Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake. Insomniacs have been known to complain about being unable to close their eyes or “rest their mind” for more than a few minutes at a time. Both organic and non-organic insomnia constitute a sleep disorder.
The most common psychological problems include anxiety, stress, and depression. In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.
Many people have insomnia. People who have insomnia may not be able to fall asleep. They may wake up during the night and not be able to fall back asleep, or they may wake up too early in the morning.
Insomnia contributes to excessive daytime tiredness, which in turn may be responsible for accidents, recurrent infections, poor concentration, irritability, work and relationship problems and a general inability to cope.
Anxiety, a condition in which individuals feel increased tension, apprehension, and feelings of helplessness, fear, worry, and uncertainty. This may be due to the effects that other people at work have on us, financial worries, concerns over relationships outside work or numerous other causes.
Insomnia symptoms may include:
Difficulty falling asleep at night
Waking up during the night
Waking up too early
Daytime fatigue or sleepiness
It’s common for older adults to sleep less deeply and for less time than they did earlier in life, and to experience fragmented sleep. However, these normal changes in the sleep patterns of older adults do not mean that they should expect inadequate rest and to awaken feeling unrefreshed.8 Routine poor-quality sleep due to health problems, medication use, and major life changes can lead to chronic sleep problems.
Diagnosis of Insomnia
Surprisingly, a sleep study is not routinely recommended for those complaining of insomnia. The reason is that when a sleep study is performed in someone suffering from insomnia, it does not generally give any new information; it simply confirms that the patient is having trouble sleeping. The best way to find the cause for insomnia is by careful history taking. Assessment of recent onset insomnia should focus on acute personal and medical problems.
The treatment of insomnia depends on its cause and severity. If insomnia results from another disorder, treatment of that disorder may improve sleep. For most people who have insomnia, some simple changes in lifestyle, such as following a regular sleep schedule and avoiding caffeine after lunch time, can improve sleep.
In addition to daytime tiredness or fatigue, chronic insomnia can be associated with a complaint of compromised intellectual function, mood disturbance, or an increase in physical complaints (e.g., headaches and gastrointestinal problems). Beyond these outcomes, there is now considerable evidence that individuals with chronic insomnia have an increased risk of psychiatric illness (especially major depressive disorder) and substance abuse and there is mounting evidence that insomnia is associated with absenteeism from work, higher health care costs, and reduced quality of life.
Cognitive Behavior Therapy
Cognitive behavior therapy helps patients change thoughts and behaviors that interfere with sleep. Treatment methods are often used in combination for increased effect.
You may find that if you are unable to fall asleep or wake up in the night, you spend a lot of time in bed trying unsuccessfully to sleep. If so, you may benefit from a sleep restriction program that initially allows only a few hours of sleep during the night. Gradually this time is increased until a normal sleep period is achieved.
Diphenhydramine (for example, Sominex, Nytol) and doxylamine (for example, Unisom) are antihistamines that are currently marketed as OTC sleep aids. Diphenhydramine is the only agent that is considered to be safe and effective by the Food and Drug Administration. The safety and effectiveness of doxylamine has not been evaluated adequately for FDA approval.