Insomnia

Insomnia: What You Should Know

By Alan S. Peterson, M.D.

What is insomnia?

Insomnia is when you often can’t fall asleep or when you wake up in the night and can’t go back to sleep. Most people need 7-8 hours of sleep every night. People 65 years or older may normally sleep less at night and nap during the day.

Who gets it and why?

Insomnia is very common. More than 1 in 3 adults have it every year. Many things can cause insomnia. Illness, some medicines, too much caffeine, too much noise, and stress can cause insomnia that last a few days or up to several weeks or longer.

Another common cause is an irregular sleep schedule (sleeping and waking up at different times), especially for people who work different shifts at their jobs. Some people who have sleep apnea (a stopping of breathing during their sleep) can also have intermittent awakening.

Unfortunately sleep apnea also causes more problems such as heart disease, arrhythmias (irregular rhythm or runs of heart beats) and blood pressure problems.

How can I find out why I have it?

Your doctor will ask you questions and examine you. You may be asked to keep a sleep diary. This is a two-week record of the times that you go to bed and get up, how long it takes you to go to sleep, if you take naps during the day, how often you wake up during the night, total sleep time, and your mood when you wake up in the morning.

Your doctor may talk to your family about your sleeping habits. You may need a test called a Sleep Study to see if there is something else keeping you awake.

How is it treated?

If an illness or medicine is keeping you from sleeping, treating the illness or changing the medicine may help.

These steps may help you get a good night’s sleep:

Follow a bedtime routine. Go to bed and try to wake up at the same time every day. Sleep only as much as you need to feel refreshed the next day. Don’t watch the clock.
Keep your bedroom dark, quiet, and at a comfortable temperature.
Exercise regularly. It helps you go to sleep and also to have deeper sleep. Don’t exercise however, just before bedtime as that may keep you awake.
Drink less caffeine (found in many coffee, tea, and cola drinks). Caffeine can make it hard to fall asleep and can wake you up in the night. Even having caffeine early in the day can affect some who have trouble sleeping.
Avoid alcohol, especially in the evening. Alcohol may help you fall asleep more easily, but it can also make you wake up in the middle of the night.
Avoid smoking. Smoking can disturb sleep.
Eat regular meals and do not go to bed hungry. A light snack at bedtime may help you sleep, but avoid heavy meals before bedtime. If you’re a diabetic discuss this with your doctor.
Use the bedroom for sleep and intimacy only. Don’t watch television or eat while you are in bed.
Do not try to fall asleep. This only makes the problem worse. If you can’t sleep, leave the bedroom and do something different such as reading. When you get drowsy then try to go back to bed.
Don’t do things that keep you awake, such as watching TV, drinking coffee, eating or worrying. Go back to bed only when you are sleepy.

Will I need to take sleeping pills?

Your doctor may prescribe sleeping pills for a very short time until you have a regular sleep routine. Be sure to tell the doctor if you are taking over-the-counter sleep aids or other medicines. These may cause serious side effects. You can also have side effects if you drink alcohol while taking sleeping pills.

Tell your doctor if you are on sleep aids if feel dizzy, confused or tired during the day, or if you have vision changes, dry mouth or throat, constipation, or trouble urinating. Sleeping pills may affect your driving. Don’t drive if you are taking sleeping aids or pills.

Do not stop taking the sleeping pills without talking with your doctor or if you have been taking them for more than a few weeks. If you do, your trouble sleeping may get worse. You also may have symptoms of withdrawal such as anxiety, nausea, memory loss, and nightmares.

There are no sleeping pills today that are completely safe, despite what the television ads are promoting. It is extremely easy to become tolerant of the drugs, in which case, you will need to continually increase the dosage of the medications to sleep until you also get significant side effects from them. When you try to stop the sleeping pills you have more trouble with your sleep than ever. This is why I rarely prescribe them .

As we age, our sleeping patterns become more irregular in that we all have more awakenings at night than we did when we were younger. Because this is perceived as a change by the individual, one believes that this is an abnormality that must be treated with a medication. Unfortunately once again, we have not found a safe answer with sleeping pills.

Where can I get more information?

Again, ask your family doctor or your medical care provider. Websites that have useful information include www.familydoctor.org, The National Sleep Foundation at www.sleepfoundation.org or The American Academy of Sleep Medicine at www.aasmnet.org.

Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.