Figure 1. Insomnia is often accompanied by feelings of anxiety and frustration.

Insomnia

A person with insomnia has a consistent difficulty in falling or staying asleep and is the most common sleep disorders. Individuals with insomnia often experience long delays between the times that they go to bed and actually fall asleep. In addition, those with insomnia may wake up several times during the night only to find that they have difficulty getting back to sleep. As mentioned earlier, one of the criteria for insomnia involves experiencing these symptoms for at least three nights a week for at least one month’s time (Roth, 2007).

It is not uncommon for people suffering from insomnia to experience increased levels of anxiety about their inability to fall asleep. Insomnia becomes a self-perpetuating cycle because increased anxiety leads to increased arousal, and higher levels of arousal make the prospect of falling asleep even more unlikely. Chronic insomnia is almost always associated with feeling overtired and may be associated with symptoms of depression.

Etiology

There may be many factors that contribute to insomnia, including age, drug use, exercise, mental status, and bedtime routines. Not surprisingly, insomnia treatment may take one of several different approaches. People who suffer from insomnia might limit their use of stimulant drugs (such as caffeine) or increase their amount of physical exercise during the day. Some people might turn to over-the-counter (OTC) or prescribed sleep medications to help them sleep, but this should be done sparingly because many sleep medications result in dependence and alter the nature of the sleep cycle, and they can increase insomnia over time. Individuals who continue to have insomnia, particularly if it affects their quality of life, should seek professional treatment.

Treatment

Treatment for insomnia includes both pharmacological and non-pharmacological treatment approaches. Common pharmacological treatment for insomnia includes Benzodiazepines; however, there also may be a withdrawal syndrome with rapid eye movement (REM) rebound. In addition, there are two newer benzodiazepine-like agents, zolpidem and zaleplon, which have fewer side effects, but good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines).^[1]

An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications, including amphetamines, may be used to induce daytime alertness. Parasomnias include disorders of arousal and of REM sleep. Chronic medical illnesses can become symptomatic during specific sleep stages. Many medications affect sleep stages and can thus cause sleep disorders or exacerbate the effect of chronic illnesses on sleep.^[2]

Some forms of psychotherapy, such as CBT, can help sufferers of insomnia. CBT focuses on cognitive processes and problem behaviors. The treatment of insomnia likely would include stress management techniques and changes in problematic behaviors that could contribute to insomnia (e.g., spending more waking time in bed). CBT has been demonstrated to be quite effective in treating insomnia (Savard, Simard, Ivers, & Morin, 2005; Williams, Roth, Vatthauer, & McCrae, 2013). Cognitive therapies for insomnia can help a patient to identify disruptive thought patterns, examine their validity, then replace harmful thoughts using strategies such as shifting attention, decatastrophizing, or reappraisal.^[3]