Sleep Disorders > Insomnias

Dyssomnias also include disorders of initiating or maintaining sleep – also known as Insomnias
Two broad types:
- Problem with sleep onset – can't fall asleep
- Problems with sleep maintenance – can't stay asleep
Must first tease out medical problems (e.g., hyperthyroidism), psychological problems (e.g., anxiety, perhaps surrounding sleep), environmental factors (e.g., bed, temperature), and potential medication issues

Diagnosis & Treatment

Insomnia is often diagnosed based on patient report (especially in case of problems with sleep initiation). Insomnia is an inability to initiate or maintain sleep, often coupled with decreased daytime functioning. It is usually long-standing condition, and often perseveres through emotional states. In other words, a person may have insomnia whether they are stressed or not. Insomnia is more common in females and in older adult population. It seems the ability to sleep (rather than need to sleep, as was previously thought) often decreases with age

Must differentiate between Insomnia and other Dyssomnias, such as:

Sleep State Misperception
- Subjective complaint of insomnia & decreased functioning
- Normal sleep latency and normal PSG
Delayed Sleep Phase Syndrome (Circadian Rhythm Disorder)
- Phase delay of sleep in relation to desired time of sleep
- "Night owls"
- Results in complaints of sleep onset insomnia or difficulty awakening at the desired time; EDS frequent
- Sleep log (chart to track sleep pattern) helps to diagnose
- Often treated with light therapy (bright light box used for a certain amount of time each day) Insomnia is often treated with medications. Behavioral treatment of insomnia also used; involves making changes in sleep habits, aimed at being long-standing. Focus on reducing anxiety surrounding sleep. Stress management, relaxation training. Sleep restriction. Main focus is on Sleep Hygiene – healthy sleep habits for healthier sleep.

Sleep Hygiene

Establish a regular routine that includes going to bed and getting up at the same time every day.
Get an adequate amount of sleep every night. Determine the amount of sleep you need by keeping track of how long you sleep without using an alarm clock for a week. Maintain this "personal" sleep requirement.
Go to bed when you are sleepy. If you have difficulty falling asleep or wake up shortly after going to sleep, leave the bedroom and read quietly or do some other relaxing activity.
Develop sleep rituals before going to bed. Do the same things to cue your body to relax.
Avoid stress and worries at bedtime. Allow a "worry time."
Use your bed for sleeping and sex only. Often, doing other activities in bed like watching TV, paying bills, or working only serve to initiate worries and concerns. Let your mind associate the bed with sleeping.
Avoid heavy meals late in the evening; similarly, avoid going to bed hungry. A light snack, especially dairy foods, can help you sleep (e.g., warm milk).
Reduce your intake of caffeine and nicotine 4-6 hours before going to sleep.
Avoid alcohol 4-6 hours before bedtime. As a depressant that slows brain activity, alcohol may initially make you tired, but you will end up having fragmented sleep. Alcohol also aggravates snoring and sleep apnea.
Exercise regularly. Regular exercise, even for 20 minutes, 3 times a week, promotes deep sleep.
Don't nap for more than 30 minutes or after 3 p.m. Avoiding naps all together will ensure that you are tired at night. Longer naps disrupt the body's ability to stay asleep.
Maintain a dark, quiet, and cool room to sleep in.
Use sleeping aids conservatively, and avoid using them for more than one or two nights per month. Avoid sleeping pills altogether if you have obstructive sleep apnea; it can be a deadly combination.

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Sleep Disorders > Insomnias

Diagnosis & Treatment

Sleep Hygiene

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