To Sleep, Perchance to Dream: All about Insomnia
Get to Sleep
The writer Fran Leibowitz once quipped that life is what you do
when you can't get to sleep. Indeed, for many of us, getting a good night's
sleep is an important but elusive goal. Up to 30% of the general population
suffers from insomnia, and half of this group experiences the problem as
serious. Up to 90% of older people report some type of sleep problem. And
drowsiness at the wheel may account for 30% of fatal driving accidents.
Kinds of Sleep Disorders
Sleep disorders are divided into several types: difficulty
falling asleep and/or staying asleep (insomnia), excessive daytime sleepiness
(hypersomnia), abnormal timing of sleep-wake cycles (circadian rhythm
disorder), and abnormal stages of sleep (parasomnia). Occasional trouble
falling or staying asleep is normal and usually due to transient stress. But
when insomnia continues for weeks or months, it's important to consider
Anxiety and depression account for as much as half of the
chronic insomnia cases. Treatment of the underlying problem usually leads to
improvement in the patient's sleep. About one-fifth of chronic insomnia cases
are so-called primary insomnia. This disorder is usually caused by a
combination of stress, poor sleeping habits, and a form of conditioned anxiety
in which simply getting into their own beds makes sufferers anxious. These
people actually sleep better in laboratories than in their homes!
Three Conditions That Can Disturb Sleep
Unlike those with chronic insomnia, only a small percentage of
people with hypersomnia have an underlying psychiatric problem. However, nearly
85% have one of three conditions: sleep apnea, narcolepsy, or myoclonus.
Obstructive sleep apnea (OSA) is a breathing disorder, usually caused by
partial blockage in the back of the throat. OSA is common in overweight,
middle-aged men with high blood pressure, and its hallmark is very loud snoring
-- the kind that sometimes wakes the neighbors.
Narcolepsy is characterized by "sleep attacks" during
the daytime, and in 75% of cases, by sudden loss of muscle tone. Some
narcoleptics also experience strange hallucinations just before falling asleep
and muscle paralysis upon awakening. Myoclonus refers to abnormal twitching of
the calf muscles during sleep, and accounts for about 10% of hypersomnia cases.
Circadian rhythm disorders include the common "jet lag" syndrome, as
well as sleeping too late or awakening too early because of irregular shift
work -- a common cause of on-the-job accidents.
Parasomnias are disorders in which the normal
"architecture" of sleep is distorted or disrupted. For example,
sleepwalking may occur during a stage of deep sleep called delta sleep. And
agitated or violent behavior may be exhibited by people with abnormal REM
(rapid eye movement) sleep, a stage normally associated with dreaming.
What should you do if you have a persistent sleep problem? A
thorough exam by your general practitioner or family physician is the best
place to begin. Doctors often are able to diagnose the problem simply by taking
a careful history. In a few cases, an overnight test called a polysomnogram
will be needed. This is a painless procedure that measures breathing,
brain-wave activity and muscle movements.