INSOMNIA   
How did you sleep last night?    
For many Americans the answer is “miserably.”

By John Winkelman, M.D.,Ph.D.Dr. Winkelman, through his position at Brigham and Women's Hospital, is the Medical Director of the Sleep HealthCenters^® LLC affiliated with that hospital. Certified by the American Board of Psychiatry and Neurology and the American Board of Sleep) Medicine, he is also an instructor at Harvard Medical School.

If you have trouble getting to sleep, wake-up frequently during the night or have difficulty getting back to sleep, you are not alone. According to the American Academy of Sleep Medicine (AASM), more than 100 million Americans of all ages fail to get a good night's sleep on a regular basis. In fact, one in three American adults have trouble falling asleep or staying asleep, commonly referred to as insomnia.

Victims of insomnia find that the condition affects them significantly during the day as well, often leaving them tired, irritable, lethargic mid less focused on die tasks at hand. The 1999 "Sleep in America" survey, sponsored by the National Sleep Foundation (NSF), found that 40 percent of adults are so sleepy during the day that they have difficulty carrying out their responsibilities. Perhaps the most alarming statistic involved the impact of sleepiness on driving. The study reported that 27 percent of adults fell asleep at the wheel this past year. This frightening statistic correlates with data from the National Highway Traffic Safety Administration, which shows at least 100,000 car crashes each year are caused by drowsiness.
 
Types of Insomnia
There are varying degrees of insomnia. Transient (short term) insomnia is often caused by excitement or stress, such as a long anticipated vacation or a highly important business meeting. The end result is usually sleeplessness for a few nights. Intermittent insomnia is characterized by several bouts of sleeping difficulty occurring over several weeks. The most debilitating form of sleeplessness is chronic insomnia, resulting in poor sleep almost nightly for a peri­od of a month or more. According to the AASM, 35 million Americans suffer from chronic insomnia.

Causes of lnsomnia
Insomnia affects all ages, however there are some groups with a higher incidence of the sleeping disorder. These groups include senior citizens, women (especially after menopause) and those with a current depression or anxiety disorder. There are several lifestyle-related factors that may produce insomnia. Persistent stress, such as a troubled marriage, a sickly child or a demanding job can be a major cause of insomnia. Quality of sleep can also be impacted by environmental conditions, such as noise levels, extremes in temperature and changes in sleeping locations and time zones. A business traveler experiencing jet‑lag in an unfamiliar hotel room without air conditioning mid adjacent to a train station would be a candidate for an episode of short term insomnia. Some medications can also trigger episodes of sleeplessness. Nicotine and caffeine are stimulants that can prevent the onset of sleep or trigger awakenings throughout the night. Likewise, the ingredients in many popular over-‑the-counter medications for the flu, weight loss or asthma can lead to poor sleep. The causes of chronic insomnia are more complex, often involving a variety of underlying mental or physical disorders, such as depression, arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease and hyperthyroidism.

See Your Doctor
The average person can help insure a restful night of sleep by following a few simple rules for good sleep hygiene (see chart). If, after follow­ing these guidelines, you still feel that you're not getting a good night's rest, you may consider undergoing a comprehensive evaluation by a team of medical experts.

Sleep Hygiene Tips

• Distraction If you don't fall asleep within 20 minutes, get out of bed and do something relaxing and distracting such as reading, then try to fall asleep again.
• Relaxation Avoid housework, bills, work or anything that is too stimulating within two hours of bedtime.
• Avoid Napping Although a nap may feel refreshing to some insomniacs, it may interfere with falling asleep at night.
• Avoid Alcohol Consumption of alcohol within five hours of bedtime can cause nighttime awakenings.
• Avoid Caffeine Coffee, tea, chocolate and soda usually contain caffeine, a stimulant that causes shallow sleep or nighttime awakenings. Avoid caffeine after noon.
• Restful Environment - Make sure your bedroom is dark, quiet, relaxing and climate controlled. Keep clocks out of sight to avoid a "wake-up countdown."
• Regular Bedtime Go - to bed and wake up at consistent times every day.
• "Worry Time" - Schedule "worry time" earlier in the day to resolve problems before bedtime.
• Exercise Daily - exercise at least four hours before bedtime improves insomnia.
• Eating Avoid going to bed with a full or empty stomach.