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Sleep Problems

Insomnia

People with insomnia have difficulty falling asleep or staying asleep. This may involve not being able to fall asleep in the beginning of the night, waking up in the middle of the night and not being able to fall back asleep, or waking up too early in the morning.


In 2008 The Institute of Medicine reported that 50-70 million people in the U.S. suffer from insomnia. However, the disorder has varying degrees of severity. Transient insomnia lasts from days to weeks, acute insomnia lasts from three weeks to about six months, and chronic insomnia can last for years. Short-term stress or changes in the environment are more often correlated with less severe instances of the disorder. Insomnia occurs 1.4 times more frequently in women than men.


While there are numerous drugs on the market that claim to relieve insomnia, the best way to combat the disorder is usually through behavioral treatment. Sleeping pills often come with the risk of dependency and usually only decrease sleep onset by about 10 minutes. In contrast, there are various behavioral therapies that have no risk of dependency and can be equally as effective as medication[1].


Behavioral Treatments


Stimulus control therapy - designed to re-associate the bed/bedroom with sleep and to re-establish a consistent sleep-wake schedule: 1) Go to bed only when sleepy 2) Get out of bed when unable to sleep 3) Use the bed/bedroom for sleep only (no reading, watching TV etc) 4) Develop an association, such as a sound or music with sleep 5) Arise at the same time every morning 6) No napping

Relaxation - procedures aimed to reduce somatic tension or intrusive thoughts at bedtime interfering with sleep. These include progressive muscle relaxation, autogenic training, imagery training, meditation, and ambient sounds.

Paradoxical intention - reducing or preventing excessive monitoring of and worrying about insomnia and its correlates/consequences

Sleep Restriction Therapy - this is based on the finding that your body can become used to the bad habits involved with getting a poor night of sleep, which can make these habits more difficult to change. The therapy involves trying to reinvigorate your body's willingness to sleep with a controlled period of sleep restriction. This builds up endogenous sleep inducing chemicals that promote sleep and helps restructure your sleep habits.

Cognitive-behavioral therapy - the above combined with cognitive procedures. General guidelines about health practices and environmental factors that may promote or interfere with sleep. General info about normal sleep and changes of sleep with age.

Sleep Apnea

This disorder involves difficulty breathing when you are asleep, the word apnea literally translating to without breathing. People with sleep apnea often snore during the night because they are gasping for air. This prevents healthy sleep, particularly because it reduces deep sleep amount [2]. The National Heart, Lung, and Blood Institute estimated in 2006 that 1 in 15 people suffer from sleep apnea.


Indicators of sleep apnea include snoring, waking up tired, being overweight, the distribution of fat in the stomach and neck areas, menopause, and heredity. The effects of sleep apnea should be taken seriously. Recent population health studies found that people with untreated sleep apnea had 5 times higher morbidity than people without sleep apnea, while people who were treated for sleep apnea only had 3 times greater morbidity [3]. So if you think you or someone you know might have sleep apnea, see a doctor and get the appropriate diagnosis and treatment.

Delayed Sleep Phase Sydrome

This is a problem widespread among adolescents and its cause is preventable. It is due to erradic sleep habbits which cause discrepent signals to get sent to your circadian component of sleep, preventing your body from getting in the correct rhythm of when to fall asleep and wake up. It is often characterized by staying up late on weekends and sleeping in and then waking up early on weekdays and taking an afternoon nap. This can make it extremely difficult to wake-up in the morning. Treatments are behaviorial, including becoming more aware of the importance of consistent sleep patterns and modifying your sleep schedule appropriately[4].

Restless Leg Syndrome

Restless leg syndrome is characterized by an irresistible urge to move one's body in order to stop an uncomfortable or odd sensation that is often described as a burning, itching, or tickling. It usually affects the legs, but can also affect the arms or torso. It is estimated that restless leg syndrome affects 7% and 10% of the population, but only approximately 2% of the population have severe symptoms. Restless leg syndrome occurs twice as common in females, and is more common with people who are Caucasian, iron deficient, pregnant, have end-stage renal disease, depression, a sedentary life style, elderly, and obese. Restless leg syndrome is treatable, so if you think you have this disorder, you should see a physician.

Narcolepsy

Narcolepsy is an uncommon disorder characterized by excessive tiredness, even after getting an adequate amount of sleep, and uncontrollable episodes of falling asleep at inappropriate times [3]. This behavior is frequent, often occurring several times a day. Nighttime sleep is also disrupted by frequent awakenings. Symptoms that some, but not all of narcoleptics demonstrate include sudden loss of muscle tone and collapse with retained consciousness, often in response to highly emotional situations, the temporary inability to talk or move immediately after waking up, vivid and often frightening hallucinations, and, more commonly, acting as if you are conscious but not remembering any events that occur. If you think that these symptoms apply to you, see a physician immediately because this disorder can be dangerous.

Mori, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., Lichstein, K. (2006). Psychologial and Behavioral Treatment of Insomnia: Update of the Recent Evidence (1998-2004). Sleep, 29, 11.

Nieto, F. J., Young, T. B., Lind, B. K., Shahar, E., Samet, J. M., Redline, S., D'Agostino, R. B., Newman, A. B., Lebowitz, M. D., & Pickering, T. G. (2000). Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. The Journal of the American Medical Association, 283, 14, 1829-1836.

Carskadon, M.A. and Rechtschaffen, A. Monitoring and staging human sleep. In Principles and Practice of Sleep Medicine, M.H. Kryger, T. Roth, and W.C. Dement (Eds.), W.B. Saunders, Philadelphia, 1989, pp. 665-583.

Dahl, R. E. & Carskadon, M. A. Sleep and its disorders in adolescents. Principles and practices of sleep medicine in the child. Philadelphia: WB Sanders, 1995: 19.

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