Insomnia

Inadequate or dissatisfying sleep is the most common sleep disturbance in America. Over forty percent of adult in the USA report at least occasional insomnia; nearly twenty percent report severe insomnia. Chronic insomnia is defined as difficulty initiating or maintaining sleep at least three times per week for one month or more, with the problem being bad enough to cause fatigue during the day and impaired functioning.

Insomnia can have many causes. Almost any sleep disorder can present itself as insomnia, including circadian disorders, sleep apnea, and restless legs syndrome (RLS). Physical problems such as pain can also cause sleep disturbance, as can medications, herbs, and caffeine. Anxiety about falling asleep can also be responsible; however, should the anxiety be due to a long history of insomnia, the anxiety would probably not be the underlying cause. Once sleep is restored to normal, the anxiety usually dissipates.

Short-term insomnia generally occurs during temporary issues such as stress, sleep/wake schedule problems (e.g. jet lag), medication reactions, and environmental disturbances. Though inconvenient, this type of insomnia is not a disorder and can be improved by the use of natural supplements or 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. Some are not 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 potential underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. It 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 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 obtain the same effect. The risk of becoming dependent on these medications is high. Taking Ambien®, which is a short-acting sleep medication, is not a long-term solution since it is habit-forming. Patients will become emotionally, if not physically, dependent on it for sleep. In general, most sleep disorder experts recommend against treating chronic insomnia with 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 hormone secreted by the pineal gland 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; supplementation may improve sleep problems. 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 complete 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 to relieve vasomotor symptoms. It has also been observed to decrease disordered breathing during sleep. Using natural progesterone versus a progestin may also improve sleep due to its sedative effects.