Insomnia becomes more of a problem in the elderly, and is more common in women generally.

What is insomnia?

Insomnia describes inadequate, or poor quality sleep. The following problems are characteristic:

• Difficulty falling asleep
• Difficulty staying asleep
• Waking up very early in the morning
• Waking feeling that you have not been refreshed by sleep

There are also daytime consequences of insomnia, such as general tiredness, lack of energy, difficulty concentrating, and irritability.

Types of insomnia

There are two main types of insomnia, acute and chronic.

Acute insomnia describes a situation in which someone has problems sleeping for between one night and a few weeks.

This is often caused by life stresses, bereavement, illness, or noises, light and extremes of temperature.

Jet lag, and the changes caused by shift work can also cause insomnia.

Chronic insomnia refers to problems with sleeping for at least three nights a week for one month or more.

The causes of chronic insomnia may be multiple, and this is often found along with other health problems. However, chronic insomnia may be the only problem.

Insomnia is one of the main symptoms of depression, and other mood disorders.

Another common reason for insomnia is medication, and substance misuse or abuse.

Drugs which are commonly associated with insomnia include stimulating antidepressants, steroids, decongestants, beta-blockers, caffeine, alcohol, and nicotine. Drugs of abuse such as cocaine, heroin and other stimulants can also cause chronic insomnia.

There are some specific sleep disorders which result in insomnia; restless leg syndrome, periodic limb movement disorder, obstructive sleep apnoea, and circadian rhythm sleep disorders.

Restless legs syndrome describes a situation in which the person experiences unpleasant sensations in the legs or feet, which are temporarily relived by moving the legs. This is generally worse in the evenings, and is often associated with periodic limb movement disorder.

Periodic limb movement disorder describes a situation in which the legs, and less often, the arms, twitch every 20 to 90 seconds. This leads to unrefreshing sleep, rather than sleeplessness.

Obstructive sleep apnoea is commonly associated with snoring, daytime sleepiness and obesity, but is sometimes associated with insomnia.

Circadian rhythm sleep disorders are characterised by insomnia because of a mismatch between the circadian sleep rhythm, and the way in which the person wants to sleep. This is often related to shift work.

Consequences of insomnia

People who suffer from insomnia feel that they cannot function well. They often complain of daytime sleepiness, negative moods, and impaired performance at work.

Chronic insomnia can lead to increased time off work, more visits to the doctor and problems interacting socially.

What can be done about insomnia?

Insomnia is difficult to treat, as anyone who has suffered from the problem knows.

What are known as sleep hygiene measures may help:

• Wake up at the same time each day
• Don't drink coffee for at least six hours before going to bed, and limit the number of cups of tea (also contains caffeine) and coffee you drink during the day
• Avoid nicotine, particularly near bedtime, and if you wake up at night
• Avoid using alcohol to help you get to sleep. It can cause wakening later in the night
• Avoid heavy meals close to bedtime, since this can interfere with sleep. On the other hand, a light snack before bed may help you sleep
• Regular exercise in the late afternoon may lead to deeper sleep, although vigorous exercise within three to four hours of going to bed may interfere with sleep
• Try to make sure that there is not too much noise or light when you go to bed. Try to avoid extremes of temperature
• Move the alarm clock away from the bed if you feel this is distracting you

Chronic insomnia is a complex problem, which often requires more than one type of treatment.

Some people find that behavioural treatment is beneficial. This can include relaxation therapy and sleep-restriction therapy.

Sleep-restriction therapy involves not staying in bed for eight hours, if you only manage to sleep for five. As the quality of sleep improves, the amount of time allowed in bed increases by 15 to 30 minutes a night.

More complex forms of behaviour therapy include stimulus control therapy and cognitive therapy.

Stimulus control therapy uses the idea that insomnia is a conditioned response to time and environmental cues; bedtime, and the bedroom. The idea is to reassociate going to bed with the rapid onset of sleep. So, you only go to bed when you are sleepy, you never read in bed, you leave the bedroom if you cannot fall asleep and go back when you are sleepy. You must also get up at the same time each day, regardless of how much sleep you have had, and avoid napping during the day.

Cognitive therapy looks at beliefs associated with sleep. For example, some people believe that they must have eight hours sleep a night in order to function. Such people are encouraged to examine themselves to see if this is really true, or if they can actually cope with less. Those who are convinced that insomnia is destroying their ability to enjoy life are encouraged to develop coping skills, and to stop seeing themselves as victims. This often reduces worry about whether or not they are going to get a good nights sleep.

See Drugs used in treating insomnia.