Insomnia is simply defined as the inability to obtain sleep of satisfying quality or duration. At least 30 percent of adults have insomnia at some point in any given year, and 10 to 15 percent report frequent or chronic insomnia. Short lasting insomnia, lasting up to a few weeks, can be triggered by situational stress, such as relocating to another country. Chronic insomnia occurs at least three nights a week for at least one month. These people often have difficulty initiating sleep, maintaining sleep, or both. The causes of chronic insomnia include medical (such as sleep-apnea syndrome), psychological and medications.

Daytime impairment of alertness or functioning suggests inadequate quality or quantity of sleep. Persons who are distressed by poor sleep but who feel alert during the day may need less sleep or may have misperceive the depth and duration of their sleep. Advanced sleep-phase syndrome can be mistaken for insomnia. This is commonly seen in the elderly and is characterized by very early bedtime and early morning awakening. Delayed sleep-phase syndrome, common in adolescents, is characterized by very late bedtime (or difficulty initiating sleep) and difficulty arising at an early hour.

What can be done to treat insomnia?

First, it is important to consult with your doctor to exude a medical cause of insomnia. Thereafter, good sleep habits improve all types of insomnia. Avoid restricting sleep on some nights and then trying to catch up on others. Restrict the use of caffeine, especially in late afternoon and evening. Many people do not realize that drinking alcohol (the so called “night cap”) also disrupts sleep especially later in the night. A long list of medications can also cause insomnia such as antidepressants, beta-blockers and agonist, steroids, decongestants, certain antibiotics (such as the fluoroquinolones), nicotine, stimulants, theophylline and excessive thyroid medication.

Cognitive behavioral therapy provides better long-term improvement in chronic insomnia than relaxation therapy. This therapy involves stimulus control, education about sleep, and restricting the amount of awake time in bed.

Finally, acute insomnia can be treated with limited use of hypnotics. Benzodizaepines are often used, however they can cause morning sleepiness, tolerance to the drug, and poor long-term efficacy. Therefore, these drugs should be limited to short-term or intermittent use. Newer, more expensive sedative-hypnotics such as zolpidem and zalephon have fewer side effects but still should be limited to short intervals. Antihistamines and tricyclic antidepressants have more side effects, including daytime sedation, although some people respond to long-term, low-dose use.

Melatonin can be useful for jet lag and other circadian rhythm disorders, but otherwise is not effective.

The above recommendations are meant as general guidelines. It is best to also consult with your doctor.

Sweet dreams!