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Insomnia is characterized by the perception of difficulty in initiating or maintaining restorative, refreshing sleep and can result in daytime sleepiness or fatigue, irritability and poor concentration.

Insomnia affects as many as 84 million Americans. Anyone can have transient insomnia due to the daily stress related to surgery, a death, a new job, a test, jet lag or a change in environment. This normal response may last three to seven days and resolve on its own.

The occurance of insomnia increases with age, occurring with greater frequency in women after menopause and in the elderly.

Intermittent or chronic insomnia occurs when either a transient insomnia is self-perpetuated or the result of poor sleep hygiene, medications, and either a physical or mental illness.

Poor sleep hygiene habits may aggravate or perpetuate insomnia:

• Ingesting caffeine (coffee, tea, cola) four hours prior to bed time. Caffeine is a stimulant.
• Smoking prior to bedtime or following awakening. Nicotine is a stimulant.
• Ingesting alcohol prior to bedtime. This results in arousal in the early morning hours after the alcohol is metabolized.
• Taking an active mind to bed and expecting sleep. Worrying or mind racing about daily events.
• Anticipating difficulty sleeping. This results in its own self-realization.
• Making up for lost sleep the next day by napping, especially in the late afternoon or early evening. This makes the next sleep onset difficult.

Common medications can result in insomnia:

• Theophylline
• Prednisone
• Propanalol
• Prozac
• Lovastatin and simuastat

Common chronic medical disorders may result in or aggravate insomnia:

• Depression
• Fibromyalgia
• Arthritis
• Heart Failure
• Parkinson's Disease
• Hyperthyroidism
• Menopause

Insomnia can be treated and cured! Identify the cause first and treat it.

Circadian Rhythm Control:

Your body sleeps best when your body temperature is the lowest. Find your maximum temperature by measuring your temperature hourly from noon to 7 pm. Your lowest temperature will be 12 hours from that time. Schedule your major sleep period such that the middle of your sleep period occurs at the time of your lowest temperature. Bright light exposure 30 minutes first thing in the morning helps coordinate the light/dark control over sleep onset and offset.

Stimulus Control:

Stimulus control teaches the patient not to engage in behaviors in the bed or bedroom that lead to wakefulness in that environment. Recommendations for stimulus control include:

1. Attempt to sleep only when sleepy.
2. Use your bed only for sleep and sex.
3. If you cannot initiate sleep within 15 minutes then get out of bed and engage in a pleasurable, non-stimulating activity.
4. Once you have set the clock, reverse it and don't look at it again.
5. If you wake up and can't reinitiate sleep within 15 minutes, repeat rule 3.

Sleep Restriction:

1. Waking up at the same time every day thus creating a degree of sleep restriction and helping to coordinate circadian rhythms.
2. Eliminate naps for the same purpose.

Cognitive Behavioral Treatment:

Cognitive behavioral treatment is meant to help restore control over stress and emotional issues that upset sleep hygiene and circadian rhythms.

Bedtime rituals:

1. Structured worry time prior to mind cleansing
2. Relaxation through:
   • meditation and breathing exercises
   • biofeedback
   • Self-hypnosis

Pharmacological Therapy:

Pharmacological therapy with a medication that hastens sleep onset, is metabolized and eliminated quickly and has limited drug interactions with no daytime hangover.

Therapy may necessitate a combination of approaches. Treatment may take 2 to 8 weeks before the desired results are achieved.

Sleep Disorders Lab at Regional Medical Center

Madisonville, Kentucky
(270) 825-5730 or 1-800-635-6506

Medical Director James Davis, MD
Clinical Coordinator Penny Hardison, RRT, RPSGT