought on by stressful situations such as work, family pressures, or a traumatic event. A National Sleep Foundation poll of adults in the United States found that close to half of the respondents reported temporary insomnia in the nights immediately after the terrorist attacks on September 11, 2001. Chronic insomnia is defined as having symptoms at least 3 nights per week for more than 1 month.Most cases of chronic insomnia are secondary, which means they are due to another disorder or medications. Primary chronic insomnia is a distinct sleep disorder; its cause is not yet well understood.About 30–40 percent of adults say they have some symptoms of insomnia within any given year, and about 10–15 percent of adults say they have chronic insomnia. Chronic insomnia becomes more prevalent with age, and women are more likely than men to report having insomnia. Insomnia often causes problems during the day, such as excessive sleepiness, fatigue, a lack of energy, difficulty concentrating, depressed mood, and irritability. Due to all of these potential consequences, untreated insomnia can impair quality of life as much as, or more than, other chronic medical problems. Chronic insomnia is often caused by one or more of the following:
- Temperature regulation issues, night sweats and overheating
- Another disease or mood disorder. The most common causes of insomnia are depression and/or anxiety disorders.
- Neurological disorders such as Alzheimer’s or Parkinson’s disease can also have insomnia as a symptom.
- Chronic insomnia can result from arthritis, asthma, or other medical conditions in which symptoms become more troublesome at night, making it difficult to fall asleep or stay asleep.
- Various prescribed and over-the-counter medications that can disrupt sleep, such as decongestants, certain pain relievers, and steroids.
- Sleep-disrupting behavior such as drinking alcohol, exercising shortly before bedtime, ingesting caffeine late in the day, watching TV or reading while in bed, or irregular sleep schedules due to shift work or other causes.
- Another sleep disorder, such as sleep apnea or restless legs syndrome.
Some people, however, have primary chronic insomnia. This condition is linked to a tendency toward being more “revved up” than normal (hyperarousal). These people may have heightened secretion of certain hormones, higher body temperatures, faster heart rates, and a different pattern of brain waves while they sleep. Doctors diagnose insomnia based mainly on sleep history, often by reviewing a sleep diary.
An overnight sleep recording may be required if another sleep disorder is suspected. Doctors also will try to diagnose and treat any other underlying medical or psychological problems as well as identify behaviors that might be causing the insomnia. Often, people who have insomnia enter into a vicious cycle—because of having trouble sleeping in previous nights, they become anxious at the slightest sign that they may not be falling asleep right away. That anxiety can make it more difficult for them to fall asleep. The more time they spend in bed not sleeping, and watching the clock, the more their anxiety—and sleeplessness—increases.
To break that cycle of anxiety and negative conditioning, experts recommend going to bed only when you’re sleepy. If you can’t fall asleep (or fall back to sleep) within 20 minutes, get out of bed and go into another room where you can pursue a relaxing activity until you feel sleepy again. Then return to bed. This reconditioning therapy has been shown to be an effective way to treat insomnia. Another effective behavioral strategy for some people is relaxation therapy. For example, progressively tense and then relax each of the muscle groups in your body before sleep.
Another method is to focus on breathing deeply. Relaxation therapy can provide a needed slowing down period so that you are indeed sleepy when the desired bedtime arrives. Sleep restriction therapy also works for some people who have insomnia. First, limit your night’s sleep to 4 or 5 hours, then gradually add more sleep time each night until you achieve a more sleep restriction therapy because napping may prolong insomnia by making it harder to fall asleep at night. In addition, during sleep restriction therapy, avoid driving a car or operating dangerous machinery until you have obtained adequate nighttime sleep. All these changes in behavior are part of what is called “cognitive behavioral therapy.” Cognitive behavioral therapy also can be used to replace negative thinking related to sleep, such as “I’ll never fall asleep without sleeping pills,” with more realistic positive thinking. Cognitive behavioral therapy is effective in most people who have chronic insomnia.
Some people who have chronic insomnia that is not corrected by behavioral therapy or treatment of an underlying condition may need a prescription medication. You should talk to a doctor before trying to treat insomnia with alcohol, over-the-counter or prescribed short-acting sedatives, or sedating antihistamines that induce drowsiness. The benefits of these treatments are limited, and they have risks. Some may help you fall asleep but leave you feeling unrefreshed in the morning. Others have longer-lasting effects and leave you feeling still tired and groggy in the morning. Some also may lose their effectiveness over time.
Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in people who do not have depression is not established, and there are significant side effects. To treat their insomnia, some people pursue “natural” remedies, such as melatonin supplements or valerian teas or extracts. These remedies are available over the counter. There is little evidence that melatonin can help relieve insomnia. Studies with valerian have also been inconclusive, and the actual dose and purity of various supplements, extracts, or teas that contain valerian may vary from product to product. In addition, because melatonin, valerian, and other natural remedies are not regulated by the Food and Drug Administration, their safety is not scrutinized.