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Some Useful Information on Insomnia

What causes insomnia?

Certain conditions seem to make individuals more likely to experience insomnia. Examples of these conditions include:

• advanced age (insomnia occurs more frequently in those over age 60)
• female gender
• a history of depression

If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely.

There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

• stress
• environmental noise
• extreme temperatures
• change in the surrounding environment
• sleep/wake schedule problems such as those due to jet lag
• medication side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

• expecting to have difficulty sleeping and worrying about it
• ingesting excessive amounts of caffeine
• drinking alcohol before bedtime
• smoking cigarettes before bedtime
• excessive napping in the afternoon or evening
• irregular or continually disrupted sleep/wake schedules

These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate the insomnia altogether.

Who gets insomnia?

Insomnia is found in males and females of all age groups, although it seems to be more common in females (especially after menopause) and in the elderly. The ability to sleep, rather than the need for sleep, appears to decrease with advancing age.

How is it diagnosed?

Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient's bed partner concerning the quantity and quality of the patient's sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.

How is it treated?

Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping medications may improve sleep and next-day alertness. However, while many doctors prescribe sleeping pills, as with all drugs, there are potential damaging side effects and the risk of addiction. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.