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INSOMNIA
BACKGROUNDER
What
is Insomnia?
Insomnia is
a sleep disorder that is defined as inadequate or poor-quality
sleep due to one or more of the following symptoms:1
- Difficulty
falling asleep
- Difficulty
staying asleep - waking up frequently during the night with difficulty
returning to sleep
- Waking up
too early in the morning
- Waking up
feeling unrefreshed
Although many
people who have trouble sleeping typically experience two or more
of these symptoms (and, for many, these symptoms may change over
time), it is unlikely they would refer to their condition as insomnia
- Many people
consider the term "insomnia" to mean not sleeping at all
Insomnia can
be divided into three categories:2,3
- Transient
(short-term): Insomnia lasting up to four weeks
- Intermittent
(recurring transient): Transient episodes that recur several times
a year
- Chronic (long-term):
Insomnia symptoms occurring at least three times a week for more
than one month, and not uncommonly lasting for years
Daytime symptoms
of insomnia may include feeling tired during the day, lack of
energy, difficulty concentrating, irritability, a lackluster feeling,
lack of productivity, frequent napping and inattentiveness4,5
Trouble sleeping
is a serious concern; if left untreated, its symptoms may become
progressively worse and can, in turn, affect a person's emotional,
mental, and physical health and well-being6
Despite widespread
prevalence, insomnia, or trouble sleeping, is under-recognized,
under-diagnosed and, as a result, under-treated. Approximately
61 percent of adults have never been asked about the quality of
their sleep by a physician,7 and despite the prevalence
of insomnia in older adults, only one in eight patients aged 55-84
have actually been diagnosed with a sleep disorder8
Who's
at Risk for Insomnia?
Insomnia is
the most common sleep disorder in America, affecting an estimated
one-third of adults,9 or approximately 100 million
Americans10
- At some point
in their lives, 58 percent of adults experience symptoms of insomnia
a few nights per week or more11
Insomnia affects
both genders and all age groups, but it is more common in females
(especially after the age of 40), the elderly, and in people with
certain medical and psychological conditions12
- Women are
more than 30 percent more likely to suffer from insomnia compared
to men13
- Most adults
diagnosed with depression report a sleep disturbance and are at
especially high risk for insomnia14
- Sixty-seven
percent of elderly adults report one or more symptoms of insomnia
at least a few nights a week and elderly adults have more trouble
staying asleep than other adults. Most elderly people diagnosed
with depression (82 percent) report having a sleep problem and
are at an especially high risk for insomnia15
What
Causes Insomnia?
While there
are many causes of insomnia, transient and recurring transient
insomnia often occur when people experience stressful or anxiety-producing
events, environmental disturbances, sleeping or waking schedule
interruptions (due, for example, to jet lag or shift work), medical
conditions, psychiatric illness and/or hormonal fluctuations16
Two of the
most common causes of chronic insomnia are depression and anxiety.
Other psychiatric illnesses, hormonal fluctuations and aging may
also contribute to chronic insomnia. Additional causes include
a variety of medical conditions such as arthritis, kidney disease,
heart failure, asthma, Parkinson's disease and hyperthyroidism.
Chronic insomnia may also be caused by behavioral/environmental
factors including caffeine and alcohol intake, other substances
including various medications, shift work, chronic stress and
a non-conducive sleep environment17
How
is Insomnia Treated?
Treatments
for insomnia include both behavioral and pharmacological options:
- Lifestyle
changes, such as maintaining a regular schedule and optimizing
the sleep environment (e.g. noise, light, temperature)
- Herbal medications:
Some people claim herbal products and nutritional supplements
help them sleep. Melatonin and valerian root are among the most
commonly used herbal medications, however, their long-term impact,
side effects and possible drug-drug interactions are not known18
- Over-the-counter
(OTC) medications used to treat insomnia often cause next day
drowsiness, lose their effect after two to three nights of continuous
use, and have not been as well studied as prescription sleep aids
- Prescription
medications for insomnia include benzodiazepines, which treat
insomnia but may cause significant side effects19,
and non-benzodiazepines, which are effective and have a better
safety profile20 than benzodiazepines
1.
"Insomnia: Assessment and Management in Primary Care"
- National Institutes of Health.
2. "Facts about Insomnia" - National Institutes of Health.
3. URL: www.americaninsomniaassociation.org/aboutaia.asp.
4. "Insomnia: Assessment and Management in Primary Care"
- National Institutes of Health.
5. National Center on Sleep Disorders Research - 2003 National Sleep
Disorders Research Plan, p. 49.
6. "Insomnia" - National Sleep Foundation. URL: http://www.sleepfoundation.org/features/insomnia.cfm#3.
7. 1999 Sleep in America Poll - National Sleep Foundation.
8. 2003 Sleep in America Poll - National Sleep Foundation.
9. URL: www.americaninsomniaassociation.org/aboutaia.asp.
10. Extrapolated to current population from 2000 census based on
Ancoli-Israel et al. SLEEP 1999;22(suppl 2):S347-S353.
11. 2002 Sleep in America Poll - National Sleep Foundation.
12. "Facts about Insomnia" - National Institutes of Health.
13. URL: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10204.html.
14. "Sleep Disturbances Associated with Depression" Sleep
Review, January/February 2004. URL: http://www.sleepreviewmag.com/Articles.ASP?articleid=S0401F02.
15. 2003 Sleep in America Poll - National Sleep Foundation.
16. "Facts about Insomnia" - National Institutes of Health.
17. 2002 Sleep in American Poll - National Sleep Foundation.
18. "Insomnia: Assessment and Management in Primary Care"
- National Institutes of Health.
19. Zammit G et al., "Efficacy and Safety of Eszopiclone Across
Six Weeks of Treatment for Primary Insomnia." Curr Med Res
Opin. 2004. 20(12).
20. "What are drug treatments for insomnia?" URL: http://www.umm.edu/patiented/articles/what_drug_treatments_insomnia_000027_8.htm.
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