InsomniaMany Americans are having a difficult time getting a good night’s sleep.  Sleep is increasingly recognized as important to public health, with sleep insufficiency linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors.  In fact, the Centers for Disease Control and Prevention has called sleep insufficiency an epidemic.

The statistics on sleep disorders bear this out.  The number of people in the U.S. who have a chronic sleep disorder is estimated to be 40 million. Of those, 5% suffer from sleep apnea. And 62%, of American adults experience a sleep problem a few nights per week. All of this sleep loss has economic consequences:
the estimated cost to U.S. employers in lost productivity due to sleep loss issues is $18 billion.

How much sleep we need varies between individuals but generally changes as we age. The National Institutes of Health suggests that school-age children need at least 10 hours of sleep daily, teens need 9-10 hours, and adults need 7-8 hours. According to data from the National Health Interview Survey, nearly 30% of adults reported an average of ≤6 hours of sleep per day. Only 31% of high school students reported getting at least 8 hours of sleep on an average school night.

drowsy-drivingUnintentionally falling asleep, nodding off while driving, and having difficulty performing daily tasks because of sleepiness all may contribute to hazardous outcomes. Persons experiencing sleep insufficiency are also more likely to suffer from chronic diseases such as hypertension, diabetes, depression, and obesity, as well as from cancer, increased mortality, and reduced quality of life and productivity.

Sleep problems can be caused by various factors. Although causes may differ, the end result of all sleep disorders is that the body’s natural cycle of slumber and daytime wakefulness is disrupted or exaggerated.

Factors that can cause sleep problems include:

  • Physical disturbances (for example, pain from ulcers)
  • Medical issues (for example, asthma)
  • Psychiatric disorders (for example, depression and anxiety disorders)
  • Environmental issues (for example, alcohol use)

Short-term or acute insomnia can be caused by life stresses (such as job loss or change, death of a loved one, or moving), illness, or environmental factors, such as light, noise, or extreme temperatures.  Long-term or chronic insomnia (insomnia that occurs at least three nights a week for a month or longer) can be caused by factors such as depression, chronic stress, and pain or discomfort at night.

Other factors that can interfere with sleep include:

  • Genetics: Researchers have found a genetic basis for narcolepsy, a neurological disorder of sleep regulation that affects the control of sleep and wakefulness.
  • Night shift work: People who work at night often experience sleep disorders, because they cannot sleep when they start to feel drowsy. Their activities run contrary to their biological clocks.
  • Medications: Many drugs can interfere with sleep, such as certain antidepressants, blood pressure medication, and over-the-counter cold medicine.
  • Aging: About half of all adults over the age of 65 have some sort of sleep disorder. It is not clear if it is a normal part of aging or a result of medications that older people commonly use.

There are a variety of treatments for sleep disorders, some of which are listed below.

  • MedicationMany types of medication have been used to treat insomnia and related sleep disorders.  Historically, chloral hydrate was the sedative/hypnotics medication of choice.  However, the lethal dose of this medication was very close to the therapeutic dose.  Since the 1970s, benzodiazepines and their derivatives have been used for the treatment of insomnia.  Sedating antidepressants are also often used to treat insomnia. A significant percentage of individuals with chronic insomnia and/or daytime sleepiness also have depressive symptoms.  Over-the-counter solutions have included ethanol based medications, and sleeping pills containing sedating antihistamines, usually diphenhydramine.
  • herbal tea2Herbal treatments – There are a number of over-the-counter herbs and supplements that have shown promise in relieving insomnia.  These include melatonin, valerian and herbal teas made from chamomile, hops, and passion flower.
  • Relaxation training - Relaxation training methods such as progressive muscle relaxation (PMR), deep breathing techniques, imagery, and self-hypnosis might help some people deal with sleep disorders. PMR involves helping the individual to sequentially tense and relax the body’s major muscle groups while concentrating on and contrasting sensations of tension and relaxation. Daily practice of relaxation techniques between therapy sessions is essential and tends to enhance the effectiveness of the treatment.
  • Cognitive therapy - Cognitive therapy for insomnia includes interventions that are meant to help people identify and correct inappropriate thoughts and beliefs that might contribute to insomnia. Cognitive therapy can give people the proper information about sleep norms, age-related sleep changes, reasonable sleep goals, and the influence of naps and exercise.
  • Stimulus control - Stimulus control derives from the belief that insomnia might be related to the bedroom having become associated with other things (stressful situations, for example) besides sleep and sex.
  • Sleep restriction therapy - Sleep restriction therapy is based on the belief that excess time in bed makes sleep problems worse. It consists of limiting a person’s time in bed to only that time when he or she is sleeping.
  • Sleep hygiene - The concept of sleep hygiene refers to practices, habits, and environmental factors that are important for getting sound sleep. The four general areas important to sleep hygiene are the circadian rhythm (24-hour cycle); aging; psychological stressors that cause mini-awakenings (in which the brain wakes up for just a few seconds); and substances such as nicotine, caffeine, and alcohol.
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