Insomnia & Sleep Disorders

Verne W. Pitman, PharmD - This article originally published on Get Healthy Stay Healthy.

Do you ever wake up feeling like you barely slept at all, or as if the quantity or quality of your sleep has left you feeling groggy, unrefreshed or irritable? Sleep trouble is very common. At least 40 million Americans suffer from chronic sleep disorders. Insomnia is the most common sleep disorder in the U.S. It is characterized by the inability to fall asleep, the inability to stay asleep, or the tendency to wake earlier than intended with the inability to fall back to sleep.

The problem can be acute, meaning it lasts for a short period time, perhaps due to a specific situation such as jet lag or travel to a place with different time zones, or anxiety and stress over such things as a new job, an important work assignment, or final exams. But insomnia can also be a chronic problem, which means it happens at least three nights a week for at least three months in a row, even with the opportunity to sleep.

As you can imagine, or maybe have experienced, ongoing disturbances in sleep, such as chronic insomnia, can lead to difficulties in daily functioning, physical well-being, and even more serious health issues.

A New Look at Sleep Disorders

Sleep problems are so wide-ranging that the medical establishment has recently changed its general approach to classifying sleep disorders. For example, until recently, most healthcare professionals had commonly referred to these categories as "primary sleep disorders" or "secondary sleep disorders":

• Primary Sleep Disorder was the term used to describe a stand-alone sleep disorder that is not caused by another underlying disorder or substance
• Secondary Sleep Disorder was the broad term often used to describe sleep disturbances that the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4) categorized into the following: sleep disorders that result from a mental condition such as anxiety disorder or depression; sleep disorders that result from a general medical condition such as thyroid problems, acid reflux, or pain conditions; and substance-induced sleep disorders from the use of certain medications, or overuse of stimulants like nicotine and caffeine

Although many healthcare providers will continue to use these terms (primary and secondary sleep disorders), the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, eliminated them. Many types of sleep disorders collectively fall under the category of what is now referred to as “sleep-wake” disorders.

By no longer dividing many of the sleep disorders into primary and secondary categories, the DSM-5 simplified the diagnosis and treatment of sleep disorders including insomnia, regardless of whether there are other medical, physical or mental conditions present. If you think you have a sleep-wake disorder, it is a good idea to talk to your doctor about it right away to see what can be done to alleviate the issue.

Diagnosing Sleep Disorders

Your primary care doctor can diagnose a sleep-wake disorder by conducting a thorough review of your medication history, medical history, and sleep history. Your doctor will also conduct a complete physical examination to identify other health conditions and/or observable issues that may be impacting your sleep.

Be prepared to answer questions such as the following:

• How long did it take you to fall asleep last night?
• How long did you sleep last night?
• After falling asleep, how many times did you wake from your sleep? How much time did you spend awake?
• How would you rate the quality of your sleep last night?

In some cases, your doctor may send you to a sleep specialist or a sleep lab. This may involve taking a monitor home with you to use at night, or staying overnight at a sleep lab, where you are being studied while asleep. Sleep lab studies can determine if the cause of your sleep disorder is due to disruptions in breathing, such as with sleep apnea, or movement disorders, such as restless leg syndrome, sleepwalking or nightmare disorders.

Lifestyle Recommendations—What You Can Do About Sleep

Your doctor will probably suggest that you first try a few lifestyle changes to see if developing better sleep habits can help with your insomnia. These recommendations may include:

• Reducing alcohol intake, which can make you fall asleep initially, but may disrupt your sleep later in the night
• Cutting back on caffeine, which is a stimulant, as it may keep you up, especially when you drink a lot of coffee or tea, or drink it late in the day
• Not smoking tobacco products close to bedtime because they are stimulating and can cause sleep disturbances (and, ultimately, quitting because nicotine is addictive and harmful to your health)
• Avoiding heavy meals close to bedtime, which can cause discomfort, making it difficult to relax. Spicy foods may also cause heartburn, which interferes with sleep for some people
• Losing weight, which can sometimes help to resolve certain sleep disruption causes
• Exercising during the day, which is associated with improved nighttime sleep
• Keeping your bed and bedroom a quiet, sleep-only environment, which means not using the bed to watch TV, to search the internet on your laptop, or to do anything else but sleep
• Creating normalizing routines, which can help you get to bed at the same time every night and get up at the same time in the morning
• Giving yourself enough time to relax, rest and sleep, even when there’s so much going on, and allowing yourself 7 or 8 hours a night if you are an adult or more if you are a teen or younger

Insomnia Treatments

Your doctor will also want to uncover any underlying illnesses or conditions you may have and offer an appropriate treatment plan to help get you on your way to a healthier body and a healthier night’s sleep. There are also over-the-counter medications or prescription medications that may help in the short-term to address your insomnia and restore your sleep.

So, if you suffer from any form of insomnia, whether it is short-term or ongoing, discuss the problem with your doctor.

National Research Program on Sleep

According to the National Institutes of Health (NIH), sleeping less than the recommended amount (7-8 hours per night for adults), irregular sleep schedules, and poor quality of sleep, have been associated with potential health risks. In fact, sleep disorders may possibly be linked to a growing number of health problems, such as heart disease, stroke, diabetes, obesity, cancer and high blood pressure.

To spark awareness and research for sleep disorders, the NIH has launched a Sleep Disorder Research Program to advance the prevention, diagnosis and treatment of sleep deficiencies. To learn more about it go to NIH Sleep Disorders. Or you can opt to participate in a variety of sleep disorder clinical trials, which may offer you additional treatment options.

Verne W. Pitman, PharmD, is a senior director of primary care clinical specialties at Pfizer.