Sleep – at its best it’s a wonderfully refreshing period where we physically and emotionally get reset for another day. But for an estimated 70 million Americans, one of the over 80 different sleep disorders intrudes on their ability to get a good night’s sleep. Everything from sleep apnea to restless leg syndrome to simple insomnia is included on the list. For our purposes today, we want to look under the covers at insomnia, defined as difficulty initiating or maintaining sleep resulting in daytime impairment.
About 10% of the population would fit the criteria for some level of chronic insomnia, hence the 60 million prescriptions yearly for sleep aids. And this doesn’t include the raft of over-the-counter sleep meds that fly off the shelves.
So is insomnia such a big deal? Well, yes, it is tied into several serious illnesses. Those with insomnia are twice as likely to have congestive heart failure, five times as likely to have anxiety or depression, and have increased rates of diabetes, obesity, motor vehicle accidents, infections, and have impaired memory, thought, and work and school performance. Of course some of these are effects of the insomnia and some are causes.
How much sleep do we really need? The average person needs 7 to 9 hours of good quality sleep. But the average American gets 6.9 hours, leading to a lot of sleep deprivation and all the baggage that comes with it. Some individuals are in bed long enough but don’t wake up refreshed and rested. This often indicates a poor quality of sleep, either through frequent awakenings, sleep apnea or some other sleep disorder that intrudes on the benefits of their sleep.
What are some of the causes of insomnia? For some, it is a built-in condition with a nearly life-long pattern of poor sleep-wake cycles. But there are a number of factors that can worsen the problem. Not surprisingly, children with smart phones, televisions or computers in their bedrooms are generally found to have poorer sleep patterns than those who do not. Certain medications, such as decongestants or corticosteroids can cause insomnia. Even meds that are used to induce sleep, such as antihistamines, can cause an opposite effect in a percentage of individuals, causing prolonged wakefulness.
So, to cut to the chase, what can you do if you notice that you are not sleeping well? Perhaps you awaken unrefreshed and have some daytime sleepiness. First, tune up your sleep habits. In general:
- avoid daytime napping
- avoid caffeinated drinks after lunch
- get some physical exercise or exertion in (preferably early in the day)
- try to go to bed at approximately the same time daily
- don’t watch TV or read in bed
- give yourself a set amount of time (perhaps 20 minutes) to fall asleep
- if you don’t fall asleep in the set time, get out of bed and read in a chair until you feel you may be tired enough to sleep. Then get back into bed and give yourself 20 minutes again.
If after 1-2 weeks of this approach you aren’t seeing good results, you may benefit from consulting your physician. Certain medications may be an issue, or health issues such as hyperthyroidism, anxiety or depression.
If other issues are ruled out and the problem is persisting, prescription sleep aids can be considered as well as something called cognitive behavioral therapy, though this can be harder to access. Sleep meds include everything from the well-known Ambien (zolpidem) to sedating anti-depressants such as trazodone, antihistamines such as diphenhydramine (Benadryl), to benzodiazepines such as temazepam (Restoril), and even stronger, less-often-needed meds such as Seroquel. Incidentally, it was recently found that for females the 10 mg. dose of Ambien was associated with a 30% higher incidence of motor vehicle accidents the next morning. This led to the recommendation that women limit their Ambien dose to 5 mg, especially if they will be driving the next morning.
Over-the-counter meds such as Tylenol PM and Advil PM often use the sedating antihistamine, diphenhydramine, which leaves many with some left over morning grogginess. Melatonin has been found to be mildly effective in shift workers, but not very effective for typical insomnia. And the list goes on.
The bottom line is that there are pros and cons to each treatment option, including the option of just trying to ignore this problem and not treat it. So if insomnia is plaguing your nights, it’s worth some attention. Good sleep and good health tend to go together.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835