Trouble Sleeping? Insomnia May Be Why

Medical Author: Melissa Stoppler, M.D.
Medical Editor: Barbara K. Hecht, Ph.D.

Insomnia is the personal perception of inadequate or poor-quality sleep. Contrary to popular belief, insomnia cannot be simply defined by the total amount of sleep you get or how long it takes you to fall asleep. People vary dramatically in both their need for sleep and in the time they require to fall asleep. What constitutes a refreshing night's sleep for one person can be insomnia for another. In other words, insomnia is in the mind of the sleeper (or non-sleeper, as the case may be).

Insomnia can be particularly devastating because it often provokes daytime behaviors that only worsen the condition. Persons without adequate sleep may attempt to combat their fatigue and trouble concentrating by excessive caffeine intake, by tobacco smoking and by consuming unhealthy or sugar-laden foods. Insomniacs may be "too tired" to exercise and may take afternoon naps, both of which further reduce the ability to fall asleep the following night.

Insomnia is more likely to occur in females, persons over 60 years of age, and persons who have a history of depression, but anyone can be affected.

Transient, or short-term, insomnia is defined as insomnia that lasts from one night to a few weeks. Having episodes of transient insomnia between periods of normal sleep is termed intermittent insomnia. Chronic, or long-term, insomnia lasts a month or more and occurs most nights.

Short-term insomnia is common during periods of increased psychological stress. For example, just before or during a trip. Short-term insomnia is also a common side effect of certain medications such as those for colds and nasal congestion.

Chronic insomnia is a more serious problem. It may be caused by a wide variety of mental and physical disorders such as depression, substance abuse, heart or kidney disease, arthritis, and chronic pain.

Sedative medications are sometimes prescribed for severe cases of insomnia, but their use is controversial in the management of long-term insomnia. Over-the-counter insomnia remedies are usually not recommended by physicians.

The most accepted treatment for insomnia today is behavioral therapy which aims to identify and eliminate behaviors that worsen the insomnia and to teach relaxation techniques. Anyone suffering from chronic insomnia should have a thorough medical examination to diagnose and treat any underlying medical conditions that may be causing the insomnia.

Chronic insomnia deserves diagnosis and treatment since, as Shakespeare observed (in Macbeth), sleep is the "chief nourisher in life's feast".

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