By some estimates, more than 35 million Americans suffer from insomnia at some point in their lives. Brief episodes of insomnia resulting from death of a loved one or the start of a new school year are not considered abnormal. Persistent insomnia, lasting more than a month, may require treatment. Treatments vary based on the cause of the insomnia. Some forms of insomnia, such as difficulty falling asleep, may be related to anxiety. Early morning awakenings are often a sign of depression. If indicated, a polysomnogram may be performed in patients complaining of insomnia to rule out restless legs syndrome, sleep apnea and other sleep pathologies.
Some people appear to have a genetic vulnerability to insomnia. They may have short sleep requirements or be especially sensitive to disruptions caused by noise or light. Psychological factors clearly play a role in insomnia, including stress, anxiety, depression and psychiatric disorders. In other patients, excessive use of caffeine or stimulants may cause insomnia. Paradoxically, sleeping pills often contribute to insomnia by the development of tolerance over time. Shift work is often associated with difficulty sleeping and daytime sleepiness.
Signs & Symptoms
Insomnia is considered significant when it interferes with daytime functioning. Daytime effects of insomnia may include difficulty waking in the morning, sleepiness during the day, trouble concentrating, irritability, depression and anxiety.
A sleep history, medical history and physical examination are essential for the proper diagnosis of insomnia. The sleep history will include discussion of the duration and severity of your problem, possible triggers, and a review of symptoms of other sleep disorders such as snoring and restless legs syndrome. The medical history will include discussion of health factors that might influence your sleep such as chronic pain, heart disease, strokes and medication use. The physical examination will include measurement of blood pressure and heart rate and tests of reflexes and coordination. If needed, the physician may request blood tests or x-rays.
You may be asked to keep a sleep diary showing sleep and wake patterns for a week or so. In some cases, an overnight sleep study may be necessary.
Insomnia may improve with education and information. Stress reduction techniques may be useful. A variety of behavioral therapies have proven effective in treating insomnia, including stimulus deconditioning therapy, cognitive behavioral therapy, and sleep restriction therapy. In most cases, these behavioral therapies can be learned in less than three months, and many patients begin to experience relief after a few weeks. Biofeedback and muscle relaxation training may also be useful.
Traditional sleeping pills (hypnotics) are generally not effective for long term treatment of insomnia. They may be useful for short-term therapy, such as for first day of school insomnia or after the death of a loved one. Other medications may promote sleep over the long term.
Often the physicians in the sleep center prescribe a combination of short-term medication and behavioral therapy for long-term benefit. This combination is frequently successful in providing immediate relief and preventing relapses.
The NorthShore University HealthSystem Sleep Disorders Program includes the Evanston Hospital Sleep Disorders Center, which is accredited by the American Academy of Sleep Medicine, and the Glenbrook Hospital Sleep Disorders Center. Physicians in the Department of Neurology serve as medical directors of the centers. Staff physicians include additional neurologists and a pulmonologist. All are experienced in the diagnosis and treatment of a broad variety of sleep disorders.
After a clinical evaluation including a detailed history and physical examination, most patients undergo a polysomnogram. Large, private bedrooms are available in both hospital laboratories for the test. State of the art monitoring equipment is used in both centers. Diplomates of the American Board of Sleep Medicine evaluate the polysomnograms. The results are discussed with the patient as well as their referring physician.