Sleeping Difficulty

Symptoms

Considerations

Everyone has an occasional sleepless night, and this is not a problem for most people. As many as 45% of Americans report occasional sleeping problems, however Chronic sleeping problems affect about 20% 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 may need up to 10 hours to feel rested.

Using medications to treat insomnia can be useful in certain situations, but there are potential risks. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to dependence, tolerance and over time may affect your memory. Sedative medication should be used under the close care of a physician because they can also cause dependence and tolerance. Stopping these medications can cause rebound insomnia and withdrawal. As with all medications, certain unknown side-effects can occur. Doing some research on the medication and understanding what the side-effects are and the potential complications is prudent. Discussing these with your medical doctor or pharmacist is important.

It is rare for a life-threatening disease to be 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 or another mental health provider to evaluate for 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. Still it is important to become informed about the possible side-effects and complications, as with all medication.

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

Causes

Causes

Sleeplessness in adults may be due to:

• Poor nutrition and digestion of food for brain nutrition.  This prevents the brain from shutting down properly due to a lack of nutrients.
• Aging
• Alcoholism or abruptly stopping alcohol after long-term use
• Anxiety
• Bed or bedroom that does not promote sleep
• Depression
• Diseases, such as an enlarged prostate, cystitis, COPD, arthritis, heartburn, and heart or lung problems
• Exhilaration or excitement
• Frequent urination
• 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 newborns 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:

• Desire for attention from parents
• Fever or other illness
• Hunger
• Indigestion
• Infantile colic or other digestive problems
• Teething

Traditional Medical Treatment Options and Diagnosis

MEDICATIONS

Some people may need medications to help with sleep for a period of time. Your healthcare provider can talk to you about using prescribed medications if they think it will be helpful. Get the understanding of how long you can safely take the medication, as many are addicting and can cause some serious side-effects.  And many times your Medical Doctor will keep you on it after the safe and recommended time period for the medication has passed.

Some antidepressants such as Trazadone can be used at bedtime because they make you drowsy. If insomnia is caused by depression, treating the depression with the right medications or therapy should solve the problem.

Benzodiazepine sedatives such as clonazepam (Klonopin) or lorazepam (Ativan) are anti-anxiety medications that can also help people sleep. They must be used with caution because they can cause addiction.

Newer sleep medicines called hynpotics 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 zolpidem (Ambien) and zaleplon (Sonata).

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.

As with all medication, certain side-effects are known and others are not known. It is important to consider the side-effects and to do some research into the medication being prescribed to determine if the side-effects are worse than the symptoms associated with your sleep concerns. Discuss these with your medical doctor or pharmacist.

Dr. Huntoon's Alternative Medical Treatment Options

Dr. Huntoon has lots of experience with supporting people back to normal sleep cycles. 

Consulting with a Holistic Chiropractor who can help you develop a well-rounded, multifaceted approach to understanding all the contributing factors to remove and reduce nerve stress is appropriate when having Sleep Difficulties. Conservative care in an effort to avoid the addicting medications is warranted. Failure to do so may result in your condition becoming chronic and may lead to other health conditions due to a lack of proper sleep.

There is a new, ground-breaking technique called Neurologic Relief Centers Technique (NRCT) which addresses a common underlying cause of Sleep Difficulties known as Meningeal Compression. This technique is currently only available through Certified Practitioners who have been trained in NRCT and who are listed on the NRCT Website at www.nrc.md  Please go to this website and review the information and videos and locate a practitioner near you to help you see if this revolutionary technique can be the solution to your Sleep Difficulties.

What to Discuss with Your Doctor

When to Contact a Healthcare Professional

Call your health provider if:

• Your sleeping problem becomes persistent and affects your quality of life, despite behavior changes
• 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 Office Visit

Your healthcare 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, staying asleep, or awakening too early?
• Do you wake up feeling unrested?
• How often do you wake up at night?
• What time do you find yourself waking?
• 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:

• Sleep log record
• Thyroid tests (TSH, T3, T4)
  
  

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

Expectations (prognosis)

Sleep Difficulties can be a long-term disorder. Sometimes with medication the symptoms improve. Other times, the problem may get worse and continue for months or years.

Medicines Two Choices for You

Prevention and Quick Tips

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.
• 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, especially if done early in the morning.  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.
• Avoid sending your child to bed as punishment, which can lead to poor sleep.
  
  

For children who have trouble falling asleep, try to make the bedroom as quiet as possible. A sound machine can help mask outside 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.

Alternative Names

Inability to sleep; Dyssomnia; Sleeplessness; Wakefulness