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What is Insomnia?

Insomnia is a difficulty with the initiation, maintenance, duration or quality of sleep that results in the impairment of daytime functioning, despite adequate opportunity and circumstances for sleep.  Insomnia is therefore a very subjective complaint, for example someone might be happy with 4 hours sleep, and therefore does not have insomnia, but another person may feel they need more, and provided this impacts on their functioning during the day, and its been present for more than 2 months, they have insomnia.





How common is Insomnia?

The quoted prevalence of insomnia varies a little between different research studies.  At least 10% of the UK population have chronic Insomnia, defined as lasting more than one month, whilst lesser, shorter lasting versions, can affect up to 50% of people.  It is more common in women, older adults and patients with chronic medical and psychiatric disorders.





What are the different types of Insomnia?



Insomnia can be divided into primary and secondary insomnia.  The cause of primary insomnia is unknown but thought to be due to hyperarousal.  Insomnia secondary to other causes, such as a medical condition, a drug or substance or to a psychiatric disorder, is termed secondary.  Primary Insomnia is thought to be due to a maladaptive conditioned response in which the patient learns to associate the bed and bedroom with heightened arousal, rather than sleep.  It often starts with an unpleasant event which causes acute insomnia, the sleep disturbance persists despite resolution of the precipitating factor.  In fact the poor sleep becomes the driver for the heightened arousal and so a vicious circle starts. By the time the patient seeks medical help the initial event is often long forgotten.






What are the symptoms of Insomnia?


* Difficulty falling asleep or staying asleep


* Variable sleep, such as several nights of poor sleep followed by a night of better sleep.


* Forgetfulness


* Poor concentration


* Anxiety and / or depression


* Ongoing worry about sleep


* Reduced motivation or energy


* Daytime fatigue




One of the things about ongoing poor sleep is that you often get concerned of the serious consequences of lack of sleep.  This worry gets worse as you are unable to sleep, which in turn makes you hyperaroused and, which in turn makes it increasingly difficult to fall asleep.  It is important that you don't get trapped in this vicious circle.





What are the treatment options for Insomnia?

Insomnia that has lasted for less than one month probably doesn't need any specific treatment.  Although it is still important to adhere to good sleep hygiene and the suggestions contained within the "how to help yourself" section. Insomnia that lasts longer than two months should be addressed as soon as possible.   Drug therapy using sedatives, such as the 'Z' drugs, Temazepam, Circadin or its equivalents (benzodiazepines) has a role to play.  However they rarely provide a satisfactory long term solution, and often become less effective with time, necessitating a dose increase.  Cognitive Behavioural Therapy for Insomnia (CBT I) is proven to be as effective as medication and its effects tend to be longer lasting.  There is some evidence that a combination of a short course of sleeping tablets along with a course of CBT I is more effective than either alone.



If there is associated anxiety or depression then treatment of this can be an effective adjunct to CBT I, sometimes therefore people need an antidepressant / antianxiety drug prescribed for 6-8 weeks before starting CBT I.