Dr. M.J. Bazos, Patient Handout
About Your Diagnosis
Insomnia is a very common condition. Studies show that 36% or about 80 million American adults currently have problems with sleep. About a third of those individuals complain that their sleep problems are chronic or recur frequently. Disturbed sleep is particularly frequent in the elderly and in patients who have other psychiatric disorders such as depression and anxiety. About half of all patients with schizophrenia have insomnia, as well as 75% of those who have a mood disorder such as depression. Adults in the United States are currently getting less sleep than was typical 100 years ago. The average adult sleeps 7 1/2 hours per night during the work week, but earlier figures suggest that 9 hours per night was more common in the past. It is believed that the decrease in average sleep time is related to many factors, including late night television watching, high-pressure lifestyles, and family and work stresses.

Living With Your Diagnosis
Primary insomnia can involve less sleep, less restful sleep, interrupted sleep, and delayed onset of sleep. Some individuals report lying in bed for hours trying to sleep and being unable to do so. They may be reliving the events of the day, or they may have a number of worries that they cannot stop thinking about. This type of trouble falling asleep is much more common with anxiety. In depression, the usual sleep disturbance is that of early morning awakening. The patient will be awake at 2 AM or 3 AM for no apparent reason, and then will be unable to fall back asleep. Restless sleep is often unnoticed by the patient initially. The patient may actually have slept 7 or 8 hours, but the sleep was tormented. Often someone who sleeps with the patient may describe how much he thrashed around during the night or how distressed he seemed to be during sleep. Therefore, measuring the total amount of sleep is not enough to detect insomnia; the quality of sleep also has to be assessed. Primary insomnia includes those sleep disturbances in which no other known sleep disorder, such as narcolepsy or sleep apnea, is present. Psychiatric criteria for the diagnosis of insomnia are that insomnia must be present for at least 1 month, and that it must have a negative impact on the individual’s social functioning, work functioning, or both. Secondary insomnia is usually related to either a psychiatric disorder such as depression or anxiety, a medical condition affecting sleep, or the use of alcohol, caffeine, or illicit drugs such as amphetamines and cocaine. In secondary insomnia, treating the condition that is causing the sleep problem will improve the sleep, and no additional medication is required. One of the most common cause of sleep disruption is a nightmare. A nightmare often occurs in the early phases of sleep, usually about 60–90 minutes after sleep has begun, and is usually remembered by the patient. This is different from night terrors, which occur often in children. Terrors occur later in sleep and are not remembered. Frequently a child experiencing night terrors will suddenly sit straight up in bed, be sweaty, have a fast heart rate, and be extremely frightened, but will not remember what they were dreaming about. Other conditions that can affect sleep include nocturnal enuresis (bed-wetting) and sleepwalking. Sleepwalking can be of concern because patients may harm themselves while sleepwalking; for example, they may fall downstairs or even leave the house. Sleepwalking also occurs during the later stages of sleep. Although elderly patients tend to spend more time in bed, their sleep is often interrupted and they are more easily aroused than are younger individuals. The elderly also complain of more trouble falling asleep.

A number of herbal, over-the-counter, and prescription medications are used to treat insomnia. Some of the popular over-the-counter medications include Sominex, Nytol, and different cough/cold preparations (e.g., Tylenol PM, Nyquil) that may have a sleep inducer in them. In addition, there has been a marked increase in the use of natural herbal agents for sleep. Perhaps the ones that are most commonly used are melatonin and Valerian Root, which are available in most pharmacies or health food stores. Many patients will try some of these medications before consulting a physician about their sleep disturbance. Unfortunately, the most frequently used self-prescribed sleep inducer is alcohol. However, what most individuals don’t recognize is that although alcohol may cause them to fall asleep, alcohol-induced sleep is fragmented and not restful. In fact, many individuals who consume alcohol at bedtime sleep very deeply initially, then awaken and are unable to fall back to sleep. Consequently, sleep is actually made worse by the use of alcohol. A variety of prescription medications are used for sleep. These drugs generally belong to the sedative/hypnotic category of medications. Perhaps the most commonly used medications are the benzodiazepines. These include drugs such as Restoril and Halcion. The main thing to remember about these drugs is that they are to be used temporarily because there is potential for drug addiction with the use of these agents. That implies that there is some withdrawal upon stopping them. Other drugs that are commonly used for sleep include Ambien, chloral hydrate (Noctec), and in some cases the barbiturates. If depression is also a problem, some of the more sedating antidepressants, such as Sinequan, Elavil, or Trazodone, are often used for sleep. There are some important side effects associated with medications used to treat insomnia. These include daytime drowsiness, potential difficulty operating motor vehicles and dangerous equipment, respiratory problems (especially if another condition such as asthma, bronchitis, or emphysema is present), some rebound insomnia once the medication is stopped, memory problems (especially with agents such as Halcion), and as mentioned previously, interactions with alcohol. Some reminders, if you are taking sleep medication:

1. Sleep medications are to be used only temporarily. Sleep problems that last longer than a couple of weeks may be caused by a more serious condition.
2. It is a good idea to leave no more than one night’s dose by your bedside to avoid the temptation of taking extra medication.
3. The medication should be taken on an empty stomach with ample fluids to promote rapid entry of the drug into your bloodstream.
4. If you use the medication for more than a few nights, then it should be tapered and not discontinued all at once.
5. Remember that over-the-counter sleep aids such as Sominex and Nytol, and some herbal agents, although available without prescription, may have serious interactions with other medication you may be taking.
6. Remember that diet is important. Any caffeine or other stimulants should not be taken late in the evening, nor should you drink a lot of fluids toward bedtime. This will certainly interrupt sleep.
7. When considering the use of medication, consider some natural aids to sleep, such as warm milk (without cocoa), melatonin, and valerian root.

The DOs
• If possible, take a medication for any pain you may be having. Pain interferes with sleep.
• Engage in exercise two or three times a week, but avoid exercising just before bedtime.
• Try to get on a consistent schedule so you go to bed about the same time every night.
• Try to avoid excessive stress or tension in the bedroom.
• If you find yourself lying in bed unable to sleep, get up, find a relaxing chair, and read or knit, or do something else until you become more drowsy. Lying in bed when you are unable to sleep will only increase the insomnia.

The DON’Ts
• Do not go to bed to try to sleep when you are not tired.
• Avoid napping during the day, even when you are tired. Also avoid early evening naps.
• Try not to consume food or drugs that are high in caffeine, especially later in the evening. These will adversely affect your sleep.

When to Call Your Doctor
• If you are sleepwalking, having night terrors, or are snoring excessively.
• If you have any side effects from prescribed medications, such as respiratory problems, amnesia, or daytime drowsiness.
• If you feel your insomnia is caused by depression, anxiety, or mania.