Do You Have Insomnia?

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Whether the culprit is stress, a room that’s too hot, or a loud neighbor, there are endless obstacles the average person faces to being able to put their head on a pillow and knock out. But just because you wish you slept better, doesn’t mean you have insomnia. Insomnia has a specific definition, which has been developed fairly recently — an inability to fall asleep or stay asleep, or problems waking up too early, that occur for at least three nights a week for three months and affect daytime performance. And although not everyone who has sleep complaints has insomnia, it is under-diagnosed, says Dr. Alon Y. Avidan, director of the UCLA Sleep Disorders Center. “We know that about 9 to 10 percent of Americans have chronic insomnia, but only a fraction are actually treated for it appropriately,” he adds. Cognitive behavioral therapy (CBT) is the standard treatment for insomnia. This is a multifaceted approach that involves medication, behavior change, and cognitive relaxation techniques. Avidan says that, while this treatment is often successful, there aren’t enough specialists trained in it, so receiving this help can be a challenge. If you think you suffer from insomnia, consider some basic indications of the disorder:

Sign #1: You have problems with sleeping through the night.

Most people know that insomnia is a problem with sleeping, but it isn’t limited to issues with falling asleep. Insomnia can also mean that someone has trouble maintaining sleep (such as continuously waking up in the middle of the night) or is waking up too early and unable to fall asleep again.

Sign #2: You suffer from daytime impairment.

For sleeplessness to be insomnia in the strict sense, the lack of sleep has to in some way impair daytime function. This comes in the form of excessive tiredness, trouble thinking clearly, or mood swings. These symptoms can lead to poor work performance, family problems, and a higher risk of accidents, such as nodding off while driving, says Avidan. A person may also experience increased irritability and depression as a result of insomnia.

Sign #3: Your trouble with sleeping is extended.

Problems sleeping that negatively affect daytime function have to go on for at least three nights a week for three months in order to fall into the category of insomnia. “And this should be in spite of a good opportunity for sleep,” adds Avidan. This means that, objectively, the person experiencing sleeplessness should have a good chance to sleeping for about seven to eight hours but are still unable to get the sleep they need.

Sign #4: You have bad habits that influence your sleep patterns.

If a person is worried about insomnia, they should evaluate some of their guilty pleasures. “People often don’t realize that there are certain things that they may do that could make them more vulnerable to having insomnia,” says Avidan. These insomnia primers include drinking alcohol close to bedtime, drinking coffee late in the afternoon, being exposed to screen light from computers or cellphones late at night, napping late in the day or for longer than 20 minutes, and sleeping in on the weekends. Insomnia is a disorder of hyperarousal, emphasizes Avidan, and all of these habits can make it difficult for the body to wind down its activities when it’s time to sleep.

Sign #5: Underlying medical conditions.

Certain medical conditions can cause insomnia. Pain, depression, and anxiety may all make it difficult to sleep. If someone snores or is kept up by strong urges to move their legs late at night or during sleep, they may want to speak with their doctor. In these cases, they may be dealing with sleep apnea or restless leg syndrome, says Avidan.

Fortunately, there are some ways people with insomnia can help themselves once they recognize their condition. As a first step, Avidan says treatment of insomnia should always start with a person’s primary care physician. Care for insomnia can involve many different methods, so it’s important to involve this medical professional, who has the most complete perspective of your health. Done that? Good. Here are the most effective treatments currently available, along with information on how they work.

Retraining how you sleep.

One piece of CBT for insomnia is retraining — basically, teaching a person how to sleep the right way. Avidan says this includes resetting expectations for good sleep and integrating proper sleep hygiene, which means both maintaining a quality sleep environment and avoiding the sleep-impairing bad habits discussed earlier. Retraining may also involve carefully orchestrated sleep deprivation.

Practicing cognitive relaxation techniques.

Being able to exert some control over the body’s arousal levels can be crucial for people dealing with insomnia. Mindfulness meditation has been shown in research to help treat insomnia. And deep-breathing exercises and yoga can also help get a person to a place where he can prepare his body for sleep.

Getting a prescription for medicine. 

Insomnia is also usually treated with medications called hypnotics. These include Lunesta and Ambien. Cognitive and behavioral techniques are powerful tools in the fight to fix insomnia, as are these medications, but Avidan says that all three work better together. He adds that patients should speak with their primary care physician to understand which hypnotics would be the best choice for them and make sure they don’t interact with any medications you’re currently taking.

Important to note: There are some great opportunities for a person to address insomnia themselves, such as practicing good sleep hygiene and learning relaxation techniques. But over-the-counter medications are not among the choice do-it-yourself treatments. “The worst thing they can do is take an over-the-counter medication, [like a Benadryl, Advil PM, or Tylenol PM]. For one or two nights of insomnia, it’s okay, but to use it chronically, many of these medications will have undesirable side effects.” One major risk is daytime impairment, including drowsiness and cognitive problems. Avidan says that older adults need to be particularly wary of the excessive sedation these medications can cause.

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