Causes And Potential Treatments For Insomnia

"If only I could get a good night's sleep" is a common lament, particularly among older persons. Many older adults have trouble falling asleep and staying asleep. They awaken often during the night, can't get back to sleep, and rise before dawn, symptoms that can cause daytime fatigue, impair normal functioning, and increase health-care costs. Some 12 to 25 percent of healthy seniors report chronic insomnia, but despite their weariness, less than 15 percent receive treatment.

Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following:

  • difficulty falling asleep
  • waking up frequently during the night with difficulty returning to sleep
  • waking up too early in the morning
  • unrefreshing sleep

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Insomnia can be classified as transient (short term), intermittent (on and off), and chronic (constant). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more.

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.

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 pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Relaxation Therapy

There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction

Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

Reconditioning

Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.

Acupuncture

Acupuncture is a simple and useful treatment for insomnia, with a success rate of around 90%. The acupuncture points applied vary depending on the doctor and on the case, but the usual points are Shenmen (HT7) and Anmien (extrapoint). The mechanism of this treatment has not been well elucidated. Acupuncture analgesia may be used as a great indicator, because in both practices needles are inserted in deep tissues as the common stimulation.

The Chinese herbal medicine, "Kanbaku-taiso-to" (KT) which is a mixture of Glycyrrhizae Radix, Triticii Semen and Zizyphi Fructus, sometimes shows marked effects on insomnia, infantile convulsions and emotional irritability. KT had local anesthetic action on frog nerve fibers. Together with our previous study, these results suggest that KT has an inhibitory effect on hyperexcitability of the neuronal membrane and this is the main cause of the sedative effect of KT.

Foods high in tryptophan promote sleep. Chamomile, Lavender flower and Valerian root steeped in a cup of boiling water and drunk hot may induce sleep.

Tips for a Good Night's Sleep

Set a schedule:
Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. "Sleeping in" on weekends also makes it harder to wake up early on Monday morning because it re-sets your sleep cycles for a later awakening.

Exercise:
Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, although a workout soon before bedtime may interfere with sleep. For maximum benefit, try to get your exercise about 5 to 6 hours before going to bed.

Avoid caffeine, nicotine, and alcohol:
Avoid drinks that contain caffeine, which acts as a stimulant and keeps people awake. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas, diet drugs, and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep and keeps them in the lighter stages of sleep.

Relax before bed:
A warm bath, reading, or another relaxing routine can make it easier to fall sleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.

Sleep until sunlight:
If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal biological clock reset itself each day. Sleep experts recommend exposure to an hour of morning sunlight for people having problems falling asleep.

Don't lie in bed awake:
If you can't get to sleep, don't just lie in bed. Do something else, like reading, watching television, or listening to music, until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.

Control your room temperature:
Maintain a comfortable temperature in the bedroom. Extreme temperatures may disrupt sleep or prevent you from falling asleep.

See a doctor if your sleeping problem continues:
If you have trouble falling asleep night after night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; if not, you can probably find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively, so you can finally get that good night's sleep you need.

The nutrients mentioned above reflect the major nutritional supplements that may help the condition. Please do remember however that nutritional supplementation is an adjunct to medical treatment and in no way replaces medical treatment.

  • Adapted from "When You Can't Sleep: The ABCs of ZZZs," by the National Sleep Foundation.
  • Lin Y, "Acupuncture treatment for insomnia and acupuncture analgesia.", Psychiatry Clin Neurosci, v49, May 1995, pp. 119-20.
  • Tsuda T, Kubota K, Yasuda K, Nishikawa S, Sugaya A, Sugaya E, "Effects of Chinese herbal medicine "kanbaku-taiso-to" on transmembrane ionic currents and its local anesthetic action.", J Ethnopharmacol, v17, Sep 1986, pp. 257-61.

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