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Insomnia

| When it occurs | Short Term | Secondary | Primary | Symptoms | Consequences | Tips |

Insomnia is the inability to fall asleep, to maintain sleep, or to get back to sleep at night.

When insomnia occurs

  1. Sleep-onset insomnia is the inability to fall asleep at night. It is commonly experienced by those who have anxiety or rumination (thinking "too hard") at night.
  2. Waking up earlier than desired in the morning and not being able to go back to sleep. This insomnia is common among those with depression.
  3. Waking up in the middle of the night and having trouble getting back to sleep.

Short term

Short term or temporary insomnia happens to almost everyone. It happens when you can't get to sleep because of the "big day tomorrow," such as an exam, a big game, or even a wedding. After the event has taken place, the insomnia is no longer a problem. Short term insomnia can also be the result of a major crisis such as a death in the family or financial trouble. In this case, as soon as the problem is dealt with, the insomnia generally will disappear.

Secondary

Secondary insomnia happens when there is a background reason for the insomnia. If you are suffering from insomnia and need help, the first step is to get a physician. The doctor will help you search for primary problems that cause insomnia and that may be treatable. Some causes for secondary insomnia include depression, fibromyalgia , gastroesophageal reflux, arthritis, or other chronic illnesses or disorders, especially those dealing with pain. People with delayed or advanced sleep phase syndrome, a circadian rhythm disorder, also suffer from insomnia. Psychological stress, nightmares, and inactivity during the day can contribute to insomnia as well.

Insomnia is considered extrinsic when it occurs due to the sleeper's surroundings. This includes sleep hygiene, sleep environment (like the room temperature or the comfort of the bed), and drugs. Often the sleep of an extrinsic insomniac can be improved by adjusting and improving the cause appropriately.

Often insomniacs recognize they can fall asleep more easily elsewhere than their bedrooms. They may fall asleep easily in a recliner in front of the t.v., or on vacation in a cool,dark cabin by a quiet, peaceful lake. These individuals need to work on their bedroom "cues for sleep." Many insomniacs will lie awake in bed for a long time, therefore associating their beds with being awake. If one eats, does homework, or watches television in bed, the brain will then associate the bed with being awake. It is therefore very important to use the bed explicitly for sleeping, so that the brain will associate the bed with sleep and sleep only.

Music: Does a radio replace the lullaby? People generally think they sleep better with music or that they could not sleep without their customary city noises, such as airplanes overhead. In reality, despite their contradictory predictions or perceptions, people generally sleep better in quiet environment. A continuous "masking" or "white noise" may be helpful if there are a lot of unavoidable external stimuli, but that is not as good as no noise. If people listen to music before going to sleep to help them relax, as the baby does to the mother's voice at bedtime, it is best for them to use a timer to turn off the music, as music actually disturbs the quality of sleep by continuing to "register" in the brain.

Why not? The reason is that music demands arousal of stimuli in the brain, even without the person's knowing it. This arousal makes it more difficult for the person to get good sleep. This is also why it is important to have the area as dark as possible as the light involves more stimuli. Room temperature and sleeping surface can also affect the person's ability to sleep. With exceptions of obvious extremes (boiling hot or concrete surface), these two factors seem to contribute to insomnia according to the sleeper's general preferences. People prefer a variety of temperatures and surfaces for sleeping.

Taking stimulants and going off depressants can cause insomnia. Many drugs, including caffeine, nicotine, alcohol, hypnotizers, tranquilizers, can be a cause of insomnia. Disruptions in circadian rhythms, such as shift work and jet lag, also tend to cause insomnia. Naps or inconsistent sleep/wake schedules often lead to insomnia.

Primary insomnia

Primary insomnia occurs when all possible explanations for insomnia seem to be wiped out. It is also called psychophysiological insomnia because there is psychological and physiological documentation involved. This insomnia is considered an intrinsic sleep disorder because the insomnia is due to the patient's surroundings.

Another intrinsic insomnia is Sleep State Misperception. People with sleep state misperception often feel that they are awake when they are actually sleeping. Sometimes they are still aware of their surroundings as they sleep. Interestingly, even normal "Good sleepers" can misperceive sleep and wakefulness. In one study (2), after five minutes of stage 2 sleep, about 40 % of good sleepers thought they were still awake and 84 % of insomniacs were "certain" that they were awake. Even in this "subjective" insomnia, it should be recognized that there are some "polysomnographic abnormalities," such as more stage 1 sleep and much less slow-wave sleep, even when their total sleep hours is the same as that of normal sleepers.

Other Common Symptoms / Test Abnormalities

There are many common traits in insomniacs. Their Multiple Sleep Latency Test results are higher than normal, meaning it takes them longer to fall asleep on cue during the day. Their metabolic rate and body temperature are also higher than normal sleepers'. Vigor usually decreases as insomnia worsens and tension and confusion are also worse. It is unknown as to whether these symptoms are the result of insomnia or whether they are precipitating factors causing insomnia. Research has found mixed results.

A Terminal Illness?

In most cases, people do not die from insomnia, although their quality of life may suffer.

Fatal Familial Insomnia is an extremely rare genetically-predisposed disease in which the patient suffers initially from sleep onset insomnia (3). The sufferer's insomnia get progressively worse to total lack of sleep which leads to death within two years. Currently, there is no cure. It is known that this rare illness is associated with autonomic hyperactivity and thalamus degeneration.

Counting SheepAlternatives to Counting Sheep

Here are some quick tips to fighting insomnia:

(1) Information on this page came from many sources, but primarily:

Morin MD, Charles M. Relief from Insomnia: Getting the Sleep of Your Dreams. New York: Doubleday Maintreet Books. 1996, and

Bootzin, Richard. Sleep and sleep disorders class, U. of Arizona, Psychology 478, Insomnia lecture, notes by Emilie Sutterlin, Tucson, AZ, Mar. 30, 1999.

(2) Borkevec, T., Lane, T. and van Oot, P. "Phenomenology of sleep among insomniacs and good sleepers. Wakefulness experience when cortically asleep." Journal of Abnormal Psychology, 1981, 90:607-609.

{As cited in: Perlis, M.L., D.E. Giles, W.B. Mendelson, R.R. Bootzin, and J.K. Wyatt. "Psychophysiological insomnia: the behavioural model and neurocognitive perspective." Sleep Research, vol. 6, 179-188. European Sleep Research Society, 1997, and as discussed in: Bootzin, Richard. Insomnia lectre. Sleep and sleep disorders class, U. of Arizona, Psychology, Insomnia lecture, notes by Emilie Sutterlin, Tucson, AZ, Mar. 30, 1999}

(3) Information on this illness was learned from:

Bootzin, Richard. Sleep and sleep disorders class, U. of Arizona, Psychology 478, Insomnia lecture, notes by Emilie Sutterlin, Tucson, AZ, Mar. 30, 1999.

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