Insomnia is a common condition that significantly affects one’s day-to-day functioning and well-being. More than one third of all Americans suffer from sleep disorders at some point in their lives. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), chronic insomnia is considered to be any type of insomnia that lasts more than six months. Chronic insomnia is associated with an increased risk of depression, anxiety, cognitive dysfunction, daytime fatigue, as well as increased use of health care resources.
The major causes of insomnia are generally divided into three categories. This includes medical conditions, psychological conditions as well as environmental problems. Psychological conditions that can affect sleep cycle regulation including depression and anxiety. Approximately 40% of people that suffer from depression also have insomnia. Depression can contribute to significant alterations in REM (Rapid Eye Movement) sleep. Stress can also shift the levels of our hormones, including the stress hormones cortisol and DHEA. Disruptions in cortisol levels throughout the day and night can significantly impact our sleep/wake cycle.
The sleep/wake cycle is regulated by a complex biological process that works like an internal clock. Within our brain, the hypothalamus, our body’s anatomic time keeper, is central to the release of the chemical melatonin. Melatonin helps to regulate the sleep/wake cycle. Additionally, several neurotransmitter systems play a role as well. This includes the Serotonergic, Dopaminergic, Acteylcholinergic, and Norepinephrenergic neurons.
Some additional examples of causes of insomnia are listed below:
Medical conditions: Fever, pain, infection, cardiac, neurological, endocrine, pulmonary, gastrointestinal conditions, adrenal dysfunction and thyroid disorders, HPA axis deregulation. Medications including antidepressants and stimulants can also cause insomnia. Rebound insomnia from benzodiazepene and hypnotic agent use can also occur.
Psychological conditions: Depression, anxiety, panic disorder, thought disorders, stressful or life-threatening events, bereavement.
Environmental problems: Shift work, jet lag, noise or frequent intrusions.
The following includes a list of behavioral techniques that may help patients with sleep disturbances:
· Practice relaxations techniques before bedtime.
· Avoid stimulating activities three hours to bedtime including intense exercise. Exercise during the day helps promote restful sleep at night.
· Avoid naps throughout the day.
· Maintain a regular sleep schedule, set a time to get up in the morning. Early rising and early to bed mimic the body’s natural day/night cycle. A "night owl" schedule disrupts the body’s natural sleep/wake cycle.
· Avoid alcohol, caffeine and stimulants. Alcohol adversely affects sleep.
· Avoid consuming large meals at least two hours prior to bedtime.
· Avoid watching the clock while in bed. This creates more anxiety.
· Avoid dehydration as well as over-hydration prior to bedtime (decrease visits to the bathroom throughout the night)
· Assess your sleep environment. Be sure that the bed and pillows are comfortable and that room temperature is ideal.
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