What is insomnia? This is one of the more common problems I encounter in my practice. It can be a difficult problem to resolve, and I will outline my treatment strategy to combat insomnia.
There are different types of insomnia, with the most common being difficulty falling asleep or early morning awakening. The first refers to difficulty shutting down at night in order to get to sleep, while the latter refers to difficulty staying asleep, which means getting to bed okay, but waking up at about 3-5 A.M. or so with difficulty getting back to sleep. Some have a combination of both of them. Sleep apnea can be related, which manifests as difficulty breathing and oxygenating during sleeping hours, with symptoms such as loud snoring and irregular breathing/choking types of sounds.
As is the case with all the topics I discuss, stress/anxiety are the top reasons for difficulty with sleep. Worry and obsessive thinking are common, with difficulty shutting down because of worries about the day and the previous week or so as well as worry about the next day and week ahead. This causes difficulty shutting down the brain so that quality sleep results.
Quality and depth of sleep is very important, with an adequate amount of REM (rapid eye movement) sleep. This is the deepest and highest quality of sleep one can get, which is most restorative. Adequate amounts of deep sleep results in better daytime energy. If one has more shallow sleep with frequent awakenings during the night, then one can still be tired despite the number of hours of sleep. The recommended hours of quality sleep should be about 1/3 of the day, which is about 7-8 hours, plus or minus an hour or so.
Unipolar disorder such as anxiety and depression results in the types of abnormal sleep patterns that I have already mentioned. Bipolar disorder results in even worse insomnia, which manifests as the mind racing with hypomania or mania occurring (mania results in more irrational thinking, while hypo-mania is a lighter version where the thinking is more rational). The thoughts can be so rapid in these states that it can be difficult for the mind to keep up with the thoughts, and this obviously makes it difficult to sleep.
In the next week or two, I will discuss the various treatments for insomnia, including sleep hygiene (good sleep habits) as well as the different medications that can be used. Bye for now- Dr. Paul
