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Sleep DisordersPage 4 of 8
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Chronic insomnia is often caused by one or more of the following:
- Another disease or mood disorder. The most common
causes of insomnia are depression and/or anxiety disorders.
Neurological disorders such as Alzheimer's or Parkinson’s
disease can also have insomnia as a symptom. Chronic
insomnia can result from arthritis, asthma, or other medical
conditions in which symptoms become more troublesome at
night, making it difficult to fall asleep or stay asleep.
- Various prescribed and over-the-counter medications that can
disrupt sleep, such as decongestants, certain pain relievers,
and steroids.
- Sleep-disrupting behavior such as drinking alcohol, exercising
shortly before bedtime, ingesting caffeine late in the day,
watching TV or reading while in bed, or irregular sleep
schedules due to shift work or other causes.
- Another sleep disorder, such as sleep apnea or restless
legs syndrome.
Some people, however, have primary chronic insomnia. This condition
is linked to a tendency toward being more "revved up" than
normal (hyperarousal). These people may have heightened secretion
of certain hormones, higher body temperatures, faster heart rates,
and a different pattern of brain waves while they sleep.
Doctors diagnose insomnia based mainly on sleep history, often
by reviewing a sleep diary. An overnight sleep recording may be
required if another sleep disorder is suspected. Doctors also will
try to diagnose and treat any other underlying medical or psychological
problems as well as identify behaviors that might be causing
the insomnia.
Often, people who have insomnia enter into a vicious cycle—because
of having trouble sleeping in previous nights, they become anxious
at the slightest sign that they may not be falling asleep right away.
That anxiety can make it more difficult for them to fall asleep. The
more time they spend in bed not sleeping, and watching the clock,
the more their anxiety—and sleeplessness—increases.
To break that cycle of anxiety and negative conditioning, experts
recommend going to bed only when you’re sleepy. If you can’t fall
asleep (or fall back to sleep) within 20 minutes, get out of bed and
go into another room where you can pursue a relaxing activity until
you feel sleepy again. Then return to bed. This reconditioning
therapy has been shown to be an effective way to treat insomnia.
Another effective behavioral strategy for some people is relaxation
therapy. For example, progressively tense and then relax each of the
muscle groups in your body before sleep. Another method is to focus
on breathing deeply. Relaxation therapy can provide a needed
slowing down period so that you are indeed sleepy when the
desired bedtime arrives. Sleep restriction therapy also
works for some people who have insomnia. First, limit
your night’s sleep to 4 or 5 hours, then gradually
add more sleep time each night until you achieve a more
normal night's sleep. Daytime naps should be avoided during this
sleep restriction therapy because napping may prolong insomnia by
making it harder to fall asleep at night. In addition, during sleep
restriction therapy, avoid driving a car or operating dangerous
machinery until you have obtained adequate nighttime sleep.
All these changes in behavior are part of what is called "cognitive
behavioral therapy." Cognitive behavioral therapy also can be used
to replace negative thinking related to sleep, such as "I’ll never fall
asleep without sleeping pills," with more realistic positive thinking.
Cognitive behavioral therapy is effective in most people who have
chronic insomnia.
Some people who have chronic insomnia that is not corrected by
behavioral therapy or treatment of an underlying condition may
need a prescription medication. You should talk to a doctor before
trying to treat insomnia with alcohol, over-the-counter or prescribed
short-acting sedatives, or sedating antihistamines that induce
drowsiness. The benefits of these treatments are limited, and they
have risks. Some may help you fall asleep but leave you feeling
unrefreshed in the morning. Others have longer-lasting effects and
leave you feeling still tired and groggy in the morning. Some also
may lose their effectiveness over time. Doctors may prescribe sedating
antidepressants for insomnia, but the effectiveness of these medicines
in people who do not have depression is not established, and
there are significant side effects.
To treat their insomnia, some people pursue "natural" remedies,
such as melatonin supplements or valerian teas or extracts. These
remedies are available over the counter. There is little evidence that
melatonin can help relieve insomnia. Studies with valerian have
also been inconclusive, and the actual dose and purity of various
supplements, extracts, or teas that contain valerian may vary from
product to product. In addition, because melatonin, valerian, and
other natural remedies are not regulated by the Food and Drug
Administration, their safety is not scrutinized.
What is Narcolepsy?
Narcolepsy is a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. At various times throughout
the day, people with narcolepsy experience fleeting urges to sleep. If the urge becomes overwhelming, individuals will fall asleep for periods
lasting from a few seconds to several minutes. In rare cases, some people may remain asleep for an hour or longer. In addition to excessive
daytime sleepiness (EDS), three other major symptoms frequently characterize narcolepsy: cataplexy, or the sudden loss of voluntary muscle tone;
vivid hallucinations during sleep onset or upon awakening; and brief episodes of total paralysis at the beginning or end of sleep. Narcolepsy is
not definitively diagnosed in most patients until 10 to 15 years after the first symptoms appear. The cause of narcolepsy remains unknown. It is
likely that narcolepsy involves multiple factors interacting to cause neurological dysfunction and sleep disturbances.
Is there any treatment?
There is no cure for narcolepsy. In 1999, after successful clinical trial results, the FDA approved a drug called modafinil for the treatment of EDS.
Two classes of antidepressant drugs have proved effective in controlling cataplexy in many patients: tricyclics (including imipramine, desipramine,
clomipramine, and protriptyline) and selective serotonin reuptake inhibitors (including fluoxetine and sertraline). Drug therapy should be supplemented
by behavioral strategies. For example, many people with narcolepsy take short, regularly scheduled naps at times when they tend to feel sleepiest.
Improving the quality of nighttime sleep can combat EDS and help relieve persistent feelings of fatigue. Among the most important common-sense measures
people with narcolepsy can take to enhance sleep quality are actions such as maintaining a regular sleep schedule, and avoiding alcohol and caffeine-containing
beverages before bedtime.
Sleep Apnea
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