Sleep & Insomnia
Although we spend nearly one third of our lives sleeping, few people understand the importance of sleep to our health and well-being. Nearly one of every two adults reports having some difficulty sleeping at some point throughout the year. Trouble sleeping, also known as insomnia, can have serious health consequences. There are, however, many ways to improve the quality of sleep, and consequently physical and mental health.
Why Do We Sleep?
Researchers still know relatively little about why we sleep. Healthy
sleep is characterized by a decrease in body temperature, blood
pressure, and rate of breathing. Although the mind is in a state
of rest during sleep, the brain is still very active, in fact, it
is just as busy during sleep as it is during wakefulness. During
sleep, the brain organizes and stores memories and continues to
process past, present, and future activities. While sleeping, the
brain repairs damaged tissues and nerve cells restoring it to full
capacity.
Getting Enough Sleep?
The average person needs about 8 hours of sleep every night, although the amount varies among individuals. Most people do not get enough sleep, and this lack of adequate sleep can have serious health consequences. For example, sleep deprivation weakens the immune system, increasing the risk of illness. Prolonged sleep deprivation may even cause irritability, mood swings, and other psychiatric problems. Compromised sleep also impairs a person's ability to perform simple tasks, which may lead to more errors at work.
Is it Insomnia?
Do you watch the hands on the clock move from hour to hour? Do you waken many times during the night or wake early in the morning and have trouble falling back to sleep? Does this restless activity at night interfere with your ability to function during the day? Most people have trouble with sleep once in awhile. If problems sleeping occur frequently, however, you may have insomnia. Insomnia is defined as inadequate sleep or poor sleep quality that causes next day consequences and may be due to difficulty falling asleep, difficulty staying asleep, or unsatisfactory/non-restorative sleep.
Insomnia is fairly common--12% of adults persistently have difficulty sleeping. While insomnia affects people of all ages, it becomes more common with age. Women are twice as likely to have insomnia than men, and people suffering from depression, anxiety disorders, or stress are also more likely to experience bouts of insomnia. Health problems, including pain, and use of medications are also associated with poor sleep. Insomnia is categorized in three different durations: transient, intermittent, and chronic. Most people have experienced transient insomnia at one time or another. This type of insomnia lasts a few nights and is typically triggered by temporary stress or excitement. Anticipating a job interview or social event may trigger transient insomnia. This type of insomnia requires no treatment and usually subsides after the stressful or exciting event passes. Intermittent insomnia lasts up to three weeks and is typically the result of prolonged stress or anxiety. Sleeping difficulties should go away once the stress is gone, but sometimes requires treatment. Chronic insomnia is defined as sleep problems lasting for three or more weeks. It will usually persist if not treated. Some causes of chronic insomnia are depression or other illnesses that cause pain such as arthritis or cancer. Chronic insomnia may also be the result of behavioral problems such as persistent use of caffeine, alcohol, or tobacco.
| Medications That May Cause Insomnia | Medications That May Cause Drowsiness |
|---|---|
|
|
Treating Insomnia
Treatment for insomnia begins with the proper diagnosis. Because there are many types of insomnia and many reasons for poor sleep, there are several ways to treat sleep problems. Altering health and lifestyle habits to promote better sleep (also called sleep hygiene) improves all types of insomnia and should be included as part of the overall treatment strategy. Behavioral techniques may include relaxation therapy to reduce anxiety and reconditioning to help associate the bed with only sleeping. Chronic insomnia is more challenging to treat. In addition to changing behaviors, chronic insomnia may require the use of sedative-hypnotics. There are many other techniques that work for people with insomnia, however, the first step is getting to a doctor. Insomnia can be treated with proper intervention.
| Improving Sleep Hygiene |
|---|
|
More information on common sleep disorders and sleep hygiene can be found in the book “All I Want is a Good Night’s Sleep” by Dr. Sonia Ancoli-Israel. Additional resources can be found on-line at the National Sleep Foundation website, www.sleepfoundation.org and the American Academy of Sleep Medicine, www.aasmet.org.
^Top
Sleep and Schizophrenia
by Danielle Kukene
People with schizophrenia often have disturbed sleep. Many of the reasons for sleep problems in these patients are the same as the reasons in individuals without schizophrenia. The more common sleep complaints found in patients with schizophrenia include excessive drowsiness during the day and difficulty falling or staying asleep at night. Sleep problems can be so debilitating that they interfere with daily tasks and subsequently decrease quality of life. Despite how common and how distressful insomnia is in people with schizophrenia, there has been limited research on the causes and treatment of disturbed sleep.
Lifestyle habits, such as consuming too much caffeine or not getting enough exercise, are often significant problems for people with schizophrenia and may contribute to sleep problems. In addition, there is research that suggests that disturbed sleep may be a symptom of schizophrenia. Researchers have compared sleep patterns in individuals without schizophrenia to individuals with schizophrenia. Individuals with schizophrenia, both those receiving antipsychotic medication and those who never received it, exhibited a significant disruption in sleep patterns, such as increased sleep latency (the amount of time it takes to fall asleep) and increased awakenings during the night. Within our MIRECC, Dr. Ancoli-Israel and her colleagues found that disturbed sleep in people with schizophrenia may be related to sleep apnea (sleep disordered breathing). Sleep disordered breathing in combination with an antipsychotic medication was also linked to excessive daytime drowsiness.
Dr. Ancoli-Israel, Dr. Dilip Jeste and graduate student Jennifer Martin, examined sleep/wake activity of older patients with schizophrenia. On average the patients were asleep for 8.5 hours a night and awake for 80 minutes, indicating that they slept only 86% of the night. When asked about their sleep, only 68% of these patients reported being satisfied with their sleep and 29% reported experiencing insomnia. One of the factors that contributes to good sleep is being exposed to bright light (such as sunlight) for about two hours a day. These patients were only exposed to 77 minutes of bright light a day.
Although the causes of sleep problems in people diagnosed with schizophrenia can be complex, a thorough assessment and treatment will most likely improve sleep and consequently, one's daily functioning and quality of life. Unrecognized or untreated depression, which is quite common in individuals with schizophrenia, can cause abnormal sleeping patterns. Awakening much earlier than one intends is a typical symptom of depression and normal sleeping patterns often resume when the depression is effectively treated. Side effects from medications may also cause sleep problems. Some antipsychotic medications cause severe sedation, which leads to daytime sleepiness and naps. Long naps during the day may lead to difficulty sleeping at night. Other medications may cause an anxious, "jumpy" feeling, making it difficult to sleep at night.