Insomnia

Wednesday, October 26, 2011

Insomnia is one of the most common complaints in primary care. It is characterized by difficulty getting to sleep or staying asleep.  It can be associated with significant anxiety, depression and numerous physical complaints.  

Insomnia is defined by how long the symptoms have lasted

Transient: < 1 week

Short Term: 1 to 3 weeks

Chronic: >3 weeks

There are numerous causes of insomnia: stress and worries, change in sleep environment, increased light exposure, noise, high or low temperatures, poor mattress, too much stimulant such as coffee, tea, nicotine or soda, anxiety or depression.   It can also be associated with other diseases like COPD/Emphysema, heart failure, Parkinson's, bipolar, drug or alcohol use, diabetes, thyroid issues and sleep apnea.  

It is very important to evaluate insomnia as it can lead to excessive daytime fatigue, accidents and clumsiness, memory loss, and eventually even more stress.

It’s important to evaluate and identify the cause to treat adequately.  Treatment could be as simple as working on sleep hygiene.  This may involve changing a mattress, temperature in the room or eliminating lights.

Eliminate any activity in bed like reading or watching TV.  Because these activities are stimulating and involve direct activating light exposure they should be avoided.  It may be fine to read or watch TV in another room but try to keep it out of the bedroom.  I get the most grief when I suggest this, but it really does help.

In the office you’ll be evaluated for sleep hygiene issues as well as physical findings such as enlarged tonsils, narrow throat, enlarged tongue size, overweight or large neck, thyroid issues or iron deficiency, and sleep apnea.  

If appropriate you can be prescribed medication for insomnia.  This can include hypnotics like zolpidem or some older medications such as trazodone for insomnia associated with depression, or a benzodiazepine which is an older and generic medication approved for sleep disorders that are associated with anxiety.   Over the counter options include benadryl or melatonin.  There are many other options and combinations that can be helpful, but identifying the cause and using non-pharmacological methods are still preferred.  

For even more information please click HERE to explore beyond the basics.

Updated 10/27/2011 - More Links

Link to Consumer Reports Health 2008 article on Insomnia.