# Wednesday, June 11, 2008
                 

While everyone will experience a sleepless night every now and then, chronic insomnia can have a very negative impact on health. Lack of sleep is one of the main causes of preventable traffic accidents as well as work-related accidents. Sleep is also required to bolster your immune system, as well as restore physical and mental energy. Long term sleep deprivation can also increase the severity of chronic diseases, such as high blood pressure and diabetes.

Everyone's sleep requirements are different; while some people only need 4-5 hours of sleep others require 9-10 hours. The average amount of sleep required for optimal health is usually 7-8 hours per night. The amount of sleep you need will change throughout your life, depending on such factors as your age, physical activity level as well as any medications you may be on. Insomnia also becomes more prevalent as people age and is usually more common in women.

Insomnia can be either temporary or chronic. Temporary insomnia can be situational, i.e. not being able to sleep before a stressful situation (exam, interview, etc). This usually resolves itself when the stressful situation is over. Chronic insomnia however happens on a regular and frequent basis, with either problems falling and/or staying asleep. Chronic insomnia often occurs for no apparent reason. Symptoms include such things as:

• Difficulty falling asleep at night
• Waking up often during the night
• Waking up too early and not being able to get back to sleep
• Daytime irritability due to lack of sleep
• Daytime fatigue

The most common reasons for insomnia include:

• Stress and/or anxiety: Worrying about work, school, family, health, etc. can result in your mind being too active to be able to relax. Everyday anxiety, as well as anxiety disorders can have the same effect.
• Depression: Depression can result in either sleeping too much or not being able to sleep. The chemical imbalances that can cause depression can result in the brain not being able to relax enough to be able to fall asleep.
• Using stimulants: Certain prescription drugs such as high blood pressure medication, some antidepressants as well as corticosteroid medication can cause insomnia. As well, over the counter medications such as decongestants, weight loss products and some pain medications contain caffeine and/or other stimulants which will interfere with the ability to fall asleep.
• Change in circadian rhythm: Jobs that require rotating shift work can interfere with the body's natural circadian rhythm and cause sleep problems. Jet lag is also another known interference, but usually resolves itself within a few days.
• Eating habits: Eating too much before bedtime can cause some people to feel uncomfortable when they lie down. As well, heartburn can cause discomfort which can result in keeping you awake.
• Pain: Medical conditions such as arthritis, fibromyalgia, etc. can cause pain that is great enough to keep some people awake.
• Behavioral insomnia: Worrying excessively about not being able to sleep can result in prolonging the pattern of insomnia. Trying too hard to force sleep can cause stress which in turn keeps the body awake.
• Changes in physical activity: A decrease in physical activity, which is common among people who are older, can cause sleeplessness.
• Change in lifestyle: Drinking more alcohol and/or caffeine can cause insomnia. As well, people who tend to nap during the day may find themselves not being able to sleep as well at night.

While there is differing opinions about the time length to wait before consulting with a doctor (a few days or a few weeks) it is advised to seek help from your physician if your insomnia is such that it drastically interferes with your daily activities. Because insomnia is not a disease, there is no specific test to diagnose it. Your doctor will ask very detailed specific questions about your regular sleep patterns and habits, i.e. snoring, medications you are currently taking, pain, and whether or not your legs jerk when you sleep, as well as other related questions. You will probably be asked to keep a sleep journal, where you can record when you go to bed, how long before you fall asleep, how many times per night you wake up, and when you get up in the morning, as well as the quality of your sleep. Your physician may also require that you spend a night in an accredited sleep disorder clinic, where your sleep can be monitored by professionals.

There are different ways that your doctor can recommend to help deal with chronic insomnia. The most common treatments are:

• Stress reduction: If your insomnia is due to increased stress, then reducing your stress will help solve the disrupted sleep patterns. Daily exercise can help as it can reduce stress, improve mood as well as deepen sleep. It is recommended to complete exercising at least 4 hours before bedtime. As well, your doctor may recommend therapy to help you manage your stress in a more productive manner.
• Sleep hygiene techniques: There are certain strategies that can be used in order to help promote a better sleep pattern. This includes such things as having a "buffer zone", in which you spend 90 minutes before your scheduled bedtime consciously trying to relax. Another successful technique is the "20 minute rule", where if you do not fall asleep within 20 minutes of going to bed, you get up; only returning to bed when feeling 'drowsy'. This should be repeated throughout the night if necessary. This technique does result in mild sleep deprivation, which should increase the pressure to sleep the following night. When repeated, over time this technique should improve sleep.
• Medications: Your physician may prescribe sleeping pills which will help you sleep. This can be especially effective for those who are going through a stressful period, as once the stress is over, a more normal sleeping pattern will return. Sleeping pills are usually prescribed as a short term solution; if used for too long insomnia can return when you stop taking them. As well, dependency will result in needing higher doses in order to obtain the original effect. However, there are cases where your doctor may extend the time that sleeping pills are used.

Getting enough sleep is essential for not only your physical health, but also your mental health. Leading a healthier lifestyle can promote better sleep patterns, as well as being aware of the amount of caffeine, nicotine and/or alcohol you consume. Talk to your family doctor if you are consistently having difficulties sleeping; finding the origin of the problem will result in a quicker resolution.

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