Sleep Disorders:  
Obstructive Sleep Apnea
Narcolepsy
RLS/PLMD
Insomnia
Pediatric

Insomnia

Insomnia is the perception of insufficient, disturbed or non-restorative sleep. Insomnia typically involves difficulty falling and/or staying asleep.

Why is insomnia such an important issue?

Insomnia can diminish a person’s quality of life by impairing concentration and memory, interfering with one’s ability to enjoy family and social relationships, and contributing to sleepiness and fatigue when awake which in turn can increase the risk of motor vehicle and work related accidents.

What do most people do when they are experiencing insomnia?

Unfortunately most never discuss their problem with a doctor and many take OTC (over the counter) medication, drink alcohol or use prescription sleep aids without ever trying to identify the cause of their insomnia.

What causes insomnia?

There are many potential causes of insomnia and often individuals have more than one factor contributing to their difficulty sleeping. There are proposed chemical mechanisms by which stress can play a role in insomnia. Certain medications/substances, medical conditions and psychiatric illnesses can lead to insomnia. Then there are the “primary” sleep disorders.

What are some of the medical and psychiatric causes of insomnia?

Depression and anxiety are frequently associated with insomnia. Schizophrenia and certain personality disorders among other psychiatric illnesses may be accompanied by insomnia. If the difficulty sleeping seems to fluctuate in relation to the mental illness then adequate treatment of the psychiatric disorder should lead to improvement in the insomnia. It may be necessary to seek psychiatric consultation.

Some medical conditions can cause insomnia such as hyperthyroidism, arthritic conditions, kidney disease, lung disease, liver disease, heart failure, acid reflux and some neurological disorders. A family physician or internist may order some testing to evaluate for possible medical causes of insomnia if you inform them of your difficulty sleeping.

What are some of the primary sleep disorders that may have insomnia as a major symptom?

Obstructive Sleep Apnea, Restless Legs Syndrome and Periodic Limb Movement Disorder may contribute to insomnia.

Inadequate Sleep Hygiene—Essentially insomnia resulting from bad habits. For more information and treatment recommendations you may download the sleep hygiene form.

Psychophysiologic Insomnia—A condition in which one learns or becomes “conditioned” not to sleep well. Often one dreads bedtime and may even sleep better in places other than their own bedroom. Individuals may describe that they become sleepy in the living room but when in bed become wide awake (essentially because the brain has become conditioned to arouse in the bedroom). To review the most common treatment you may download the Stimulus Control Therapy form.

Sleep State Misperception—Essentially one is sleeping longer than they perceive.

Circadian Rhythm Disorders—These disorders involve desynchronization between the brain’s internal sleep/wake propensity (drive) and the “normal” sleep/wake schedule (i.e. there is a phase shift in what is otherwise a normal sleep/wake cycle). This results in a normal sleep cycle at an abnormal time.

A common circadian rhythm disorder is “jet lag”. Another is delayed sleep phase syndrome, more often seen in teenagers and young adults, in whom the sleep phase is delayed, such as to 3a-11p, causing both difficulty falling asleep at a typical hour (subsequently the affected individual falls asleep late) and difficulty waking up in the morning (when forced to awaken at a typical time the person exhibits excessive sleepiness). In the elderly the opposite sometimes occurs leading to an early bedtime and early awakening, such as 8p-4a.

Circadian rhythm disorders are often treated with “light therapy” and require vigilance in maintaining a routine sleep schedule.

What should I do if I have insomnia?

It is always recommended that you discuss any problems with your doctor. You may consider downloading the Sleep Hygiene form. It is quite possible that you may have more than one bad habit for which you should attempt to correct as many as possible. For instance if you stop caffeine intake in the early afternoon but still smoke close to bedtime or worry and think about things in bed you will still probably continue to have difficulty sleeping.

If you believe you have a form of conditioned insomnia as previously mentioned you may consider downloading the Stimulus Control Therapy form.

Tracking your progress with a sleep diary may be helpful in allowing you to see the results you achieve through changes in your habit(s). You may download the Sleep Log form to assist you in tracing your sleep-wake schedule.

If I have made attempts to improve my sleep but still am having problems what should I do?

If you have not already done so you should see your doctor or a sleep specialist. Having sleep logs completed for a few weeks may be of great assistance to the physician.

What can I expect from an evaluation with a sleep specialist?

Do not expect to receive a prescription sleep aid on your first visit especially if your insomnia is chronic. While a sleep aid may be prescribed, your sleep physician will likely first attempt to identify and treat the cause of your insomnia only considering a sleep aid after other treatments have failed.

For additional information consider visiting the American Insomnia Association.

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