Insomnia, Sleep Disorders
Sleep disorders
Sleep is a state of physical and mental rest when you become relatively inactive and unaware of your environment. Sleep plays a significant role in brain development, it is essential in maintaining normal levels of cognitive skills such as speech, memory, and thinking. And the lack of sleep has serious effects on the brain's ability to function properly.
Somnipathy is a term that refers to any disorder that involves sleep. Some examples of sleep disorders are:
- Delayed sleep phase syndrome - the person cannot fall asleep or wake up at normally accepted times.
- Hypopnea syndrome - too shallow or slow breathing during sleep.
- Narcolepsy - a chronic sleep disorder where the brain is unable to regulate the body's sleep-wake cycles.
- Obstructive sleep apnea - the person stops breathing for 10 or more seconds during sleep.
- Periodic limb movement disorder - sudden jerks of an arm or leg during sleep.
- Insomnia - when it is hard to fall asleep or stay asleep.
- Rapid eye movement behavior disorder - abnormal behavior during REM (rapid eye movement) phase. The body starts to undergo complex integrated movements - as if the patient were physically acting out the dream.
- Restless legs syndrome - a disorder which causes a strong urge to move your legs.
- Somnambulism - sleepwalking.
- Somniphobia (hypnophobia) - an abnormal fear of sleep.
What is insomnia?
Insomnia is a very common sleep disorder that probably affects most people
at one time or another. Insomnia is more common among women and older adults
but can occur in people of all ages and all social classes. Over the age
of 65, 29% of men and 37% of women are affected.
Insomnia is an experience of inadequate or poor quality sleep characterized
by one or more of the following problems: difficulty falling or
maintaining sleep, waking up too early in the morning and sleep that is
not refreshing. It also involves daytime consequences such as fatigue,
lack of energy, difficulty concentrating and irritability. Insomnia is not
a serious medical condition but it can greatly affect the patient's work
and social life.
Periods of sleep difficulty lasting between one night and a few weeks are
referred to as acute (transient) insomnia. Chronic insomnia refers to sleep
difficulty occurring at least three nights per week for one month or more.
Over 90 percent of people experience transient or short-term insomnia at
some point during their lives, and up to 30 percent of the general U.S.
population struggle with chronic insomnia.
Insomnia causes
There are many possible causes of insomnia. Sometimes there is one main
cause, but often several factors interacting together will cause a sleep
disturbance. Some conditions and situations that commonly lead to insomnia
include:
- Psychological Causes
- Anxiety, a condition in which individuals feel increased
tension, apprehension, and feelings of helplessness, fear, worry,
and uncertainty. Everyday anxieties as well as severe anxiety disorders
may keep your mind too alert to fall asleep.
- Stress. Exposure to stress may contribute to the development
or worsening of insomnia. Relationship problems, a chronically ill
child, or an unrewarding career may contribute to sleep problems.
If you suffer from these types of stresses, you should seek counseling
to gain a new outlook on your troubles and more control in your life.
Concerns about work, school, health or family can keep your mind too
active, making you unable to relax.
- Depression, a mood disturbance characterized by feelings
of sadness, despair, and discouragement. About 90% of people with
depression have insomnia. This may be due to chemical imbalances in
the brain or because worries that accompany depression may keep person
from relaxing enough to fall asleep.
- Learned insomnia (also known as psychophysiological insomnia).
Occurs when an individual worries so much about whether or not he/she
will be able to go to sleep, that the person's bedtime rituals and
behavior actually trigger insomnia. The more the person worries about
falling asleep, the harder it becomes. Some individuals with learned
insomnia have trouble sleeping in their own beds yet may fall asleep
quickly when they don't intend to - while reading the newspaper, sleeping
away from home, or watching TV. Just a few nights of poor sleep during
a month can be enough to produce a cycle of poor sleep and increase
the worry about it. Treatment for learned insomnia aims to improve
sleep habits and reduce unnecessary worry.
- Hormonal changes in women. These include premenstrual syndrome,
menstruation, pregnancy, and menopause.
- Menopause. Insomnia is frequently reported by women experiencing
menopause. Insomnia can be a major problem in the first phases of
menopause, when hormones are fluctuating intensely. Insomnia during
this period may be due to different factors that occur. In some women,
hot flashes, sweating, and a sense of anxiety can awaken women suddenly
and frequently at night.
- Menstruation. Progesterone promotes sleep, and levels of
this hormone plunge during menstruation, causing insomnia.
- Pregnancy. The effects of changes in progesterone levels
in the first and last trimester can disrupt normal sleep patterns.
- Decreased melatonin. The levels of melatonin, the hormone that
helps control sleep, decrease as a person ages. By age 60, the body produces
very little melatonin.
- Medical conditions. These include allergies, arthritis, asthma,
headache disorders, heart disease, gastroesophageal reflux, high blood
pressure, restless legs syndrome, hyperthyroidism, Parkinson's disease.
Such medical problems usually require the attention of a physician who
can diagnose and treat the underlying condition. Treatment of the underlying
cause of insomnia hopefully will result in improved sleep.
- Pain. Pain and discomfort from a medical illness or injury often
interfere with sleep.
- Sleep related disorders. These include sleep apnea (in which
one temporarily stops breathing during sleep) and periodic leg and arm
movements during sleep (in which one's muscles excessively twitch or jerk).
Severely disrupted breathing during sleep, known as sleep apnea, may affect
people who breathe normally while they are awake. Breathing related sleep
problems are most common in men, snorers, overweight people, and older
adults.
- Genetics. Problems with insomnia do seem to run in some families,
although researchers have yet to identify how genetics play a role.
- Jet lag. Air travel across time zones often causes brief bouts
of insomnia. After long plane trips, one day of adjustment is usually
needed for each time zone crossed. Traveling west to earlier times seems
to be less traumatic than going east to a later time because it is easier
to lengthen a circadian phase than to shorten it.
- Working the night shift or long shifts. Individuals who work
at night and those who work long shifts may have trouble adjusting their
sleep habits. If you maintain later hours on weekends than during the
week, you are more likely to experience sleep problems.
- Medications. Insomnia can be caused by various medications, such as antidepressants,
corticosteroids, high blood pressure medications. Many over-the-counter
medications, including some pain medication combinations, decongestants
and weight loss products, contain caffeine and other stimulants. Antihistamines
may initially make you groggy, but they can worsen urinary problems, causing
you to get up more during the night.
- Long-term use of sleep medications. Sleeping pills often become
less effective over time. If a person suddenly stops taking or becomes
tolerant of a long term medication, insomnia may result.
If you need sleep medications for longer than a few weeks, take them no
more than two to four times a week, so they don't become habit forming.
- Substance abuse:
- Caffeine. Caffeine (contained in popular drinks like coffee,
tea and cola or chocolate) is a stimulant and may prevent
you from getting the sleep you need. The National Sleep Foundation
reports the effects of caffeine can cause problems falling asleep
as much as 10-12 hours later in some people. Consider halting your
caffeine intake earlier in the day to ensure you get quality sleep.
- Nicotine also stimulates the brain. Regular smokers often
sleep very lightly and have reduced amounts of REM (rapid eye movement)
sleep. They also tend to wake up after 3 or 4 hours of sleep due to
nicotine withdrawal.
- Alcohol. You may think that having a glass of wine will
help you sleep. However, while it may help you fall asleep quickly,
alcohol consumption is likely to produce interrupted sleep. After
we have had a few drinks, alcohol often causes drowsiness and lets
us get off to sleep quite easily. Later in the night, however, when
the alcohol level in our blood decreases, our body's arousal mechanism
is stimulated and our normal sleep pattern is impaired. In addition,
one of the effects of alcohol is to stimulate the pouring of adrenalin
into the bloodstream, causing arousal, sweating and palpitations.
This can result in waking up half-way through the night, or earlier
than normal, with the heart pounding, making it quite difficult to
get to sleep again.
- Inactive behavior. People whose lifestyles are very quiet or
restricted may experience difficulty sleeping at night.
- Excessive computer work.
- Environmental factors. In one study, 20% of adults reported that
light, noise, and uncomfortable temperatures caused their sleeplessness.
- Noise. Traffic, airplanes, television, and other noises
can disturb your sleep even when they don't cause you to wake up.
- Light. It is well known that a person's biologic circadian
clock is triggered by sunlight and very bright artificial light maintains
wakefulness. Light affects your brain's production of the hormones
that regulate sleep rhythms. Too much light in the bedroom can keep
your body from deep sleep. Insufficient exposure to light during the
day, as occurs in some disabled elderly patients who rarely venture
outside, may also be linked with sleep disturbances.
- Room temperature. Extreme temperatures and changes in the
surrounding environment can contribute to sleepless nights. You will
be restless if you are too hot or cold. A comfortable room temperature
is best.
- Sleep partner or other family members. A sleep partner who
snores, has sleep apnea, is very restless, gets up frequently, or
has difficulty sleeping will affect your ability to sleep. Interruptions
from other family members, such as a toddler or new baby, can also
keep you up.
Insomnia risk factors
The following factors may increase an individual's risk for insomnia:
- Age. Elderly people are more likely to be sedentary than younger adults. Medical
conditions that cause pain or nighttime distress are common in the elderly.
Neurologic diseases in the elderly, such as Parkinson's, Alzheimer's,
and other forms of dementia, can cause nighttime disorientation, confused
wandering, and delirium. Older people are also prone
to grief, worry, and anxiety, the handmaidens of sleeplessness. Older
people are more sensitive to environmental disruptions, such as light,
noise, or jet lag. Subtle and dramatic hormonal shifts also occur, including
reductions in melatonin and growth hormone and increases in stress hormones,
creating an imbalance that may reduce all stages of sleep.
- Psychiatric problems. The strongest risk factors for insomnia
are psychiatric problems and physical complaints,
such as headaches and chronic pain, that have no identifiable cause (called
somatic symptoms). About 90% of people with depression have insomnia.
In addition, these conditions often coincide with somatic symptoms,
particularly chronic pain. In fact, insomnia worsens chronic pain even
in people who are not depressed. Headaches that occur during the night
or early in the morning may actually be caused by sleep disorders.
- Negative thinking. Negative thoughts and attitudes toward events
can be significant factors in insomnia, however they do not cause insomnia
in everyone.
- Gender. Insomnia is more common in women than men. In
women, a number of hormonal events can disturb sleep, including premenstrual
syndrome, menstruation, pregnancy, and menopause. After childbirth, most
women develop a high sensitivity to the sounds of their children, which
causes them to wake easily. It is possible that many women never unlearn
this sensitivity and continue to wake easily long after the children have
grown. Older women who are not bothered by sleeplessness tend to have
longer and better sleep than noninsomniac men their own age.
- Woking during night. Shift workers are at considerable risk for
insomnia. Workers over 50 and those whose shifts are always changing are
particularly susceptible, although night-shift workers also
have a high rate of sleeplessness.
- Childhood fears. One study found that people who had experienced
long-term insomnia had been prone to nightmares and fear of the dark as
children.
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