Insomnia

1. Insomnia

3. CONTENTS • What is insomnia? • What causes insomnia? • What are the symptoms of insomnia? • How is insomnia treated? • What are non-medical treatments for insomnia? • Will prescription sleeping pills help? • What can I do to improve my sleep habits? • What is sleep restriction? • Tips to help you sleep. • Quiz

4. What is insomnia? Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep. Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia. Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men. Insomnia may be divided into three classes based on the duration of symptoms. • Insomnia lasting one week or less may be termed transient insomnia; • short-term insomnia lasts more than one week but resolves in less than three weeks; and • long-term or chronic insomnia lasts more than three weeks. Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on. It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation. • Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia. • In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.

5. What causes insomnia? Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause. Situational and stress factors leading to insomnia may include: • jet lag, • physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings), • working different shifts, • stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination), • illicit drug use, • cigarette smoking, • caffeine intake prior to going to bed, • alcohol intoxication or withdrawal, or • certain medications. Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.

6. What are the symptoms of insomnia? Impairment of daytime functioning is the defining and the most common symptom of insomnia. Other common symptoms include: • daytime fatigue, • daytime sleepiness, • mood changes, • poor attention and concentration, • lack of energy, • anxiety, • poor social function, • headaches, and • increased errors and mistakes.

7. How is insomnia treated? • The treatment of insomnia depends largely on the cause of the problem. In cases where an obvious situational factor is responsible for the insomnia, correcting or removing the cause generally cures the insomnia. For example, if insomnia is related to a transient stressful situation, such as jet lag or an upcoming examination, then insomnia will be cured when the situation resolves. • Generally speaking, the treatment of insomnia can be divided into non-medical or behavioral approaches and medical therapy. Both approaches are necessary to successfully treat insomnia, and combinations of these approaches may be more effective than either approach alone. • When insomnia is related to a known medical or psychiatric condition, then appropriate treatment of that condition is in the forefront of therapy for insomnia in addition to the specific therapy for insomnia itself. Without adequately addressing the underlying cause, insomnia will likely go on despite taking aggressive measures to treat it with both medical and non-medical therapies.

8. What are non-medical treatments for insomnia? There are several recommended techniques used in treating people with insomnia. These are non-medical strategies and are generally advised to be practiced at home in combination with other remedies for insomnia, such as medical treatments for insomnia and treatment for any underlying medical or psychiatric disorders. Some of the most important of these behavioral techniques are sleep hygiene, stimulus control, relaxation techniques, and sleep restriction. What is sleep hygiene? Sleep hygiene is one of the components of non-medical treatments for insomnia and includes simple steps that may improve initiation and maintenance of sleep. Sleep hygiene consists of the following strategies: • Sleep as much as possible to feel rested, then get out of bed (do not over-sleep). • Maintain a regular sleep schedule. • Do not force yourself to sleep. • Do not drink caffeinated beverages in the afternoon or evening. • Do not drink alcohol prior to going to bed. • Do not smoke, especially in the evening. • Adjust the bedroom environment to induce sleep. • Do not go to bed hungry. • Resolve stress and anxiety before going to bed.

9. Will prescription sleeping pills help? Prescription sleeping pills are not a cure for insomnia. Although they can help in some cases, they're only a temporary form of relief. Most types of sleeping pills should only be used for a limited time. Regular use may lead to rebound insomnia. This happens when a person quits taking sleeping pills and his or her insomnia comes back even worse than before. Sleeping pills can be unsafe to use if you have certain health problems. Ask your doctor if sleeping pills would be helpful for you.

10. What can I do to improve my sleep habits? The following are some things you can do to help you sleep better: • Go to bed and wake up at the same time every day, including weekends, even if you didn't get enough sleep. This will help train your body to sleep at night. • Develop a bedtime routine. Do the same thing every night before going to sleep. For example, take a warm bath and then read for 10 minutes every night before going to bed. Soon you'll connect these activities with sleeping, and doing them will help make you sleepy. • Use the bedroom only for sleeping or having sex. Don't eat, talk on the phone or watch TV while you're in bed. • Make sure your bedroom is quiet and dark. If noise is a problem, use a fan to mask the noise or use ear plugs. If you must sleep during the day, hang dark blinds over the windows or wear an eye mask. • If you're still awake after trying to fall asleep for 30 minutes, get up and go to another room. Sit quietly for about 20 minutes before going back to bed. Do this as many times as you need to until you can fall asleep.

11. What is sleep restriction? Sleep restriction refers another non-medical behavioral therapy for insomnia which involves limiting the time spent in bed for sleeping only. Many people with insomnia may stay in bed for a long time after they wake up in the morning. This over-sleeping may disrupt the circadian rhythm and make sleep initiation more difficult the following night. Sleep logs are used to record the actual time spent sleeping each night, and the time spent in bed is gradually reduced to the exact time spent sleeping by shortening the total time in bed. This method gradually reduces and eliminates over-sleeping over a period of time. It also increases the drive to sleep and makes sleep more efficient, as the time spent in bed approximates the duration of sleep.

12. Tips to help you sleep • Avoid or limit your use of caffeine (coffee, tea, caffeinated soda, chocolate), decongestants, alcohol and tobacco. • Exercise regularly, but don't exercise within a few hours before going to bed. • Find ways to reduce or manage the stress in your life. • Don't lie in bed worrying about things. Set aside another time just for worrying. For example, spend 30 minutes after dinner writing down what's worrying you and what you can do about it. • Try eating a light snack before going to bed, but don't eat too much right before bedtime. A glass of warm milk or some cheese and crackers may be all you need. • Don't nap during the day if naps seem to make your insomnia worse.

13. QUIZS TRUE OR FALSE ? _____ 1. Sleep is a time when your body and brain shut down for rest and relaxation. _____ 2. If you regularly doze off unintentionally during the day, you may need more than just a good night's sleep. _____ 3. If you snore loudly and persistently at night and are sleepy during the day, you may have a sleep disorder. _____ 4. Opening the car window or turning the radio up will keep the drowsy driver awake. _____ 5 . Narcolepsy is a sleep disorder marked by "sleep attacks.“ _____ 6 . The primary cause of insomnia is worry. _____ 7. One cause of not getting enough sleep is restless legs syndrome. _____ 8. The body has a natural ability to adjust to different sleep schedules such as working different shifts or traveling through multiple time zones quickly. _____ 9. People need less sleep as they grow older. _____10. More people doze off at the wheel of a car in the early morning or mid afternoon than in the evening.

14. QUIZS ______ 11. Snoring is a common problem, especially among men, but it isn’t harmful ______ 12. You can “cheat” on the amount of sleep you get ______ 13. It is important to maintain a regular bed and wake time schedule including weekends. ______ 14. One way to establish a regular, relaxing bedtime routine is to try soaking in a hot bath or hot tub and then reading a book or listening to soothing music. ______ 15. Turning up the radio, opening the window, or turning on the air conditioner are effective ways to stay awake when driving. ______ 16. Teens who fall asleep in class have bad habits and/or are lazy. ______ 17. Insomnia is characterized by difficulty falling asleep. ______ 18. It is best to use your bedroom only for sleep and sex. ______ 19. Daytime sleepiness always means a person isn’t getting enough sleep. ______ 20. Health problems such as obesity, diabetes, hypertension and depression are unrelated to the amount and quality of a person’s sleep.

15. QUIZS ANSWERS TRUE OR FALSE ? FALSE 1. Sleep is a time when your body and brain shut down for rest and relaxation. TRUE 2. If you regularly doze off unintentionally during the day, you may need more than just a good night's sleep. TRUE 3. If you snore loudly and persistently at night and are sleepy during the day, you may have a sleep disorder. FALSE 4. Opening the car window or turning the radio up will keep the drowsy driver awake. TRUE 5 . Narcolepsy is a sleep disorder marked by "sleep attacks.“ FALSE 6 . The primary cause of insomnia is worry. TRUE 7. One cause of not getting enough sleep is restless legs syndrome. FALSE 8. The body has a natural ability to adjust to different sleep schedules such as working different shifts or traveling through multiple time zones quickly. FALSE 9. People need less sleep as they grow older. TRUE 10. More people doze off at the wheel of a car in the early morning or mid afternoon than in the evening.

16. QUIZS ANSWERS False 11. Snoring is a common problem, especially among men, but it isn’t harmful False 12. You can “cheat” on the amount of sleep you get True 13. It is important to maintain a regular bed and wake time schedule including weekends. True 14. One way to establish a regular, relaxing bedtime routine is to try soaking in a hot bath or hot tub and then reading a book or listening to soothing music. False 15. Turning up the radio, opening the window, or turning on the air conditioner are effective ways to stay awake when driving. False 16. Teens who fall asleep in class have bad habits and/or are lazy. False 17. Insomnia is characterized by difficulty falling asleep. True 18. It is best to use your bedroom only for sleep and sex. False 19. Daytime sleepiness always means a person isn’t getting enough sleep. False 20. Health problems such as obesity, diabetes, hypertension and depression are unrelated to the amount and quality of a person’s sleep.

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