Egon Schiele, "Agony", 1912 Insomnia and Sleep Disorders There are numerous websites that provide detailed information about insomnia and other sleep disorders.  This material will not be reiterated here - please refer to these good websites: www.americaninsomniaassociation.org or www.nationalsleepfoundation.org or www.aasmnet.org. Only a few clinical observations & ideas about insomnia and sleep disorders are offered here. These are some of the conditions I'm most interested in.  None of this is intended as specific medical advice. If you have problems or symptoms of any sleep-wake disorder please speak with your doctor.
Comments Regarding Medications To Promote Sleep Don’t count on medications to completely “cure” your insomnia! Many sleeping pills can be helpful on a short-term basis, but these can be habit forming and people learn to depend on drugs to promote sleep rather than learning to control their troubles falling and remaining asleep.  Also, many people keep using these to combat the “battle of the bed” because the anxiety of not sleeping is just too stressful. If you decide that you want to stop using sedative-hypnotics, consult with your physician before taking any futher steps.  Some people can slowly taper the use of medication and use non-drug measures.  For example, some people will start going to bed only when sleepy, arising at the same time daily, reducing time in bed without sleeping, and avoiding naps during the day, ALONG with reducing sedative-hypnotic use. In addition, it usually helps to realize that "You didn't get this way overnight... and it's not likely to change immediately".  You can change your sleep-wake patterns but must learn to be patient.
What is Insomnia? Insomnia refers to problems falling or remaining asleep.  Some people awaken too early in the morning.  Others do not feel rested after sleeping. It is often caused by stress, numerous medical problems (examples: pain, asthma, arthritis, restless legs, hyperthyroidism), depression and other sleep disorders.  It can also be associated with medication usage.  Insomnia occurs more frequently with women and among people aged 60 and older. Insomnia can be due to caffeine or alcohol intake, smoking, napping during the day, irregular sleep-wake patterns and expecting (or worrying) about sleeping.  Many develop habits or patterns that promote poor sleep quality - some condition themselves to sleep poorly.	Insomnia Can Promote These Problems Physical - Higher risk of elevated blood pressure (hypertension) and diabetes.  Some people are more likely to experience conditions associated with pain or gastrointestinal problems. Social - Increased moodiness or irritability, potential troubles getting along with friends, family and partner. Psychologic - Increased risk for depression Career - Lower performance at work, less productive and less satisfaction with working
Obstructive Sleep Apnea Syndrome (OSAS) OSAS is a very common sleep-wake disorder.  Some symptoms include snoring, breathing cessations during sleep, awakening with a dry mouth and/or headache, and daytime sleepiness.  Many people with this condition report moodiness, attention/concentration and memory problems, feelings of depression and stress.  OSAS occurs with children, women and men of all ages and sizes.  It is a risk factor for heart disease, stroke, diabetes and several other medical problems.  The good news is that this condition can be evaluated in a sleep lab and excellent treatments are available.  Positive airway pressure (PAP) therapy continues to be the main form of treatment.  Some people benefit from certain dental appliances and others respond positively to weight loss.  Surgery can sometimes help. If you or a family member snores, stops breathing during sleep or believe that sleep apnea is occurring, please call your doctor as soon as possible. If PAP has been initiated it is very important that regular visits with your sleep doctor occur.  The newer machines acquire and store important information about  your ability to use PAP and how effectively it is treating the sleep apnea.	How is Insomnia Treated? We now know that insomnia is best treated through the use of non-drug techniques.  This type of treatment is called cognitive-behavioral therapy.  It utilizes several different types of interventions, depending upon what is best for the individual.  Through the years I've used a six-step approach - a very brief overview is provided below. First, we work together to determine the cause of the problem and identify factors which seem to keep it going.  We also begin self-monitoring and begin using strategies to reduce time in bed without sleeping.  Second, we modify certain habits (such as watching the clock or eliminating naps) and address fears associated with not sleeping.  Third, we work on reducing the tendency to "take problems to bed" and also begin to work on decreasing the pattern of trying too hard to sleep.  Fourth, we continue working on negative thoughts and feelings associated sleep.  Fifth, we address treatment gains and discuss other problem areas associated with poor sleep.  Last, we address relapse prevention. These "medication free" treatments have been found to have positive lasting effects.  Most people can learn to sleep reasonably well without the use of "sleeping pills".   People with insomnia associated with depression, anxiety or other psychiatric disorders can also benefit from these treatments.  Individualized treatment strategies are always considered.
Circadian Rhythm Disorders These are the conditions in which there is a "mis-match" between the optimal timing of sleep or alertness, and the opportunity to sleep or remain awake.  When this occurs regularly and the person reports insomnia or daytime sleepiness, the end result is a circadian rhythm disorder. Several disorders exist.  One type is called "Delayed Sleep Phase Syndrome".  People with this condition seem to be "night-owls" - they simply cannot fall sleep during socially acceptable times & usually prefer later sleep "offset" times.  This mis-alignment can cause people to have trouble falling asleep at night and subsequently end up sleeping through morning activites.  Some resort to using alcohol or sleeping pills to promote sleep but these strategies are obviously not suitably effective. Shift-Work Sleep Disorder is another example.  Most simply, people with this condition force themselves to remain awake during hours "biologically programmed" for sleep and cannot sleep sufficiently during off hours.  Most report insomnia or significant daytime sleepiness.  Satisfactory or good quality sleep does not occur.  People with this problem sometimes sleep reasonably well during "off nights" (provided that another sleep-wake disorder is not co-occurring). You can find other circadian rhythm disorders in the International Classification of Sleep Disorders - second edition.	Parasomnias These often undesirable experiences, movements or behaviors occur when falling asleep, during sleep or upon awakening.  It seems that some of our basic survival instincts can emerge while asleep.  Sleepwalking, sleep-related eating, sexual activity during sleep and numerous other unexpected activities can occur during sleep WITHOUT the sleeper's awareness.  Aggressive behavior during sleep has been very well documented over the years.  Sleep-related eating can be extremely distressing especially if one lives alone and awakens to a messy kitchen! When awakened from these experiences, disorientation and confusion are common, and the sleeper usually has minimal or no memory of what he or she has been doing.  Behaviors during sleep can be simple or complex, and can involve vocalizations and even violent behaviors.   These conditions are referred to as clinical disorders because they can have markedly negative effects upon peoples lives.  Injuries can occur during sleepwalking, sexual activity with a stranger has happened during sleep, and countless other unwanted experiences can occur during this time.  Several of these conditions arise during non-rapid eye movement (NREM) sleep, yet some occur  during rapid eye movement (REM) sleep.  Many NREM parasomnias occur during the first third of the night during NREM stage 3 sleep.      If any unusual sleep-related behaviors are occuring during your sleep, it is important that you speak to your doctor about seeing a sleep disorders specialist.  The conditions can be very dangerous.