May 2005

Sleep Talk: Doctor, I Just Can't Sleep....Insomnia?
We have all experienced a sleepless night or two. It is estimated that approximately 35 million Americans have chronic insomnia. About 20% claim to have a serious problem with insomnia. 10 million complain to their physician about sleeping problems, and about one half of these receive a sleeping medication prescription. The estimated annual cost for treatment is over $10 billion.

INSOMNIA IS A SYMPTOM, not an entity unto itself. Insomnia is divided into two major categories: situational or transient insomnia lasting less than 3 weeks, and persistent insomnia lasting for more than 3 weeks.

SITUATIONAL PSYCHOPHYSIOLOGIC INSOMNIA (SPI) typically is associated with an acute emotional event such as divorce, a death in the family, loss of a job, etc. Typically the difficulty in initiating or maintaining sleep may manifest itself as either racing thoughts or muscle tension. We suggest visual imagery for the former (wind in a wheat field, waves, etc.), and progressive muscle relaxation (tense then relax the feet, legs, etc.) for the latter. SPI normally will dissipate once the triggering event is removed or otherwise "delt with". Short-term use of medication may be appropriate and beneficial during the acute phase of SPI. A hot bath or drinking warm milk may be helpful.

PERSISTENT PSYCHOPHYSIOLOGIC INSOMNIA (PPI) begins in a crisis period and functions autonomously after the acute event itself ends. This may result in chronic somatized tension anxiety and negative conditioning of sleep. Those at risk are often habitually tense, rigid, obsessive and restless with multiple somatic complaints such as tension and headaches. This debilitating condition may last for months or even years. Effective treatment requires the identification and eventual reversal of the initial insomnia-triggering event. The insomnia has become self-perpetuating, and this cycle ultimately must be broken.

PSYCHOPATHOLOGIC INSOMNIA is more serious. These insomnias are associated with anxiety, depression or schizophrenia. Typically, anxiety is associated with sleep initiation insomnia, and depression is associated with sleep maintenance insomnia with early morning awakening. Schizophrenia is associated with progressive sleep initiation insomnia. Once asleep the person remains asleep for 7 to 8 hours. These individuals wake later and later resulting in a complete inversion of the day to night sleep cycle.

Other psychiatric disorders related to insomnia include bipolar disorder, panic disorder, obsessive-compulsive disorder, eating disorders, post-traumatic stress disorder, psychotic disorders and alcohol and substance abuse.

Of course insomnias may have other origins. These may include medical conditions such as chronic pain, effects from drug or alcohol withdrawal, restless leg syndrome, periodic limb movement disorder, various parasomnias (sleep-walking, teeth-grinding), various metabolic disorders as well as neoplastic diseases, brainstem lesions, or menstrual and perimenopausal associated insomnias. Others include shortness of breath or nighttime coughing, nocturnal asthma, chest pain and palpitations, headache, heartburn and increased testosterone levels.

Medications and drugs can also disrupt sleep. These include antidepressants, antihypertensives, antineoplastic agents, central nervous system stimulants (caffeine and nicotine), corticosteroids, decongestants, respiratory stimulants and nonsteroidal anti-inflammatory agents.

A final factor that affects sleep is age. People over the age of 40 need to understand the normal physiologic changes that occur in sleep with aging. Sleep efficiency falls, and the number of awakenings and minutes awake after sleep onset rise precipitously around the age of 45, and only increase with age.

INPRACTICE

Psychologist, Laurie Sackett-Maniacci, Psy.D. is available through Midwest Center for Sleep Disorders to help in the diagnosis and treatment of insomnia, please call 630.375.9499 for more information.

back to top ^