The Insomnia and Sleep Institute of Arizona treats sleep disorders

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What is insomnia?

Insomnia is actually a generalized term for difficulty sleeping.  Insomnia may refer to difficulty falling asleep (sleep onset insomnia), difficulty maintaining / staying asleep (sleep maintenance insomnia), early morning awakening (waking up earlier than one's alarm for an unexplained reason consistently), and / or non-restorative sleep (waking up feeling tired each morning regardless of perceiving you slept well).

Out of the 80+ sleep disorders that currently exist in adults and children, insomnia tends to be the most challenging as a result of a strong subjective nature of one's sleep quality.  Sleep onset insomnia can be the most challenging for us in sleep medicine to treat.  There is a classic "3 P Model" for insomnia.  There are three main factors that can result in an individual developing insomnia: a) Predisposing factor (something inherent within us that increases our risk for developing insomnia), b) Precipitating factor (some acute event resulted in an abrupt change in our sleep pattern), and c) Perpetuating factor (after the precipitating factor initiated the insomnia, we essentially forget how to "sleep normally" as we did prior to the acute change and we keep perpetuating our sleep difficulty).

Most individuals also have a powerful paradoxical component to how little they believe they have slept.  The reason for this paradox is that we can only recall the period when we were awake laying in bed but we cannot remember the time when we were actually sleeping.  As a result we have a strong tendency to over-estimate how much we did not sleep.  

Can insomnia occur because of another sleep disorder?

The short answer is YES.  Sleep onset insomnia can occur secondary to uncontrolled restless legs syndrome (RLS) or also secondary to a circadian rhythm disorder known as Delayed sleep phase disorder (DSPD).  DSPD essentially is a condition where the individual's "internal clock" (the inherent clock that determines what time he or she goes to sleep and what time he or she wakes up) is shifted later in time, i.e., the person's natural bedtime becomes 2 or 3 or 4 AM compared to most people's bedtime of 10 - 11 PM.  

Sleep maintenance insomnia, early morning awakening, and non-restorative sleep are very often signs of an underlying sleep disorder such as sleep apnea or another sleep disorder known as periodic limb movement disorder.  Sleep maintenance insomnia generally would be best investigated via an overnight sleep study.

Are medications the only treatment for insomnia?

No.  In fact, there have been numerous research studies in sleep medicine that show medications such as Ambien, Lunesta, Temazepam, etc. do not lead to long term resolution of insomnia.  This definitely holds true, as most of my insomnia patients will present reporting a history of having used many different sleep aids.  The most effective treatment for long-term resolution of insomnia is actually cognitive behavioral therapy for insomnia (CBT-I).  
CBT-I is a form of behavioral therapy with various different behavioral modifications that are instituted that slowly (over several weeks) allows an individual to slowly improve his or her sleep without the need for medications.  Keep in mind that most sleep onset difficulty is psychological and hence the long-term benefits of CBT-I.

I have taken care of many insomnia patients in the past that presented with wanting to sleep naturally again and discontinue sleep medications.  CBT-I definitely requires patience as it is not an immediate resolution to the insomnia but rather a gradual improvement that slowly leads to having normal sleep again and with the added benefit that one has learned the behavioral tools necessary to self-treat his or her insomnia should it happen arise again.

Finally, it is important to mention that a recent study published in the British Medical Journal revealed that individuals that took sleep medications such as Ambien long-term had a nearly 4 times higher risk of death from any cause compared to individuals that did not use prescriptions sleep aids.

Sleep and dream well,

Ruchir P Patel, M.D.
Medical Director, The Insomnia and Sleep Institute of Arizona

The Insomnia and Sleep Institute of Arizona is a paid advertiser of Sonoran Living Live

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