Sleeping Difficulty
Alternate Names : Dyssomnia, Inability to Sleep, Insomnia, Sleeplessness, Wakefulness
Definition Chronic and persistent difficulty in either (1) falling asleep (initial insomnia), (2) remaining asleep through the night (middle insomnia), or (3) waking up too early (terminal insomnia). All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning.
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Overview & Considerations
Insomnia is not, by itself a disease, but it is an occasional problem for over 70 million Americans. Every year, 98 million dollars are spent on over-the-counter sleeping aids and another 50 million on caffeine tablets to stay wake during the day.
Everyone has an occasional sleepless night, of course, but for most people, this is not problematic. However, as many as 25% of Americans report occasional sleeping problems and insomnia is a chronic problem for about 10% of the population. In these cases, people will be unable to carry out their daily responsibilities either because they are too tired or because they have trouble concentrating due to lack of restful sleep.
Most adults do best with about 8 hours of sleep a night until age 60, after which 6 hours may be adequate. Even though the elderly need less sleep, almost one-half of people over 60 experience some degree of insomnia.
The best measure of the amount of sleep needed is how you feel. If you awaken feeling refreshed, you are getting enough sleep. For some people, this may take only 4 hours -- others can need up to 10 hours to feel rested.
The use of long-acting or high-dose sedatives as a cure for insomnia can increase daytime drowsiness -- over time, making the problem worse, not better.
The use of antihistamines (the main ingredient in over-the-counter sleeping pills) as a cure for insomnia can also lead to similar difficulties. Chronic antihistamine usage may also lead to reversible memory impairment.
Stronger tranquilizers, available by prescription, often induce drug tolerance and do not produce a natural, restful sleep. As a result, one may feel more dependent on the drug and may conclude that more of the drug is needed. The more drug used, the more side effects and tolerance develop. Upon discontinuation of these tranquilizers, rebound worsening of insomnia is very common.
A life-threatening disease is rarely the cause of problems with sleep. For many people, poor sleep habits are the cause. However, because insomnia is a key symptom of depression, you should be evaluated for depression if you are having sleeping difficulties.
Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes, and fatigue.
Counseling may be helpful for psychological disorders that lead to insomnia; antidepressants can often help both the sleeping problem and the depression. Antidepressant medications are not abusable and do not lead to the feeling of a need for increased doses the way many prescription sleeping medications can.
Nightmares and dreams that interfere with sleep may also respond to psychological interventions.
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