Insomnia is a condition in which a person gets inadequate amounts of sleep even though the sufferer has the opportunity to get a full night's sleep. Sleep deprivation, unlike insomnia, occurs when an individual does not have the opportunity to get a full night's sleep, something on-call physicians and nurses understand all too well.

Generally statistics show that people who get six hours or less of sleep per night have a higher incidence of heart disease and high blood pressure.

"Statistically, if you sleep less than six hours a night, your life expectancy is 10 to 15 years shorter than if you sleep more than six hours," noted Dr. Neal Aguillard, pulmonologist with Methodist Sleep Disorder Center. "Now is your life shortened because you're not getting enough sleep or is it that you have some major health problems that are keeping you from sleeping?"

Aguillard explains there are many secondary reasons for insomnia. Top on the list is pain, whether it's arthritic pain or pain from an injury or surgery. Anxiety and life issues are common causes, as well. Many other biological issues can cause insomnia, even sleep apnea. The trick is identifying it as a problem and discovering if there are any other health problems to blame before prescribing sleep medications.

"If you have a new onset of insomnia and it's gone on for one to three months and it's still there, go see a doctor, something is wrong," said Aguillard. By the time Aguillard sees patients for insomnia, they've already been on sleeping pills for months and the pills no longer work.

The American Academy of Sleep Medicine (AASM) indicates 30 percent of adults have symptoms of insomnia and about 10 percent of adults have insomnia that is severe enough to cause daytime consequences. However, less than 10 percent of adults are likely to have chronic insomnia.

Technically insomnia is only considered a disorder when it causes significant distress or anxiety or when it results in daytime impairment. A higher rate of insomnia is seen in middle-aged and older adults.

"There are age effects that are independent of medical problems," explained Aguillard. "It's a misconception that older people need more sleep. The older you are, the longer you have to stay in bed to get the same amount of sleep because the more likely you are to get insomnia."

Women are more likely than men to develop insomnia as well as people with medical or psychiatric illness including depression. Certain medications may trigger insomnia as a side effect. Common effects of insomnia include fatigue, moodiness, anxiety about sleep, poor memory, headaches and lack of concentration.

Treatment Options

Initial treatment for insomnia is usually prescription hypnotics such as benzodiazepine receptor agonists. Aguillard said using them is not a big deal in the short term, but none of these medications keep working long-term. Over-the-counter agents such as herbal supplements and melatonin can be effective but they don't work for everyone.

When medical problems are removed, there are many techniques to combat insomnia. In sleep centers, patients can learn how to introduce cognitive behavior therapy into their daily lives in order to affect their sleep patterns.

First, it's important to understand the body is alerted by its temperature. When the core body temperature is up, the body wants to be awake. When core temperature goes down, the body becomes relaxed. Exercising just a few hours before bed or taking long, hot baths is a sure way to keep the body activated.

Aguillard said it's also important for the bedroom to not be an area of frustration. People shouldn't be doing work in bed and if they cannot fall asleep or they wake up in the middle of the night, he suggests they get up and do something relaxing until they are ready to go back to sleep.

Aguillard listed several additional tools for getting a good night's sleep:

· Set your internal clock. Have a set sleep and wakeup time every day.

· Control stimuli. Try to make things quiet before bedtime, go to bed only when sleepy, leave the bed when unable to sleep, avoid naps and use the bed for only sleep and sex.

· Practice relaxation therapy. It relaxes the mind and body and includes sequential muscle relaxation

· Control light exposure. Upon your set wakeup time, have exposure to powerful, bright light such as sunlight. (For shift workers it is important not to be exposed to light when going to sleep because light triggers the body to go into "awake mode.")

· Try sleep restriction, severely limiting and then gradually increasing time in bed.

· Avoid food and stimulants (coffee, soda, chocolate) three to four hours before bedtime.

After determining patients don't have a concurrent sleep disorder such as apnea, restless leg syndrome, or any other medical problems, Aguillard typically has insomnia patients keep a two-week sleep diary. This tracks sleep and wakeup schedules. By doing this, patients can understand what they're doing to exacerbate their insomnia and make the proper behavior modifications.

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