Sleeping difficultyDefinition Sleeping problems, called insomnia, can take several forms:
All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning. 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 the population. In these cases, the lack of restful sleep impairs the person's ability to carry out daily responsibilities because they are too tired or they have trouble concentrating. Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be adequate. 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 lead to reversible memory impairment. Strong, prescription sedatives do not produce a natural, restful sleep. In addition, you can develop tolerance or dependence on these drugs. In this case, the same dose of the drug no longer produces sleep, which may lead you to try a higher dose. The circular situation becomes worse. 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 evaluated for depression if you are having sleeping difficulties. Insomnia may cause a reduced energy level, irritability, disorientation, dark circles under the eyes, posture changes, and fatigue. It may help to consult a psychiatrist, another physician, or another mental health practitioner for evaluating 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. Nightmares and dreams that interfere with sleep may also respond to counseling. Common Causes
IN INFANTS Most newborn babies wake several times during the night, but by the age of 6 months they typically sleep through the night. At one year, babies will sleep an average of about 16 hours in every 24. Two to three hours of this sleep will be during the day. Causes of sleeplessness in infants may include:
Home Care Try modifying your nighttime sleeping habits and other behavior before resorting to drugs to cure insomnia. For example:
IN INFANTS AND CHILDREN
MEDICATION
Call your health care provider if Call your health provider if:
What to expect at your health care provider's office Your provider will perform a physical examination. To help better understand your sleeping problems, he or she may ask the following:
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 In most cases, medication will not be necessary. Your health care provider can explore with you the possibility of using prescribed medications if everything else has failed. Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they are sedating. They require a prescription. If insomnia is caused by depression, proper treatment of the depression with other appropriate medications or therapy should solve the problem. Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help induce sleep. They must be used with caution because they can be addictive. They too require a prescription. Newer medications called hypnotics are now available. They are help reduce the time needed to fall asleep but are less likely to be addictive than benzodiazepines. Ambien (zolpidem) and Sonata (zaleplon) are two examples. Illustrations
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