Insomnia Disorders

Inadequate or dissatisfying sleep is the most common sleep disturbance in America. Over 40% of adult Americans report at least occasional insomnia and nearly 20% have severe insomnia. Chronic insomnia is defined as difficulty initiating or maintaining sleep at least three times a week for 1 month or more, with the problem being bad enough to cause fatigue during the day or impaired functioning.

A variety of things can cause insomnia. Almost any sleep disorder can present itself as insomnia, including circadian disorders, sleep apnea, restless legs, and so on. Physical problems like pain can cause sleep disturbance, and medications, herbs, and caffeine can also play a strong role. Anxiety about falling asleep can also be responsible; however, if the anxiety is due to a long history of insomnia, the anxiety is probably not the problem and patients need to find out what the underlying cause could be. Once sleep is restored to normal the anxiety will usually go away.

Transient and short-term insomnia generally occurs in people who are temporarily experiencing stress, temporary sleep/wake schedule problems (i.e. jet lag), medication reactions, or have conditions in their environment disturbing their sleep.  Though annoying, this type of insomnia is not a disorder and can be improved by the use of natural supplements or by medications. Many people have transient sleep disturbances and treat them with over-the-counter medications, while others turn to their healthcare provider for prescription medications. Each has its benefits and risks, indications, and side effects, and these medications are not interchangeable. More importantly, some aren’t safe to use together, so professional advice is important.

Chronic insomnia is more complex and often results from a combination of factors. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles also may occur with shift work or other nighttime activity schedules and chronic stress. Deficiencies in certain vitamins, minerals, amino acids and enzymes may also disrupt sleep.

The most widely used sleep medications are the benzodiazepine and non-benzodiazepine drugs. These medications are believed to be safe because they are difficult to overdose, but long-term studies have not been completed to confirm their total safety. Tolerance develops quickly, and over time, a higher dose is required to get the same effect as the initial dose. The risk of becoming dependent on these medications is also very high. Taking Ambien®, which is a short-acting sleeping medication, is not meant as a long-term solution since it is habit forming. You will become emotionally if not physically dependent upon it for your sleep. In general, most sleep disorder experts recommend against treating chronic insomnia with continuous sleeping medications. Regardless of the mechanism of action of sleeping medications, they are all “downers”.  They depress brain function, and if mixed, overused, or taken in conjunction with alcohol or drugs may create a dangerous health condition where the brain can become depressed and the body begins to break down.

Natural supplements, such as Melatonin, have been proven to be effective for both short-term and chronic insomnia. Melatonin is a brain hormone (pineal gland) that is secreted according to a person’s biorhythm. It is low during the day and peaks in the middle of the night. It has been well documented to be lower than normal in subjects with insomnia and supplementation may improve sleep problems in most people. The hormone is a marker for circadian rhythm disturbance (as is cortisol) but it is not necessarily something that needs to be replaced on a daily basis.

Women especially may experience many sleep disturbances during the perimenopause transition and menopause itself, especially those who do not take bio-identical hormone replacement therapy (BHRT). These sleep problems may be due to nighttime vasomotor symptoms, anxiety, or the effect of hormonal changes on brain neurotransmitters. BHRT has been shown to improve nighttime restlessness and awakening and is proven to relieve vasomotor symptoms. It has also been observed to decrease sleep disordered breathing. Using natural progesterone versus a progestin may also improve sleep due to the sedative effects of natural progesterone.