By Will Oberndorf
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Discovery and Epidemiology
Insomnia is simply difficulty sleeping. This disorder was never really discovered, as sleep problems and difficulty sleeping have been an issue since the beginning of human existence.
Most people admit to having insomnia at some point in their life. A survey recorded that 95% of people admitted that they have had insomnia. This survey included people of all ages, and led to the discovery that many adolescents and children complain about sleeping problems. A survey in December 1995 administrated by the Gallup Poll organization found that 48% of all adults in the U.S. have had problems with insomnia. Of these 48%, 25% had chronic or severe insomnia, in which an individual has trouble sleeping almost every night. Another survey reflected that only 35% of the adults in the United States have insomnia. From these surveys, chronic insomnia was found more in elders and is more prevalent in females. One survey found that chronic insomnia is 1.2-2.0 times greater in women than in men. In addition, chronic insomnia was extremely rare among young people. Temporary insomnia, on the other hand does not have gender or age distinction factors. A recent survey of high school and college students found that 50% of them have disrupted sleep because of stress and anxiety.
Temporary and Persistent Insomnia
There are two types of insomnia: temporary and persistent. Temporary insomnia occurs under circumstances which produce an inability to obtain a healthy amount of sleep. This only lasts a few days long, and then usually disappears. The main difference between persistent and temporary insomnia is the amount of disturbed sleep episodes that occurs over a given period of time. In addition, temporary insomnia is not the sleep loss but the accumulated sleep debt over a time period where persistent insomnia is linked with huge sleep loss and very large sleep debt.
Temporary insomnia is usually caused by or linked to temporary circadian sleep disturbance caused by abrupt time zone changes or sleeping schedules. In addition, direct environmental disturbances such as noise, light, temperatures, or a strange bedroom or uncomfortable bed are common causes of temporary insomnia. Stress and anxiety as well are considered common causes. The severity of temporary insomnia should take into account the number of nights of sleep disturbance, amount of sleep per night, and the overall feeling during the day. Keep in mind; the most severe consequence of insomnia is not necessarily lack of sleep, but daytime fatigue and sleepiness. If one accumulates a large sleep debt, sleepiness can overtake an insomniac victim very unexpectantly.
Persistent insomnia, also known as clinically significant insomnia, is manifested by chronically intermittent episodes where there are several occurrences of sleep disturbance almost every night over a period of several weeks or months. Clinically significant insomnia must include at least one daytime consequence as a result of accumulating sleep debt. Someone who cannot sleep but feels great, alert, and energetic all day long does not have persistent or chronic insomnia. It is very rare, but sometimes people who sleep very little but feel alert have a condition called “normal short sleepers.” They have no sleep problems; they can just function at very high levels off of very little sleep.
Keep in mind that the main purpose of sleep is so that we can function the next day and be alert and wide-awake. Daytime fatigue, tiredness, drowsiness, trouble concentrating during the day, trouble remembering things, jitteriness, unable to accomplish simple tasks, impaired relationships with friends and family, unusual sleep episodes, depression, and frequent automobile accidents are all indicative of a severe form of insomnia. Such severe cases can be life-threatening because of impaired alertness during the day.
Because the individuals build a large sleep debt as a result of disturbed sleeping episodes during the night, the individual has a very strong tendency to fall asleep at very inopportune times during the day. This can happen even with temporary insomniacs if they have accumulated a large sleep debt from poor sleeping habits in the past. In a survey carried out by the National Sleep Foundation, chronic and temporary insomniacs reported car accidents twice as often as individuals who do not have insomnia. From this, we can infer that since a lot fatalities occur because of sleep-related driving accidents, it is very likely that insomnia is one of the disorders that contributes heavily to many fatal in car crashes around the globe.
Common Complaints, Treatment, and Contacts
Symptoms are based on complaints by patients. People may only complain about having
difficulty falling asleep. Others complain about waking up several times during the night. This is called “middle-of-the-night” insomnia, which is when one long awakening occurs in the middle of the night and then is exacerbated by anxiety, making the subject unable to fall back asleep. It is important to note that people who complain about insomnia almost always obtain some sleep. It is absolutely impossible to not get an hour of sleep in weeks or months.
The main problem with insomnia is everybody talks about it or refers to having it, but nobody does anything about it. Most Americans will not do anything about it unless a physician or close family member points it out. The most effective treatment for insomnia is sleeping pills. However, most physicians will not give sleeping pills to temporary insomniacs because they feel that the sleeping pills are addicting and have serious side effects.
Persistent insomnia has a completely different approach than temporary insomnia and physicians usually prescribe sleeping pills. Using medication for temporary insomnia is considered an unreasonable approach. A person who complains about insomnia could have a different specific, diagnosable sleeping disorder that is causing the problem. Therefore, a specific form of therapy or medicine will take precedent such as resetting the biological clock, relaxation techniques, biofeedback, counseling, or psychotherapy.
Luckily, here at Stanford, there is a Sleep Disorders Clinic. It is located in the psychiatry building on 401 Quarry Road, Stanford, Ca Suite 3301. It operates Monday-Friday from 8:30 am to 5 pm. If you cannot make it during these times, you can call at (650) 723-6601 to set up an appointment. For more information see this website:
http://www.stanfordhospital.com/clinicsmedServices/clinics/sleep/sleepDisorders. Remember that it is really important to address sleeping problems, and do not ignore them. Drowsiness is red alert!