Tuesday, August 25, 2009

Health Care and Insomnia

Ever have a problem falling asleep at night? Has your sleep been missing for a while and you find yourself laying in bed wide awake for hours on end when you should be sleeping? How much sleep is enough varies from person to person, according to the Mayo Clinic. More than one-third of adults have insomnia at some time, while 10 to 15 percent report long-term (chronic) insomnia. Insomnia includes having trouble falling or staying asleep. It's one of the most common medical complaints. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood, but also your health, work performance and quality of life.

According to eMedicineHealth.com, Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" and it may be due to inadequate quality or quantity of sleep. Insomnia is not defined by a specific number of hours of sleep that one gets, since individuals vary widely in their sleep needs and practices. Although most of us know what insomnia is and how we feel and perform after one or more sleepless nights, few seek medical advice. Many people remain unaware of the behavioral and medical options available to treat insomnia. Insomnia is generally classified based on the duration of the problem. Not everyone agrees on one definition, but generally:
--Symptoms lasting less than one week are classified as transient insomnia,
--Symptoms between one to three weeks are classified as short-term insomnia, and
--Those longer than three weeks are classified as chronic insomnia.

Insomnia affects all age groups, according to eMedicineHealth.com. Among adults, insomnia affects women more often than men. The incidence tends to increase with age. It is typically more common in people in lower socioeconomic (income) groups, chronic alcoholics, and mental health patients. Stress most commonly triggers short-term or acute insomnia. If you do not address your insomnia, however, it may develop into chronic insomnia. Many of the causes of transient and short-term insomnia are similar and they include:
--Jet lag
--Changes in shift work
--Excessive or unpleasant noise
--Uncomfortable room temperature (too hot or too cold)
--Stressful situations in life (exam preparation, loss of a loved one, unemployment, divorce, or separation)
--Presence of an acute medical or surgical illness or hospitalization
--Withdrawal from drug, alcohol, sedative, or stimulant medications
--Insomnia related to high altitude (mountains)

The majority of causes of chronic or long-term insomnia are usually linked to an underlying psychiatric or physiologic (medical) condition. The most common psychological problems that may lead to insomnia include:
--Anxiety,
--Stress,
--Schizophrenia,
--Mania (bipolar disorder), and
--Depression.
In fact, insomnia may be an indicator of depression. Many people will have insomnia during the acute phases of a mental illness.

Physiological causes span from circadian rhythm disorders (disturbance of the biological clock), sleep-wake imbalance, to a variety of medical conditions. The following are the most common medical conditions that trigger insomnia:
--Chronic pain syndromes,
--Chronic fatigue syndrome,
--Congestive heart failure,
--Night time angina (chest pain) from heart disease,
--Acid reflux disease (GERD),
--Chronic obstructive pulmonary disease (COPD),
--Nocturnal asthma (asthma with night time breathing symptoms),
--Obstructive sleep apnea,
--Degenerative diseases, such as Parkinson's disease and Alzheimer's disease (Often insomnia is the deciding factor for nursing home placement.)
--Brain tumors, strokes, or trauma to the brain.

In addition to the above medical conditions, certain groups may be at higher risk for developing insomnia:
--Travelers,
--Shift workers with frequent changing of shifts,
--Seniors citizens,
--Adolescent or young adult students,
--Pregnant women, and
--Menopausal women.

Certain medications have also been associated with insomnia. Among them are:
--Certain over-the-counter cold and asthma preparations.
The prescription varieties of these medications may also contain stimulants and thus produce similar effects on sleep.
--Certain medications for high blood pressure have also been associated with poor sleep.
--Some medications used to treat depression, anxiety, and schizophrenia.

Also, according to eMedicineHealth.com, common stimulants associated with poor sleep include caffeine and nicotine. You should consider not only restricting caffeine and nicotine use in the hours immediately before bedtime but also limiting your total daily intake. People often use alcohol to help induce sleep, as a nightcap. However, it is a poor choice. Alcohol is associated with sleep disruption and creates a sense of non-refreshed sleep in the morning. A disruptive bed partner with loud snoring or periodic leg movements also may impair your ability to get a good night's sleep. More indepth info is available at http://www.emedicinehealth.com/insomnia/article_em.htm .

According to the Mayo Clinic, sleep is as important to your health as a healthy diet and regular exercise. Whatever your reason for sleep loss, insomnia can affect you both mentally and physically. People with insomnia report a lower quality of life compared with people who are sleeping well. Complications of insomnia may include:
--Lower performance on the job or at school.
--Slowed reaction time while driving and higher risk of accidents.
--Psychiatric problems, such as depression or an anxiety disorder.
--Overweight or obesity.
--Poor immune system function.
--Increased risk and severity of long-term diseases, such as high blood pressure, heart disease and diabetes.

According to FamilyDoctor.org, your family doctor may ask you and your bed partner some questions about your sleep habits (such as when you go to bed and when you get up), any medicine you take, and the amount of caffeine and alcohol you drink. Your doctor may also ask if you smoke. Other questions may include how long you've been having insomnia, if you have any pain (such as from arthritis), and if you snore while you sleep. Your doctor may also ask about events or problems in your life that may be upsetting you and making it hard for you to sleep. If the cause of your insomnia is not clear, your doctor may suggest that you fill out a sleep diary. The diary will help you keep track of when you go to bed, how long you lie in bed before falling asleep, how often you wake during the night, when you get up in the morning and how well you sleep. A sleep diary may help you and your doctor identify patterns and conditions that may be affecting your sleep.

Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people, according to the Mayo Clinic. Good sleep hygiene — simple steps such as keeping the same bedtime and rising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep. Behavioral treatments teach you new sleep behaviors and ways to make your sleeping environment more conducive to sleep. Studies have shown behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.

According to the Mayo Clinic, sleep hygiene teaches habits that promote good sleep:
--Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
--Cognitive therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive therapy can be taught through one-on-one counseling or in group sessions.
--'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.
--Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
--Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside for 30 minutes or obtain light via a medical-grade light box.

According to the Mayo Clinic, taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.
Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone (Desyrel), doxepin (Sinequan, Adapin) or mirtazapine (Remeron). Over-the-counter sleep aids contain antihistamines that can induce drowsiness. But antihistamines may reduce the quality of your sleep, and they can cause side effects such as daytime sleepiness, dry mouth and blurred vision.

According to FamilyDoctor.org, most adults need about 7 to 8 hours of sleep each night. You know you're getting enough sleep if you don't feel sleepy during the day. The amount of sleep you need stays about the same throughout adulthood. However, sleep patterns may change with age. For example, older people may sleep less at night and take naps during the day. Insomnia is not really a serious problem for your health, but it can make you feel tired, depressed and irritable. It can also make it hard to concentrate during the day. Insomnia is the body's way of saying that something isn't right. The treatment of insomnia can be simple. Often, once the problem that's causing the insomnia is taken care of, the insomnia goes away. The key is to find out what's causing the insomnia so that it can be dealt with directly. Simply making a few changes in their sleep habits helps many people.

Until next time. Let me know what you think.

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