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Depression and insomnia
Depression and insomnia


Definition:

Sleeping difficulty, called insomnia, can involve difficulty falling asleep when you first go to bed at night, waking up too early in the morning, and waking up often during the night.



Alternative Names:

Insomnia; Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness



Considerations:

Everyone has an occasional sleepless night, and this is not a problem for most people. However, as many as 25% of Americans report occasional sleeping problems, and insomnia is a chronic problem for about 10% of people.

The lack of restful sleep can affect your ability to carry out daily responsibilities because you are too tired or have trouble concentrating. All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning.

Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be enough. Even though the elderly need less sleep, almost one half of people over 60 experience some degree of insomnia.

The best measure of the amount of sleep needed is how you feel. If you awaken feeling refreshed, you are getting enough sleep. For some people, this may take only 4 hours. Others can need up to 10 hours to feel rested.

Using long-acting or high-dose sedatives as a "cure" for insomnia can make the problem worse, not better, over time. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to similar difficulties. Using antihistamines over time may also affect your memory.

Strong, prescription sedatives do not produce a natural, restful sleep. In addition, you can become dependent on or tolerant of these drugs. In this case, the same dose of the drug no longer produces sleep, which may lead you to try a higher dose. Higher doses worsen the chance of dependence, tolerance, and side effects. Stopping these medications can cause a rebound insomnia and withdrawal.

A life-threatening disease is rarely the cause of problems with sleep. For many people, poor sleep habits are the cause. However, because insomnia is a key symptom of depression, you should be checked for depression if you are having trouble sleeping.

Insomnia may cause:

  • Dark circles under the eyes
  • Disorientation
  • Fatigue
  • Irritability
  • Posture changes
  • Reduced energy level

It may help to see a psychiatrist, doctor, or another mental health provider to evaluate psychiatric disorders that can lead to insomnia. If you are depressed, antidepressants can help both the sleeping problem and the depression. These medications do not carry the same concerns about tolerance and dependence as sedatives.

Counseling may help with nightmares and dreams that interfere with sleep.



Common Causes:

Sleeplessness in adults may be due to:

  • Aging
  • Alcoholism or abruptly stopping alcohol after long-term use
  • Anxiety
  • Bed or bedroom that does not promote sleep
  • Depression or major depression
  • Diseases, such as an enlarged prostate, cystitis , COPD , arthritis , heartburn , and heart or lung problems
  • Exhilaration or excitement
  • Grief
  • Illicit street drugs, such as amphetamines and cocaine
  • Jet lag
  • Lack of exposure to bright light or sunlight
  • Medications, such as too much thyroid medicine, ephedrine, phenylpropanolamine, theophylline derivatives, and others
  • Overactive thyroid
  • Restless leg syndrome
  • Shift work
  • Sleeping too much during the day
  • Stimulants taken in the evening, including nicotine, alcohol, caffeine, or food
  • Stress and worrying
  • Suddenly stopping a medication (such as sleeping pills or sedatives)
  • Too much stimulation at bedtime
  • Wake-sleep pattern disturbances

IN INFANTS

Most newborn babies wake several times during the night, but by the age of 6 months they usually sleep through the night. At age 1, babies will sleep an average of 16 out of every 24 hours. Two to three hours of this sleep will be during the day.

Sleeplessness in infants may be due to:



Home Care:

Try changing your nighttime sleeping habits and other behavior before taking drugs for insomnia. For example:

  • Avoid emotional upset or stressful situations before bedtime.
  • Avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking, because nicotine is a stimulant.
  • Eat a light snack before bedtime. Foods such as warm milk or turkey contain a natural sleep inducer called L-tryptophan.
  • Establish a regular bedtime, but don't go to bed if you feel wide awake.
  • Exercise regularly, but not in the last 2 hours before going to bed. Exercise, especially aerobic exercise, has been shown to make people fall asleep faster and get deeper and more restful sleep. Sex can be a natural sleep inducer for some people.
  • Relax by reading, taking a bath, or listening to soothing music before going to bed.
  • Take your TV or computer out of your bedroom. Otherwise, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.
  • Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.

IN INFANTS AND CHILDREN

  • Avoid going in to your child's room throughout the night. Otherwise, the child may depend on the attention and become sleepless if you don't offer it.
  • Avoid sending your child to bed as punishment, which can make the child afraid and lead to poor sleep.
  • For children who have trouble falling asleep, try to make sure that the child is not disturbed by noise. Leaving a radio playing soft music may help cover up disturbing noises.
  • Never give a child sleeping medicine without asking the doctor first. It's usually not a good idea to treat the problem with drugs.

MEDICATION

  • Avoid all sedatives, including benzodiazepines, during pregnancy.
  • Over-the-counter sleep medicines can have side effects, including a "hangover" effect the next morning. If these fail, you may want to ask your health care provider to recommend other options.
  • Use medication as a last resort.


Call your health care provider if:

Call your health provider if:

  • Your sleeping problem becomes persistent and unbearable, despite home treatment
  • Your sleeping problem occurs more than 3 nights per week for more than 1 month
  • You have other worrisome symptoms, such as chest pain or shortness of breath


What to expect at your health care provider's office:

Your health care provider will do a physical examination. To help better understand your sleeping problems, he or she may ask the following:

  • Do you have difficulty falling asleep or staying asleep (insomnia)?
  • Do you wake up not feeling rested?
  • How often do you wake up at night?
  • How long have you had the problem?
  • Have you taken any over-the-counter sleeping products?
  • What medications do you take?
  • Do you take any herbal supplements or alternative remedies?
  • Do you drink much coffee or alcohol? Have you recently cut down on your coffee or alcohol?
  • Do you have any excessive stress or anxiety ?
  • How much do you normally sleep? What hours?
  • What do you do during the few hours before you go to bed?
  • Does your sleep schedule change often? (shift work)
  • Do you fall asleep at the wrong times or places?
  • Does your sleep schedule change a lot on weekends?
  • Do you worry too much about sleep?
  • Do you have breath-holding spells, or do you snore ?
  • Do you have any aches or pains that prevent you from sleeping?
In some cases, the health care provider may recommend the following tests:
  • Psychological tests
  • Sleep log record
  • Thyroid tests (TSH , T3 , T4 )

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS

Most people don't need medication. Your health care provider can talk to you about using prescribed medications if everything else has failed.

Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they make you drowsy. They require a prescription. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.

Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can be addictive. They also require a prescription.

Newer sleep medicines help reduce the time it takes you to fall asleep. They are less likely to be addictive than benzodiazepines. Two examples are the prescription medicines Ambien (zolpidem) and Sonata (zaleplon).

WARNING: The FDA has asked manufacturers of sedative-hypnotic sleep medicines to put stronger warning labels on their products so that consumers are more aware of the potential risks. Possible risks while taking such medicines include severe allergic reactions and dangerous sleep-related behaviors, including sleep-driving.



Prevention:




Review Date: 2/6/2008
Reviewed By: Christos Ballas, M.D., Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Phone: (603) 742-5252
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