There are two working definitions of insomnia: it is generally defined as the condition of not getting enough sleep, or as getting sleep that is not restful. Slightly more than 1 in 3 adults report experiencing one or more symptoms of insomnia, and 1 in 10 report that this lack of sleep affects their daytime functioning and activities. For most adults, insomniac is episodic but for a small percentage, the condition lasts more than one month and is not caused by or with another sleep problem or complicating condition (i.e. sleep apnea).
Doctors can categorize insomnia in two ways — what causes the disease and how long the condition lasts. Categorizing insomnia by its cause includes:
- Primary insomnia. Primary insomnia is not caused by other known conditions. This condition is a form of restlessness; the symptoms it produces are generally treatable.
- Secondary insomnia. Secondary insomnia can be caused by other physical, sleep, or psychiatric illnesses. Medication can also cause secondary insomnia.
Categorizing insomnia by the duration of the condition includes:
- Acute insomnia. Linked to a temporary, outside event, acute insomnia is caused by emotional trauma, a dramatic change in schedule, or some other disruption of your daily routine. Events such as these may trigger a few nights of poor or disturbed sleep.
- Chronic insomnia. Chronic insomnia occurs at least three times per week and lasts anywhere between one to six months. People with chronic insomnia are the more likely of the two groups to experience reduced daytime functioning because of lost nighttime sleep.
Insomnia: How to Find Relief
Your doctor will first attempt a common-sense approach to treating your insomnia. He or she will advocate that:
- your sleeping arrangements are to be cool, dark, quiet, and free of disturbances
- that you go to bed and wake up at approximately the same time every day
- that those times are respectful of your body’s natural rhythms
The doctor may also recommend to avoid or to engage in certain activities during the daytime to aid sleep. Regular exercise and good nutrition are beneficial to overall sleep habits but medical research overwhelmingly shows to avoid eating and exercise within 2 hours of going to bed, as well as avoiding caffeine and naps longer than 40 minutes. Keep a detailed sleep diary with information about how well and long you sleep each night, as well as your daily and bedtime routines. This information is of great benefit to helping your doctor diagnose your condition correctly.
If there are physical or emotional issues that are causing the insomnia, a personal history and physical exam will hopefully shed light on them. Often mental health counseling is helpful to the patient. Cognitive-behavioral therapy (CBT), which is a type of counseling, has been shown to help patients reduce anxious feelings regarding sleep, and to improve length and quality of sleep.
Insomnia: Medication Options
When all other avenues have been explored, your doctor may suggest medication to treat insomnia. Generally, the doctor’s criteria for prescribing medication are if the lack of sleep is affecting daytime activities.
There are several different types of sleep medications:
Antihistamines. Antihistamines are OTC medications sold to alleviate allergy symptoms. Some, in their original formulations, cause drowsiness and are therefore also marketed as sleep aids. Examples: doxylamine (Unisom), and diphenhydramine (Benadryl) for mild cases
Sedative hypnotics. Hypnotics work by suppressing excitement or cognitive irritability. They are divided into 2 groups: Benzodiazepines, such as temazepam (Restoril) and triazolam (Halcion), are effective for managing insomnia but can cause dependency, and Non-benzodiazepines, such as zolpidem (Ambien) and eszopiclone (Lunesta) have a lower risk of dependency
Melatonin receptor medication. Plants, animals, and humans manufacture melatonin, a hormone, to help regulate sleep and wake cycles. Melatonin is also sold as a nutritional supplement. It does not help primary insomnia but does help temporary conditions such as jet lag. (Ramelteon [Rozerem] mimics melatonin and may be useful for people who have trouble falling asleep.)
Antipsychotics and antidepressants. This class of drugs has long been used to treat insomnia. (Trazadone [Desyrel], nortriptyline [Pamelor], and thioridazine [Mellaril] can be used to successfully treat insomnia, but their common side effects limit their use.)
For the patient’s health and well-being, it is important that insomnia sufferers see their health care team and to be informed about choices for treatment.