Insomnia | Temporary insomnia | Chronic insomnia | Evaluation and treatment | Resources
Insomnia is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. People with insomnia do not feel refreshed when they wake up. Insomnia is a common symptom affecting millions of people that may be caused by many conditions, diseases, or circumstances. Primary insomnias include chronic and temporary sleeplessness. Secondary insomnias are defined as unusual sleeping patterns like sleepwalking or nocturnal eating, night terrors or nightmares, and respiratory movement or nervous disorders such as the restless leg syndrome.
Most adults require between seven and eight hours of sleep each night. However, scientists who deal with insomnia state that about 58% of adults experience symptoms of insomnia on a weekly basis, a few days each week on average, while 35% of adults report some type of insomnia every night or at least almost every night. Statistics Canada reported in 2005 that about 3.3 million Canadians (that is about one in every seven people 15 years old or older) have difficulties going to sleep or staying asleep. These statistics are consistent with sleep difficulties in U.S. citizens.
Sleep is essential for mental and physical restoration. It is a cycle with two separate states: rapid eye movement (REM), the stage in which most dreaming occurs; and non-REM (NREM). Four stages of sleep take place during NREM: stage I, when the person passes from relaxed wakefulness; stage II, an early stage of light sleep; stages III and IV, which are increasing degrees of deep sleep. Most stage IV sleep (also called delta sleep), occurs in the first several hours of sleep. A period of REM sleep normally follows a period of NREM sleep.
Temporary insomnia
Anyone will, at some point during his or her lifetime, experience a temporary inability to fall asleep.
This is officially known as psychophysiological insomnia (PI), because the body and mind can react to different kinds of stress by developing insomnia. A change in work schedule, jet lag, a recent death in the family, or the use of certain prescription medicines or drugs like caffeine can disrupt a person’s circadian rhythm. This rhythm is a roughly 24-hour cycle of sleeping and waking, but it can be set off-balance by an all-night study session, during a hospital stay, or by traveling from one time zone to another.
Other forms of temporary insomnia accompany stages of the life cycle. Children, pregnant women, and the elderly exhibit sleeplessness in reaction to changes in their body chemistry or of their surroundings. Preschool children commonly find it hard to go to bed on schedule every day. Physicians are wary of prescribing unnecessary drugs to pregnant women, so often they are prevented from relying on their usual sleep aids.
Certain acute medical conditions count insomnia among their symptoms. The endocrine disorder called hyperthyroidism can interfere with brain wave patterns, and also obstruct the throat to cause sleep apnea or intermittent breathlessness during sleep. Any medical condition that causes chronic pain will also keep people awake, from ulcers or angina for instance. Psychiatric causes of insomnia range from depression to anorexia-nervosa to psychotic breakdowns. Drug addicts such as alcoholics will encounter insomnia as a withdrawal effect.
Chronic insomnia
Idiopathic, which means primary, insomnia develops in childhood and persists throughout a person’s lifetime. Its true cause is a mystery, though people who exhibit this chronic sleeplessness often suffer from particular brain dysfunctions as well; dyslexia, for example. These disorders may share a root cause with idiopathic insomnia, but more studies will have to be commissioned before any theories may be formed. Those who suffer from childhood tend to cope more easily than those who develop temporary insomnias. Idiopathic insomniacs are thereby less prone to sleep phobias and other psychological reactions that often accompany transient insomnias.
Evaluation and treatment
Pseudoinsomnia remains a puzzle for sleep researchers. While the prefix pseudo indicates a false impression of sleeplessness, there is a possibility that current monitoring technologies like the EEG (electroencephalogram) may not differentiate clearly enough between sleeping and waking states. Further complications involve variations in sleep needs from person to person. For instance, German–American physicist Albert Einstein (1879–1955) was fond of naps but American inventor Thomas Alva Edison (1847–1931) hardly slept at all.
KEY TERMS
Circadian rhythm —The rhythmical biological cycle of sleep and waking that, in humans, usually occurs every 24 hours.
Idiopathic insomnia —Chronic insomnia that begins in childhood and continues into adulthood.
PI —An acronym for psychophysiological insomnia. This term applies to insomnia that may begin in response to emotional distress, illness or disruptions of the daily schedule.
Pseudoinsomnia —A complaint of insomnia or insufficient sleep not supported by sleep log reports or medical examinations.
Sleep apnea —A disorder that contributes to insomnia, during which a sleeper stops breathing for seconds at a time throughout the night.
Sleep hygiene —A form of therapy that attempts to treat insomnia without using drugs, by instead changing disruptive behavioral patterns of the patient.
Is one person’s good night’s rest another person’s waste of time? Self-described ‘night owls’ function better by working evening shifts and sleeping daytime, but this can be debilitating for ‘larks’ or morning people. Some individuals operate on a 25-hour circadian rhythm, which does not synch with 24-hour clock time.
Self-administered sleep aids can sometimes backfire on an insomniac. Alcohol can at first lull one to sleep, but habitual use of this depressant can in turn further disrupt sleeping patterns. A vicious cycle may soon surface, in which increased use of sleep aids like over-the-counter pills and/or alcohol contributes only to worsening the original condition.
An alternative that does not resort to prescription drugs is known as sleep hygiene. This regimen of behavior modification is designed to lessen exposure to stress and improve the patient’s attitude towards sleeping and waking. A sleep log is kept to help a therapist pinpoint the probable causes of the patient’s insomnia. Then, self-monitoring is encouraged, so the patient learns to avoid excitement or heavy meals before bed, curtail the use of stimulants and depressants, and avoid naps. More experimental modification techniques like biofeedback may also be prescribed. Sleep hygiene programs are thereby tailored to individual needs.
Resources
BOOKS
Butcher, Nancy. 101 Ways to Fall Asleep. New York: Berkley Books, 2002.
Morin, Charles, and Colin A. Espie, eds. Insomnia: A Clinical Guide to Assessment and Treatment.New York: Kluwer Academic/Plenum Publishers, 2003.
Szuba, Martin P., Jacqueline D. Kloss, and David F. Dinges, eds. Insomnia: Principles and Management. Cambridge, UK: Cambridge University Press, 2003.
Jennifer Kramer
