Insomnia

What is insomnia?

Insomnia is the inability to sleep when you desire to sleep or sleep that is not restorative. Typically, it is separated into 3 patterns of disrupted sleep: sleep initiation insomnia, sleep maintenance insomnia, and early morning awakening. Sleep initiation insomnia refers to the inability to fall asleep in a desired time. Most people fall asleep within 10-20 minutes of going to bed, and it is considered abnormal to take more than 30 minutes. Sleep maintenance insomnia refers to the pattern of being able to fall asleep but there are repeated or prolonged (or both) periods of wakefulness during the desired sleep time. Early morning awakening refers to a pattern in which the person can fall asleep adequately, but then awakens earlier than desired (typically up to several hours before the alarm clock).

Insomnia needs to be distinguished from voluntary sleep restriction. For example, someone who goes to bed at 2am and gets up at 6am does not have insomnia (actually they would have behaviorally induced insufficient sleep syndrome if this were a chronic pattern of sleep).

Insomnia as a symptom needs to be differentiated from insomnia as a sleep disorder. Insomnia as a symptoms refers to the problems described above. Insomnia as a disorder has several different classifications. Click here to see the characterization of insomnia as sleep disorders according to the International Classification of Sleep Disorders, 2^nd Edition (also known as ICSD-2). Insomnia can also be a symptom related to another sleep disorder other than the group classification of insomnias. These include the circadian rhythm sleep disorders (advanced sleep phase syndrome, delayed sleep phase syndrome, jet lag), the sleep related movement disorders (restless legs syndrome, periodic limb movements of sleep) and rarely can be a major symptom seen in sleep related breathing disorders (including obstructive sleep apnea, central sleep apnea).

What are the treatments available for insomnia?

There are 2 major groups of treatments for insomnia: behavioral interventions or medications. In general, medications work more quickly than medications, but behavioral interventions have better long term results.

Some basic rules for good sleep are the basis of “Sleep Hygiene”. Many people pick-up some bad habits, often because they are bored and looking for something to do at night when they can’t sleep. However, these are counter-productive and tend to lead to more insomnia, not more sleep.