“We are such stuff as dreams are made of,
And our life is rounded with a sleep.”
William Shakespeare The Tempest 4.1.168-170
If you have unsatisfactory sleep, you are not alone.
Definition
Insomnia is a sleep disorder characterized by trouble falling asleep initially, waking up during the night, or waking earlier than desired. These sleep patterns can lead to daytime impairments including fatigue, irritability, depressed mood, problems with concentration and memory and increased accidents and mistakes.
Sleep disorders affect up to 70 million Americans every year, and insomnia symptoms affect 33-50% of adults. Chronic insomnia, defined as sleep difficulties occurring at least 3 days per week for 3 months or longer, is found in 10-15% of adult Americans.
Risk Factors
People more likely to suffer insomnia include women; those who are pregnant; people over age 60; light sleepers; people who have anxiety, depression, chronic diseases (such as cancer, heart failure or severe kidney disease), chronic pain, neurological disorders (such as Parkinson’s disease and Alzheimer’s disease), or other sleep disorders (such as sleep apnea or restless legs syndrome); those who have had recent stress in life (such as job loss, divorce, or death of a loved one); or people taking certain medications.
Complications of insomnia can include:
· diabetes
· driving accidents, injuries and falls
· high blood pressure, heart disease and stroke
· mood disorders
· weight gain and obesity
Evaluation
If insomnia makes it hard for you to function during the day, see your doctor to investigate the cause of your disorder and how it could best be treated. After performing a history and physical examination, your doctor may recommend:
· blood tests to look for relevant medical conditions such as thyroid disease and low iron levels
· sleep diary (or use of a smartphone or watch)
· a sleep study, whether at a sleep disorder center or at home
Short-term insomnia will often resolve on its own. For chronic insomnia, the latest
research recommends beginning with cognitive behavioral therapy for insomnia (CBT-I).
Treatment
CBT-I is a brief, structured intervention that helps identify thoughts and behaviors that can cause or worsen sleep problems and replace them with habits that provide sound sleep. CBT-I involves several techniques that may be used alone or in combination:
· Cognitive restructuring identifies and changes unhelpful thoughts and feelings affecting sleep, such as anxiety about insomnia or unrealistic expectations.
· Stimulus control guides you in setting up a healthy sleep environment.
· Sleep restriction includes the use of a sleep diary in which patients record the amount of time spent sleeping and then plan to stay in bed only for that amount of time plus 30 minutes. By making themselves tired enough to get sound sleep, patients will gradually increase time spent in bed.
· Relaxation techniques use breathing exercises and meditation to help calm a patient’s mind.
CBT-I has been proven effective when administered in-person as well as on-line as part
of telemedicine video visits.
Somryst is a new smartphone app approved by the Food and Drug Administration that uses CBT-I techniques to train the brain to get higher quality sleep. Somryst is indicated for individuals aged 22 or more who read and speak English, who live in the United States and who are able to use the app. Somryst users must be under the care of a medical provider.
Somryst uses six CBT-I-based lessons that patients can complete at their own pace in up to 9 weeks. It provides specific, individualized instructions to help users sleep better.
Medications may also be recommended to help promote sleep, reduce abnormal sleep patterns and decrease daytime impairment. Commonly known as sleeping pills, these drugs come with risks and side effects and some are habit forming. There are a variety of prescription medications for sleep, as well as the over-the-counter drug melatonin. Doctors usually only prescribe them short-term and these drugs should only be discontinued gradually.
Lifestyle changes that may improve sleep include:
· avoiding large meals, caffeine and alcohol before bed
· being physically active during the day
· cutting back on caffeine day and night
· following a consistent sleep routine by going to bed at the same time every night and waking at the same time every day
· eliminating all screens (cellphones, TV’s and computers) at least 30 minutes before bedtime
· quitting smoking
· turning your bedroom into a cool, dark, quiet sanctuary
· unwinding before bed with soothing music, a good book, or meditation
Light therapy with artificial light can help mimic sunlight and reset the body’s sleep-wake cycle. Prescribed by a physician, this technique uses a special box that provides intense light at the same time of day and for the length of time prescribed.
Acupuncture was shown in two separate 2021 studies to help patients sleep longer and to wake up less often.
In Conclusion
Insomnia is common, can be disabling, and should not be ignored. The goal for every adult is to get 7-9 hours of good, restful sleep per night, whether or not they have been affected by insomnia.
“The best cure for insomnia is to get a lot of sleep.”
W. C. Fields