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-Trouble falling asleep or staying asleep-commonly termed insomnia-plagues
one in three American adults. If you suffer from insomnia, it
disturbs your waking hours as well as your sleeping hours, since
you're likely to feel sleepy during the day and have trouble concentrating
on tasks after a poor night's sleep.
-Insomnia afflicts people of all ages, most often just for a night
or two, but sometimes for weeks, months, or even years.
-Understanding insomnia presents an interesting puzzle: It's clear
that trouble sleeping at night can make you sleepy during the
day, but why can't you fall asleep easily at bedtime or sleep
through the night?
-Recent advances in understanding both the day and night components
of insomnia are making it possible for healthcare providers to
help most troubled sleepers.
Types of Insomnia-
Transient insomnia-Transient insomnia is an inability to sleep
well over a period of a few nights. This type of insomnia is usually
brought on by excitement or stress.
Short-term insomnia-Periods of ongoing stress at work or at home
can result in two or three weeks of poor sleep.
Chronic insomnia-More than 35 million Americans complain of chronic
insomnia-poor sleep every night or most nights.
What causes insomnia? What helps?
Insomnia is a symptom of another problem, much like a fever or
a stomachache. It can be caused by any number of things.
Vulnerability to insomnia: Some people seem more likely than others
to experience insomnia during times of stress, just as some people
might tend to have headaches or indigestion. Knowing that the
problem may occur and that it will subside can be helpful in coping
with bouts of poor sleep.
Persistent stress: Problems such as a troubled marriage, a chronically
ill child, or an unrewarding career can often contribute to poor
sleep. People with these problems can be helped by counseling
to gain a new outlook on their continuing troubles and to exert
Psychiatric problems: Insomnia-especially with awakenings earlier
than desired-is one of the most common symptoms of depression.
People with anxiety, schizophrenia, and other psychiatric disorders
may also sleep poorly. Treatment of the underlying disorder, often
including both medications and psychotherapy, can help improve
Use of stimulants: The use of caffeine near bedtime, even if it
doesn't interfere with the onset of sleep, can trigger awakenings
later in the night. Nicotine is also a stimulant, and smokers
may take longer to fall asleep than non-smokers. Ingredients of
many common drugs, including nonprescription drugs for weight
loss, asthma, and colds, can interfere with sleep.
Use of alcohol: A nightcap, while it may help induce sleep, is
likely to make sleep more fragile throughout the night.
Erratic hours: Shift workers (those who work nontraditional hours,
such as nights or rotating shifts), along with those who maintain
later hours on weekends than during the week, are likely to experience
sleep problems. Maintaining regular hours can help program the
body to sleep at certain times and to stay awake at others.
Interactive behavior: People whose lifestyles are very quiet or
restricted may find it difficult to sleep at night because of
their inactivity during the day.
Learned insomnia: People who sleep poorly during times of stress
are likely to worry about not being able to function effectively
during the day. They resolve to try harder to sleep at night,
and unfortunately this determined effort makes them more alert
and sets off a new round of worried thoughts
Activities in and around the bedroom-changing into night clothes,
turning off the lights, pulling up the blankets-can serve as cues
that encourage wakefulness. People who have trouble sleeping in
their own beds may fall asleep quickly when they don't intend
to-while reading the newspaper, watching TV, or driving for example.
Even a few nights of poor sleep during a month can be all it takes
to maintain this cycle of poor sleep and continuing concern about
poor sleep. Treatment for this type of insomnia aims to improve
sleep habits and defuse the accompanying anxiety.
Misuse or overuse of sleeping pills: If used every night, sleeping
pills stop being effective after a few weeks. When their use is
stopped suddenly, however, sleep can temporarily be worsened.
Noise: Passing traffic, airplanes, television and other noises
can disturb sleep even when they don't cause the sleeper to wake
up. Light: Light comes through the eyelids even when the eyes
Breathing disorders: Certain disorders can cause repeated interruptions
in breathing during sleep which can rouse a sleeper dozens or
even hundreds of times a night. These pauses can be as short as
10 seconds and may not be remembered in the morning. Breathing-related
sleep disruptions becomes more common with advancing age. Most
cases are mild and don't require treatment, but it's generally
wise to avoid sleeping pills, which can make breathing problems
worse. Severe cases of sleep apnea often benefit from a treatment
known as continuous positive airway pressure. This treatment keeps
the breathing passages open with a steady stream of air delivered
through a mask worn over the nose and mouth during sleep.
Periodic leg movement: Brief muscle contractions can cause leg
jerks that last a second or two and occur roughly every 30 seconds
(often for an hour or longer) several times a night. Treatment
can include sleeping pills, pain relieving drugs, evening exercise,
a warm bath, or a combination of these. Iron replacement can be
helpful in people who have an iron deficiency, especially if they
also experience restless legs.
Waking brain activity that persists during sleep: Sleep monitoring
during the night demonstrates that some people who complain of
light or nonrestorative sleep fail to sink fully into sleep.
Gastroesophageal reflux: The back-up of stomach contents into
the esophagus (commonly known as heartburn), can awaken a person
several times a night. Elevating the head of the bed on 6- to
8-inch blocks can help prevent reflux. Medication can also provide
Pain: Disorders such as arthritis, angina, lower back pain, fibromyalgia,
and headache may upset sleep and waking hours. Sometimes a Change
in the positioning of pillows, the correct mattress, and pre-sleep
behavior can make a difference.
When to seek help
-If your sleep has been disturbed for more than a month and interferes
with the way tou feel or function during the day, see your healthcare
provider, or ask for a referral to a sleep disorders specialist.
Can sleeping pills help?
Sleeping pills can help provide sounder sleep and can improve
alertness the following day. This relief is only temporary, since
sleeping pills are not a cure for insomnia. For some types of
insomnia-such as that resulting from breathing disorders-sleeping
pills can be dangerous. Insomnia needs to be properly diagnosed
and treatment options discussed with a healthcare provider.
Sleeping pills can help with the following conditions:
-Shift work schedule changes that affect sleep time
-Certain medical disorders