Do I have insomnia?
In general, if it takes you more than 30 minutes to fall asleep, if you are awake during the night for 30 minutes or more, or if you wake up 30 minutes or more before your desired wake time for at least three nights per week, your insomnia is considered significant.
You are not alone!
Surveys have found that insomnia is increasing at an alarming rate with more than one third of the US population experiencing significant insomnia for at least two weeks or more.
Trouble initiating or maintaining sleep, or non-refreshing sleep that lasts for 6 months is called, chronic. It has been estimated that approximately 10%-15% of the population of the United suffer from chronic insomnia. That's more than 28 million people!
Is insomnia serious?
Yes. Research has found that persistent insomnia that goes untreated increases the risk of developing both medical and psychiatric disorders. Chronic insomnia has been found to be associated with increased work-related accidents and decreased quality of life.
How much sleep do I need?
Individuals vary on how much sleep they require for optimal functioning. Individuals with insomnia often report six and a half hours or less of total sleep per night, depending on age.
Sometimes people with insomnia find that although they may get a normal amount of sleep, they do not feel refreshed when they wake up.
Is all insomnia the same?
There are two main types of insomnia:
Primary Insomnia
Primary insomnia is having sleep difficulties without the presence of any other
medical or psychiatric condition. Although primary insomnia often begins due to
stress or physical injury, it continues long after the factors that first
started it have been resolved.
Scientists have found a variety of factors that maintain and contribute to
insomnia, these include:
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heightened states of arousal before and during sleep
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problems with the biological rhythms that regulate the timing of sleep
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interruption of the sleep systems that control the amount and quality of your
sleep
In addition, many people with insomnia often try to make up for lost sleep or
to improve their sleep using strategies that actually MAKE THE PROBLEM WORSE!
Such problematic strategies include:
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napping
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spending excessive time in bed trying to sleep
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keeping erratic bed and wake times
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worrying about not sleeping or the consequences of not sleeping
Secondary Insomnia
Often insomnia is a symptom of another medical condition such as overactive thyroid or major depression. Sometimes insomnia is a side effect of medications. Insomnia is also commonly caused by physical injury, or another sleep disorder such as sleep apnea. These forms of insomnia are called secondary insomnia because the sleep disturbance is related to another condition.
How is insomnia treated?
There are two main forms of treatment for insomnia, medication-based treaments and behavioral strategies.
Medication-based strategies
Medication based treatments include prescription sleep aids, over-the-counter
sleep aids and herbal supplements.
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Prescription Medications:
Examples include benzodiazepines such as Dalmane (flurazepam), benzodiazepine
receptor agonists such as Ambien (zolpidem), and Sonata (zaleplon).
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Over-the-counter Medications:
Many over-the-counter remedies such as Sominex contain diphenhydramine, a
sedating antihistamine.
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Herbal Supplements: Popular herbal and alternative remedies include
valerian root, melatonin, passion flower, and skull cap.
Do medications work?
While medications and over-the-counter remedies may help some people with
occasional or short-term cases of insomnia, they are not recommended for
long-term use. Many individuals with chronic primary insomnia find both
prescription and over-the-counter remedies ineffective or undesirable
Common Problems Associated with Prescription Medications:
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Long-term use may be lead to the development of tolerance (more and more of the
medication is required to produce the same effect
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Discontinuing sedative hypnotics may be associated with a withdrawal syndrome,
including a resumption of severe insomnia
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May impair daytime performance. Medications with long half-lives may lead to
feeling groggy in the morning
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May interact negatively with other medications
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Medications have not been found to "cure" insomnia because they are not thought
to address the underlying causes of the problem
Common Problems with Over-the-counter Medications
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While sedating, these medications interfere with the normal structure of sleep
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Morning "hang over"
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Side effects, such as dry mouth, nose, and throat
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Not recommended for chronic insomnia
Common Problems with Herbal Supplements
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Largely untested-not much may be known about their safety or effectiveness
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The herbal supplement industry is not regulated by the Food and Drug
Administration (FDA). You never know what you may be actually getting and
whether the quality is acceptable
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Many supplements contain active chemical compounds, which may interact with
other medication
Behavioral Treatments
The behavioral medicine approach to treating insomnia uses behavior change strategies that have been proven effective for treating many conditions such as chronic anxiety, depression, and chronic pain. In addition, these strategies have been found to be successful for wellness programs such as smoking cessation, stress management and of course, insomnia!
How do behavioral interventions help with insomnia?
Behavioral treatments for insomnia help you improve your sleep by:
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Breaking the association between lying in bed and experiencing intrusive sleep
interfering thoughts
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Making changes to your sleep schedule to consolidate your sleep
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Improving your sleep environment
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Addressing lifestyle contributors to insomnia
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Targeting the worry and anxiety that results from poor sleep
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Enhancing your ability to relax in order to minimize the tossing and turning
that contributes to your sleep difficulties
What are some of the strategies used in behavioral treatment?
Behavioral treatment uses scientifically proven strategies to help improve your
sleep including:
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Sleep restriction:
Sleep restriction puts you back in control of your sleep schedule. By measuring
the amount of sleep your body needs, sleep restriction procedures determine
your optimal sleep schedule to first improve the quality of your sleep, and
then to improve the quantity of your sleep. This involves setting your bedtime
and wake time on a weekly basis.
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Stimulus control:
Stimulus control is a set of instructions designed to break the association
between your bed and bedroom and being awake with insomnia. They are designed
to help you associate your bed and bedroom environment with sleeping soundly.
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Sleep hygiene:
Sleep hygiene involves an assessment of your sleep habits and your sleep
environment. By making simple changes to your sleep routines, health habits and
sleep environment, your sleep will improve in both quality and quantity.
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Cognitive strategies and relaxation training: Many persons suffering
from insomnia describe extreme anxiety, worry or racing thoughts that prohibit
them from getting the sleep they need. By teaching individuals simple and
effective strategies and relaxation techniques, these worries or anxieties can
be controlled or eliminated, allowing you to get the sleep your body needs.
How does behavioral treatment compare to medications?
A recent scientific evaluation of the major studies of chronic insomnia conducted since 1965 found that behavioral treatment is as effective as the best sleeping medications in the short term. In addition, other clinical studies have shown behavioral treatment is the best approach for long-term improvement.
In comparison, medications provide only short term relief from insomnia. When medications are discontinued, the insomnia returns.