Causes of Insomnia
Short-term insomnia, lasting up to three weeks, may result from anxiety, nervousness, and physical and mental tension. Typical causes are worries about money, the death of a loved one, marital problems, excessive concern about health, boredom, social isolation, or physical confinement.
Long-term insomnia often stems from such health conditions as heart disease, arthritis, diabetes, asthma, chronic sinusitis, epilepsy, ulcers, and depression. Long-term impaired sleep can also be brought on by chronic drug or alcohol use as well as by excessive use of beverages containing caffeine and abuse of sleeping pills.
Anxiety, Depression, and Sleep
Many of those who have severe problems sleeping report a high level of emotional distress. In depressed people, an overwhelming feeling of sadness, hopelessness, worthlessness, or guilt can be associated with abnormal sleep patterns. Often, the depressed person awakens early and cannot return to sleep. Yet, sometimes, just the opposite is true. Some depressed people find relief in sleeping. They deny or escape from the problems of living.
Many depressed people complain of insomnia without recognizing that they are depressed. If you have lost interest in activities you used to enjoy or if you have feelings of hopelessness or suicidal thoughts, your sleep problems may be a result of depression. Discuss the problem with your physician, who may recommend mental health counseling. When the depression is treated, the accompanying sleep problems usually disappear.
Ways to Improve Sleep
Insomnia is a complex problem, not given to simple solutions. Chronic insomnia usually develops over a long period of time; similarly, the response to treatment occurs gradually. Most experts agree that the following are the first steps to obtaining better sleep.
Exercise
Regular exercise tends to benefit sleep; however, vigorous exercise--especially just before sleep--can arouse a person and delay sleep. Exercise in the morning also has little beneficial effect on sleep. The best time to exercise is in the afternoon.
Daytime Naps
Daytime naps tend to disrupt normal nighttime sleep. Naps should not be used as a substitute for poor sleep at night. There are exceptions to this general rule; many older people do sleep better at night when they take daytime naps. However, if you nap regularly and sleep poorly at night, your nighttime sleep might improve if you skip the naps.
Bedtime Snacks
If hunger keeps you awake, a light snack might help you sleep, unless it causes problems with digestion. Avoid heavy meals, alcohol, and caffeine beverages. For those who can tolerate milk, that old, time-tested remedy may work best.
Regular Bedtime
The best way to sleep better is to keep a regular schedule for sleeping. Go to bed at about the same time every night, but only when you are tired. Set the alarm clock to awaken you at about the same time every morning including weekends and regardless of the amount of sleep you have had. If you have a poor night's sleep, don't linger in bed or oversleep the next day. If you awaken before it is time to rise, get out of bed and start your day.
Most people who have trouble sleeping stay in bed too long and get up too late in the morning. By establishing a regular wake-up time, you help solidify the biological rhythms that establish your periods of peak efficiency during the 24-hour day.
Alcohol
The effect of alcohol is deceiving. It may induce sleep, but chances are it will be a fragmented sleep. The sleeper will probably wake up in the middle of the night when the alcohol's relaxing effect wears off.
Trying too Hard
Trouble falling asleep may be brought on simply by going to bed too early. Sleep cannot be forced. You should not go to bed and try to sleep until you are sleepy.
If you turn in too early--even if you do fall asleep--you could experience a disturbed night's rest or could wake early without feeling refreshed.
If you go to bed and you find you can't fall asleep, don't stay in bed brooding about being awake. It is best to get out of bed. Leave the bedroom. Read, sew, watch TV, take a warm bath, or find some other way to relax before slipping between the sheets once more. Go to bed only when you are sleepy.
Sleeping Pills: A Temporary Solution
All sleeping medications should be used sparingly, for the shortest possible time, and in the smallest effective dose. At best, sleeping pills have only limited usefulness. Although temporarily helpful, sleep-promoting medications can eventually cause disturbed sleep, side effects, a sleep "hangover" during the day, and dependence on the drug. Sleeping medications pose particular difficulties for older people, because of their reduced tolerance to all medications. Sleeping pills may cause older people to stumble or fall, feel groggy or hung-over, or appear forgetful and senile.
Conclusion
If you have difficulty sleeping, try the suggestions in this pamphlet for improving your sleep. If you are still having difficulty, discuss the problem with your physician. Poor sleep may be a sign of some underlying health problem. Most sleep disorders, whether caused by physical or mental factors, can be treated or managed effectively once they are properly diagnosed.
Adapted from Sleep Disorders, U.S. Department of Health and Human Services; Public Health Service; Alcohol, Drug Abuse and Mental Health Administration, 1987.
Narcolepsy FAQ
Q. What is narcolepsy and how common is it?
A. Narcolepsy is a chronic sleep disorder with no known cause. The main characteristic of narcolepsy is excessive and overwhelming daytime sleepiness, even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime sleep attacks may occur with or without warning and may be irresistible. These attacks can occur repeatedly in a single day. Drowsiness may persist for prolonged periods of time. In addition, nighttime sleep may be fragmented with frequent wakenings.
Q. What are the symptoms of narcolepsy?
A. In addition to overwhelming irresistible sleepiness, there are three other classic symptoms of narcolepsy, which may not occur in all patients:
Cataplexy: sudden episodes of loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse.
Sleep paralysis: temporary inability to talk or move when falling asleep or waking up. It may last a few seconds to minutes.
Hypnagogic hallucinations: vivid, often frightening, dream-like experiences that occur while dozing or falling asleep.
Only about 20 to 25 percent of people with narcolepsy experience all symptoms. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious disruptions in a person's social, personal, and professional life and can severely limit activities.
In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime sleep attacks.
Q. When should you suspect narcolepsy?
A. You should be checked for narcolepsy if:
you often feel excessively and overwhelmingly sleepy during the day, even after having had a full night's sleep;
you fall asleep when you do not intend to, such as while having dinner, talking, driving, or working;
you collapse suddenly or your neck muscles feel too weak to hold up your head when you laugh or become angry, surprised, or shocked; or
you find yourself briefly unable to talk or move while falling asleep or waking up.
Q. How common is narcolepsy?
A. Although it is estimated that narcolepsy afflicts as many as 200,000 Americans, fewer than 50,000 are diagnosed. It is as widespread as Parkinson's disease or multiple sclerosis and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medications.
Narcolepsy can occur in both men and women at any age although its symptoms are usually first noticed in teenagers or young adults. There is strong evidence that narcolepsy may run in families; 8 to 12 percent of people with narcolepsy have a close relative with the disease.
Q. What is happening to someone during a narcoleptic attack?
A. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again, even though the person is in deep sleep. This sleep state, called rapid eye movement (REM) sleep, is when dreaming occurs.
In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep--lack of muscle tone, sleep paralysis, and vivid dreams--occur at other times in people with narcolepsy.
Q. How is narcolepsy diagnosed?
A. Diagnosis is relatively easy when all the symptoms of narcolepsy are present. But if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult.
Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test. These tests are usually performed by a sleep specialist. The polysomnogram involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders that could cause daytime sleepiness.
For the multiple sleep latency test, a person is given a chance to sleep every 2 hours during normal wake times. Observations are made of the time taken to reach various stages of sleep. This test measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep early.
Q. How is narcolepsy treated?
A. Although there is no cure for narcolepsy, treatment options are available to help reduce the various symptoms. Treatment is individualized depending on the severity of the symptoms, and it may take weeks or months for an optimal regimen to be worked out. Treatment is primarily by medications, but lifestyle changes are also important. The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants. For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are prescribed. Caffeine and over-the-counter drugs have not been shown to be effective and are not recommended.
In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible.
Ongoing communication among the physician, the person with narcolepsy, and family members about the response to treatment is necessary to achieve and maintain the best control.
Q. What are the latest findings and research on narcolepsy?
A. Studies supported by the National Institutes of Health (NIH) are trying to increase understanding of what causes narcolepsy and improve physicians' ability to detect and treat the disease. Some of the specific questions being addressed in NIH-supported studies are the nature of genetic and environmental factors that might combine to cause narcolepsy and the immunological, biochemical, physiological, and neuromuscular disturbances associated with narcolepsy.
Q. What do people with narcolepsy need to tell the people around them about their condition?
A. Learning as much about narcolepsy as possible and finding a support system can help patients and families deal with the practical and emotional effects of the disease, possible occupational limitations, and situations that might cause injury. Support groups exist to help persons with narcolepsy and their families.
Parents, teachers, spouses, and employers should be aware of the symptoms of narcolepsy. This will help them avoid the mistake of confusing the person's behavior with laziness, hostility, rejection, or lack of interest and motivation. It will also help them provide essential support and cooperation if they know that:
Narcolepsy is an incurable life-long condition that requires continuous medication to reduce its symptoms.
People with narcolepsy can lead productive lives if they are provided with proper medical care, avoiding when possible. Jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods. Employers can promote better working opportunities for individuals with narcolepsy by permitting special work schedules and nap breaks.
For more information.....
You can find out more about sleep and sleep disorders by contacting the following organizations:
National Center on Sleep Disorders Research (NCSDR)
National Heart, Lung, and Blood Institute
You can find out more about narcolepsy and patient support groups by contacting the following organizations:
Narcolepsy Network
P.O. Box 42460
Cincinnati, OH 45242
This information was abstracted from Facts About Narcolepsy prepared by the National Heart, Lung, and Blood Institute.
All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the sources is appreciated.
