Insomnia

Insomnia can be defined as having difficulty falling or staying asleep, or having poor quality of sleep. This results in daytime fatigue, impaired performance, and falling asleep at inappropriate times. A change in sleep pattern as you age, including awakening several times during the night, is considered normal unless daytime functioning is affected.

Symptoms of insomnia may be short-term (up to three weeks) or long-term (more than three or four weeks). Long-term insomnia is associated with increased automobile accidents, attention and memory problems, irritability, and health problems including depression and a modest increased risk of heart disease.

Acute illness, injury, surgery, bereavement, job loss, and temperature extremes are common stresses causing short-term insomnia. Other causes for insomnia include shift work, travel, lack of daylight exposure (disabled and institutionalized people), sleep apnea (temporary absence of breathing), psychiatric diseases (anxiety and depression), substance abuse (alcohol, caffeine, cocaine, marijuana, amphetamines, smoking); pregnancy; and medical conditions (chronic pain, heart disease, thyroid disorders, etc.).

Some medications may cause insomnia. Talk to your pharmacist about how to minimize this side effect.

Treatment of insomnia begins by practicing good sleep hygiene. This includes: a regular sleep-wake schedule; avoiding naps; exercising regularly; getting outside regularly; avoiding caffeine 8 hours before bedtime; keeping the bedroom quiet and dark; not being obsessed about sleep; eating a light snack or drinking warm milk before bedtime; going to bed only when sleepy; and getting out of bed if no sleep occurs in 20 minutes.

Ask your pharmacist about the benefits and side effects of nonprescription medications (e.g., diphenhydramine) and herbal products (e.g., Valerian) used for the treatment of insomnia.

Consult your doctor if your insomnia affects daytime functioning or continues for more than two weeks. Your doctor may recommend behavioural, light or medication therapy, or refer you to a sleep specialist. Behavioural therapies can be as effective as medication therapy. Medications do not cure insomnia but do lessen symptoms. The effects of sedatives and hypnotics can be minimized.

One in 10 Canadians experiences insomnia during any 12-month period. Try to prevent short-term insomnia from progressing into long-term insomnia, and be sure to consult your doctor.

Internet-based information on sleep disorders:

• http://www.sleepnet.com
• and the Canadian SleepSociety at http://www.css.to/about/index.htm