Sleep is vital to human life yet over 100 million Americans of all ages regularly fail to get a good night’s sleep (Morin, 2004).
This is especially visible at university where students always complain of being tired because of a lack of sleep. One disorder that can lead to lack of good sleep is insomnia. It is therefore significant, in our sleep-deprived society, to learn what insomnia is, how it is caused, and how it is treated.
According to the 2004 National Heart, Lung, and Blood Institute of America (NHLBI) insomnia is the complaint of inadequate and poor-quality sleep because of difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, and waking up too early in the morning. Insomnia can cause problems during the day, such as sleepiness, fatigue, difficulty concentrating, and irritability. Individuals vary in their need for sleep, so insomnia is not determined by the number of hours of sleep.
There are two types of insomnia. One is called “acute insomnia”, and it is often caused by emotional or physical anxiety. Some common factors include significant life stress, acute illness, and environmental disturbances such as noise, light, and temperature. Sleeping at a time inconsistent with the daily biological rhythm can also cause acute insomnia. The other type is called “chronic insomnia”. One study states that chronic insomnia afflicts approximately five to ten percent of the adult population in Western industrialized countries (Riemann et al., 2002).
It can be caused by many different factors, and it often occurs in conjunction with other health problems (Hunt et al., 2004).
It often results from a combination of factors, including underlying physical or mental disorders. Ailments such as arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease, and hyperthyroidism may also lead to insomnia (NHLBI, 2003).
However, chronic insomnia may also be due to behavioral factors, including the misuse of substances such as caffeine and alcohol. Disrupted sleep-wake cycles, as may occur with nighttime activity schedules, and chronic stress may also lead to chronic insomnia.
According to a study done by Jindal and Thase (2003), one of the most fundamental aspects of poor sleep is depression. According to them, insomnia is associated with a 2-4 fold increased risk for depression. Another study suggests that major depression in up to 90% of the afflicted individuals is accompanied by disturbances of sleep continuity (Riemann et al., 2002).
Insomnia is also strongly correlated with other emotional and psychological disorders. For example, one research team found that 75% of people clinically diagnosed with “Generalized Anxiety Disorder” also showed symptoms of insomnia (Belanger et al., 2003).
Since improvement in insomnia is closely related to improvement in depression, finding right treatments for insomnia is important.
However, insomnia is particularly difficult to treat as it is a multifaceted disorder. It has a varying pattern of symptoms and is often the result of a combination of dissimilar causes (Morin et al., 2004).
Acute insomnia may not require intensive treatment since symptoms last only a few days at a time. For example, if the insomnia is due to jet lag, a temporary change in the sleep-wake cycle, the person’s biological clock will often get back to normal on its own. Sleeping pills could also be used to alleviate acute insomnia (NHLBI, 2004).
Chronic insomnia is not as simple to alleviate due to its complex nature. The NHLBI (2004) suggests that underlying medical or psychological problems must be diagnosed and treated first. Secondly, behaviors that worsen or perpetuate insomnia must be stopped. Once potential underlying medical and psychiatric conditions have been treated, hypnotics, or sleeping pills, represent an effective and readily available treatment for episodic insomnia (Hajak et al., 2002).
One study suggests that non nightly sleeping medication would be a good treatment (Hajak et al., 2002).
According to their study, non-nightly hypnotic use has several potential advantages. First, the many patients with chronic insomnia who do not experience sleeping problems every night would avoid unnecessary drug intake, an advantage in both medical and economic terms. Second, non-nightly treatment should reduce the onset of psychological dependence to the drug and give the patient the feeling of more control.
Third, non-nightly treatment offers a way of introducing behavioural treatment on drug-free nights while providing the patient with the reassurance of being certain of good sleep when the hypnotic is taken. This is further supported by results from another study that indicated that insomnia symptoms significantly decreased following a cognitive behavior treatment which addressed worries without specifically addressing sleep (Belanger et al., 2003).
Fourth, it could resolve the dilemma of how to provide long-term treatment for chronic insomniacs while keeping the duration of continuous treatment short. Fifth, it could potentially reduce medication costs for patients since they must pay more for nightly treatments. Estimated costs for prescription medication for the treatment of insomnia in the USA in 1995 exceeded $800 million and studies have shown that most sleep medication is consumed by nightly users (Hajak et al., 2002).
Although insomnia is a widespread condition that is associated with significant problems and disorders, it remains for the most part untreated (Morin, 2004).
Among the barriers to treating insomnia is the perception among some clinicians that insomnia is fairly trivial. Another deterrent is the very poor reimbursement from third party payers, which is also frequently justified with the argument that insomnia is not a serious medical condition. To change such perceptions, it is imperative to increase awareness of the effects of insomnia such as decreased functionality and increased risk of depression (Morin, 2004).
It is also important to demonstrate to government officials and third-party payers that not treating insomnia is actually more costly than treating it.
References
Belanger, Lynda., Langlois, Frederic., Morin, Charles., & Ladouceur, Robert. (2003).
Insomnia and generalized anxiety disorder: Effects of cognitive behavior therapy for gad on insomnia symptoms. Journal of Anxiety Disorders, 100, 1-11.
Hajak, G., Cluydts, R., Allain, H., Estivill, E., Parrino, L., Terzano, M.G., et al. (2003).
The challenge of chronic insomnia: is non-nightly hypnotic
treatment a feasible alternative. European Psychiatry, 18, 201-208.
Jindal, R. D., & Thase, Michael. (2004).
Treatment of insomnia associated with clinical depression. Sleep Medicine Reviews, 8, 19-30.
Morin, C.M. (2004).
Insomnia treatment: taking a broader perspective on efficacy and cost-effectiveness issues. Sleep Medicine Reviews, 8, 3-6.
National Heart, Lung, and Blood Institute. (2004).
Facts About Insomnia. March 14, 2004, http://www.nhlbi.nih.gov .
Riemann , Dieter., & Voderholzer, Ulrich. (2003).
Primary insomnia: a risk factor to develop depression. Journal of Affective Disorders, 76, 255-259.