Although one-third of the average person’s life is spent sleeping, many of the physical and chemical bases of sleep remain a mystery. Sleep-wake patterns are governed by circadian rhythms, which usually run on 25-hour cycles with two natural daily peak times for sleeping, at night and at mid-day, the traditional siesta time.
There are three main types of insomnia based on the time of difficulty:
1) sleep onset insomnia
2) maintenance insomnia
3) early a.m. insomnia (often a symptom of underlying depression).
There is also mixed insomnia, conditioned insomnia (chronic disturbance such as a baby in the house), and dream-interruption insomnia (caused by deep anxiety). Compulsive urination insomnia is often seen in patients suffering from fibromyalgia (FMS) due to hypersensitive nerve endings that cause wakening due to bladder pressure.
Chronic primary insomnia is diagnosed when, for at least a month, a person has difficulty in falling asleep, maintaining sleep, or has non-restorative (ineffective) sleep, and, in addition, the patient is distressed and believes that normal functioning is impaired because of sleep loss. Primary insomnia is not due to any other sleep disorders such as restless legs syndrome, medical conditions, drugs, or mental disorders.
Transient insomnia lasts for a few days and short-term insomnia for no more than three weeks; if sleep is disturbed for a longer period of time, a person is considered to have chronic insomnia. It can take 4-6 weeks of getting enough sleep to fully recover from prolonged sleep deprivation.
A large percentage of chronic insomnia cases have a serious psychological cause. The disorders that most often cause insomnia are chronic anxiety, depression, and bipolar (manic) depression. At least 70% of people with depression complain of insomnia.
Onset and maintenance insomnia are often associated with anxiety, and maintenance insomnia and early morning awakening are often associated with depression.
Many common medical problems (and some of the drugs that treat them) can cause insomnia, including allergies, arthritis, heart disease, hypertension, asthma, arthritic conditions, Alzheimer’s disease, Parkinson’s disease, hyperthyroidism, and attention deficit hyperactivity disorder (ADHD). Some women experience insomnia around menopause and find that hormone evaluation and balancing helps.
There are many natural treatments for insomnia that should be considered before resorting to medications. Tryptophan, melatonin, 5-HTP, Valerian, and St. John’s Wort may help with sleep. In difficult cases, use of these in combination have been successful.
Valerian is sometimes used as a treatment for anxiety. However, it is more commonly recommended as an aid for occasional insomnia. Kava is probably better for anxiety but is sometimes recommended at higher doses to treat insomnia as well.
Make sure that something you are currently taking is not causing the problem. Substances such as panax ginseng, hydrocortisone taken late in the day, caffeine, and too much alcohol, cocaine or sedatives can cause insomnia.
Other suggestions
- A 1995 study showed that poor sleepers do not clear caffeine from their systems as rapidly as normal sleepers. Even one cup of coffee at breakfast only was enough to keep them awake at night. A two week trial of no caffeine may be beneficial.
- Sleep in complete darkness. A recent study indicated that even dim artificial light may disrupt sleep and melatonin production.
- Don’t nap. Sleep disturbances may encourage napping during the day, which can make it harder to fall asleep at a normal hour. Avoiding naps can promote sleep at an earlier hour.
- Try taking your watch off and any clocks out of the room. This simple technique has worked for a surprising number of people.
- Reading for 45-60 minutes.
- Aerobic exercise 3-5 times per week.
- Many with FMS need a water bed, sometimes even with an egg-crate pad. Some need a hard bed. Find out what works for you. Go to a store and try some.
- If hypoglycemia is a problem, some are helped by a snack before going to bed.
- Go to bed only when you are sleepy but get up at the same time each morning.
- If medication is necessary, find out which works for you. Don’t give up – good sleep is worth the search.
- Vitamin B12 can help with fatigue, insomnia, depression, and the anxiety of getting older, especially if low stomach acid is suspected. Shots may be required for large doses.
- Mild acting agents like homeopathic preparations, chamomile tea, a long relaxing bath, or a touch of sea salt on the tongue with a glass of water can be tried.