Are You An Insomniac?

“I remember when staying up until midnight was hard to do - now it's a bad habit”

Insomnia is a symptom, not a stand-alone diagnosis or a disease.  By definition, insomnia is "difficulty initiating or maintaining sleep, or both" or the perception of poor quality sleep.  Insomnia may therefore be due to inadequate quality or quantity of sleep.  Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices.  Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice.

Insomnia affects all age groups.  Among adults, insomnia affects women more often than men.  The incidence tends to increase with age.  It is typically more common in people in lower socioeconomic (income) groups, chronic alcoholics, and mental health patients.  Stress most commonly triggers short-term or acute insomnia.  If you do not address your insomnia, however, it may develop into chronic insomnia.

Insomnia is generally classified based on the duration of the problem.  Not everyone agrees on one definition, but generally:

·         symptoms lasting less than one week are classified as transient insomnia,

·         symptoms between one to three weeks are classified as short-term insomnia, and

·         those longer than three weeks are classified as chronic insomnia

Insomnia Causes

Insomnia may be caused by a host of different reasons.  These causes may be divided into situational factors, medical or psychiatric conditions, or primary sleep problems.  Insomnia could also be classified by the duration of the symptoms into transient, short-term, or chronic. Transient insomnia generally last less than seven days; short-term insomnia usually lasts for about one to three weeks, and chronic insomnia lasts for more than three weeks.

Many of the causes of transient and short-term insomnia are similar and they include:

·         Jet lag

·         Changes in shift work

·         Excessive or unpleasant noise

·         Uncomfortable room temperature (too hot or too cold)

·         Stressful situations in life (exam preparation, loss of a loved one, unemployment, divorce, or separation)

·         Presence of an acute medical or surgical illness or hospitalization

·         Withdrawal from drug, alcohol, sedative, or stimulant medications

·         Uncontrolled physical symptoms (pain, fever, breathing problems, nasal congestion, cough, diarrhea, etc.)

Causes of Chronic or Long-Term Insomnia

The majority of causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiological condition.

Psychological Causes of Insomnia

The most common psychological problems that may lead to insomnia include:

·         anxiety,

·         depression

·         stress (mental, emotional, situational, etc),

·         schizophrenia, and/or

·         mania (bipolar disorder)

Physiological Causes of Insomnia

Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. The following are the most common medical conditions that trigger insomnia:

·         Chronic pain syndromes

·         Chronic fatigue syndrome

·         Congestive heart failure

·         Night time angina (chest pain) from heart disease

·         Acid reflux disease (GERD)

·         Chronic obstructive pulmonary disease (COPD)

·         Nocturnal asthma (asthma with night time breathing symptoms)

·         Obstructive sleep apnea

·         Degenerative diseases, such as Parkinson's disease and Alzheimer's disease

·         Brain tumors, strokes, or trauma to the brain

High Risk Groups for Insomnia

In addition to people with the above medical conditions, certain groups may be at higher risk for developing insomnia:

·         Travelers

·         Shift workers with frequent changing of shifts

·         Seniors

·         Adolescents or young adult students

·         Pregnant women

·         Women in menopause

·         People who use abuse drugs

·         Alcoholics

Medication Related Insomnia

Certain medications have also been associated with insomnia. Among them are:

·         Certain over-the-counter cold and asthma preparations.

The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.

·         Some medications used to treat high blood pressure have also been associated with poor sleep.

·         Some medications used to treat depression, anxiety, and schizophrenia.

Other Causes of Insomnia

·         Common stimulants associated with poor sleep include caffeine and nicotine.  You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake.

·         People often use alcohol to help induce sleep, as a nightcap.  However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning.

·         A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep.

Insomnia Symptoms

Doctors associate a variety of signs and symptoms with insomnia.  Often, the symptoms intertwine with those of other medical or mental conditions.

Some people with insomnia may complain of difficulty falling asleep or waking up frequently during the night.  The problem may begin with stress.   Then, as you begin to associate the bed with your inability to sleep, the problem may become chronic.

Most often daytime symptoms will bring people to seek medical attention.   Daytime problems caused by insomnia include the following:

·         Poor concentration and focus

·         Difficulty with memory

·         Impaired motor coordination (being uncoordinated)

·         Irritability and impaired social interaction

·         Motor vehicle accidents because of fatigued, sleep-deprived drivers

·         People may worsen these daytime symptoms by their own attempts to treat the symptoms.

·         Alcohol and antihistamines may compound the problems with sleep deprivation.

Primary Sleep Disorders

In addition to the causes and conditions listed above, there are also a number of conditions that are associated with insomnia in the absence of another underlying condition.  These are called primary sleep disorders, in which the sleep disorder is the main cause of insomnia.  These conditions generally cause chronic or long-term insomnia. Some of the diseases are listed below:

·         Idiopathic insomnia (unknown cause) or childhood insomnia, which starts early on in life and results in lifelong sleep problems.  This may run in families.

·         Central sleep apnea. This is a complex disorder.  It can be the primary cause of the insomnia itself or it may be caused by other conditions, such as brain injury, heart failure, high altitude, and low oxygen levels.

·         Restless legs syndrome (a condition associated with creeping sensations in the leg during sleep that are relieved by leg movement)

·         Periodic Limb movement disorder (a condition associated with involuntary repeated leg movement during sleep)

·         Circadian rhythm disorders (disturbance of the biological clock) which are conditions with unusual timing of sleep (for example, going to sleep later and waking up late, or going to sleep very early and getting up very early).

·         Sleep state misperception, in which the patient has a perception or feeling of not sleeping adequately, but there are no objective findings of any sleep disturbance.

·         Insufficient sleep syndrome, in which the person's sleep is insufficient because of environmental situations and lifestyle choices, such as sleeping in a bright or noisy room.

·         Inadequate sleep hygiene, in which the individual has poor sleep or sleep preparation habits

Insomnia Medications and Medical Therapies

There are numerous prescription medications to treat insomnia.  Generally, it is advised that they should not be used as the only therapy and that treatment is more successful if combined with non-medical therapies.   In a study, it was noted that when sedatives were combined with behavioral therapy, more patients were likely to wean off the sedatives than if sedatives were used alone.

Herbal Remedies for Insomnia

St. Johns Wort and chamomile have not shown any real benefit in treating insomnia.

Valerian is a popular herbal medication used for treating insomnia with possibly some benefit in some patients with chronic insomnia.

Valerian

(valeriana officinalis)

Available as

Tablets

Tincture

Dosage

Most commonly taken as tablets per specifications

Up to 3 grams of dried plant, equivalent to 700mg of standardized extract

As tincture, 20 drops in a cup of hot water, four times a day for anxiety, or half an hour before bed time for insomnia

What is it?

Valerian is an attractive perennial with pretty pink flowers.  It grows throughout Europe and is now well established in North America.  As far back as the 1^st century AD, the physician Dioscorides used it, as did Hippocrates before him, and Paracelsus after that.

In the Middle Ages, valerian was used for many medicinal properties, though proof of its efficiency in the treatment of epilepsy has never been substantiated.   While the ancient Greeks and Romans understood the herb’s value as a gentle sedative, it wasn’t until the middle of the 18th century that it became widely accepted in the treatment of anxiety and insomnia.  Valerian contains many active constituents, including volatile oils, iridoids and alkaloids.

What it does

Prolonged periods of stress lead to a state of constant heightened arousal, and overproduction of the activity hormone adrenaline.  This is the hormone that prepares the body for the “fight or flight” – the heart rate increases, blood pressure rises and mental faculties are sharpened so that mind and body are prepared for instant action.

Valerian can break this vicious cycle.  Taken in small doses, its action is calming without causing drowsiness.  Larger doses become mildly sedative and help to restore regular sleep patterns in those suffering from insomnia.  As a bonus, valerian is an effective anti-spasmodic which helps to relieve colic, stomach cramps and irritable bowel syndrome.

“Without enough sleep, we all become tall two-year-olds”