insomnia


Alternative names
sleeplessness, primary insomnia, wakefulness, inability to sleep 

Definition
Insomnia includes difficulty falling asleep or staying asleep, and early morning awakening. Insomnia can be a symptom of another disorder. It may vary from restlessness or disturbed sleep to a shortened length of sleep. Some individuals suffer complete wakefulness. Primary insomnia is diagnosed if sleep should normally occur, and two possible influences are ruled out. The first influence is something external, like noise or bright light that hinders sleep. The second influence is any disorder, medication, or other substance that might be causing the sleep problem. 

What is going on in the body?
Sleeplessness is considered to be a problem when it is severe enough to prevent the brain from getting enough rest on a consistent basis. An occasional sleepless night is not usually considered a problem. However, when sleeping problems last 2 weeks or more, the insomnia becomes more serious. Insomnia can be a short-term problem. If insomnia extends beyond 3 to 4 weeks, it is considered chronic. 

What are the signs and symptoms of the condition?
Symptoms of insomnia include: the inability to fall asleep or to stay asleep repeated awakening in the night early morning awakening daytime sleepiness or fatigue depression or anxiety irritability difficulty concentrating 

What are the causes and risks of the condition?
Insomnia can be caused by many factors, or a combination of factors. Causes of insomnia may include:

side effects of medications, especially amphetamines, excessive thyroid replacement, and many decongestants and antihistamines 
caffeine 
nicotine 
alcohol 
side effects of some drugs of abuse 
stress 
anxiety 
depression 
poor sleep surroundings 
chronic illness 
chronic pain 
daytime napping 
poor sleep routine or sleep habits 
grief 
withdrawal of certain drugs (stopping abruptly) 
restless leg syndrome 
What can be done to prevent the condition?
Methods to prevent insomnia are the same as those used to treat insomnia. The best prevention is to develop good sleep habits. 

How is the condition diagnosed?
Primary insomnia is diagnosed when difficulty falling asleep or staying asleep becomes a persistent problem. If there are decreases in work productivity, increased health problems, or difficulties in concentration and memory, a diagnosis of insomnia may be made. A complete medical history will be taken, and a physical exam will be done. The doctor will ask about average sleep habits and about anything that might be interfering with the ability to sleep. 

What are the long-term effects?
The persistent loss of sleep may result in:

decreased work productivity 
increased accidents 
decreased concentration 
short-term and long-term memory problems 
irritability 
fatigue 
What are the risks to others?
Insomnia is not contagious. Sleep deprived persons might cause injury to others by being involved in accidents. 

What are the treatments?
The best way to prevent insomnia is to develop good sleep habits. This includes maintaining a regular and predictable sleep schedule. Substances known to cause insomnia, such as nicotine, caffeine and alcohol, should be avoided. Creation of a quiet, comfortable sleep environment is also useful. Regular exercise is important, but should not be done within 2 hours of going to bed. Quiet, relaxing activities before bedtime, such as reading, listening to music, or watching TV, can help. Using medications such as zolpidem, zaleplon, or temazepam to induce sleep should be considered a last resort. Long-term use of these medications can actually cause more sleep problems. 

What are the side effects of the treatments?
Side effects of the many medications used to induce sleep include:

day time sleepiness 
physical tolerance to and dependence on some of the medications 
memory impairment 
rebound insomnia when medication is stopped 
psychological dependence on the medication 
poor quality sleep produced by some medications 
What happens after treatment?
Good sleep habits should be followed for life. Early identification and resolution of contributing factors may help reduce the number of sleepless nights. 

How is the condition monitored?
Insomnia may be self-monitored. Healthcare providers can be notified of persistent sleeping problems. 

Author: Ann Reyes, Ph.D.
Date Written: 09/29/99