Insomnia is the inability to obtain an adequate amount or quality of sleep. The difficulty can be in falling asleep, remaining asleep, or both. People with insomnia do not feel refreshed when they wake up. Insomnia is a common symptom affecting millions of people that may be caused by many conditions, diseases, or circumstances.

Sleep is essential for mental and physical restoration. It is a cycle with two separate states: rapid eye movement (REM), the stage in which most dreamingoccurs; and non-REM (NREM). Four stages of sleep take place during NREM: stage I, when the person passes from relaxed wakefulness; stage II, an early stage of light sleep; stages III and IV, which are increasing degrees of deep sleep. Most stage IV sleep (also called delta sleep), occurs in the first several hours of sleep. A period of REM sleep normally follows a period of NREM sleep.

Insomnia is more common in women and older adults. People who are divorced, widowed, or separated are more likely to have the problem than those who are married, and it is more frequently reported by those with lower socioeconomic status. Short-term, or transient, insomnia is a common occurrence andusually lasts only a few days. Long-term, or chronic, insomnia lasts more than three weeks and increases the risk for injuries in the home, at the workplace, and while driving because of daytime sleepiness and decreased concentration. Chronic insomnia can also lead to mood disorders like depression.

Transient insomnia is often caused by a temporary situation in a person's life, such as an argument with a loved one, a brief medical illness, or jet lag. When the situation is resolved or the precipitating factor disappears, the condition goes away, usually without medical treatment.

Chronic insomnia usually has different causes, and there may be more than one. These include medical conditions or treatment; use of caffeine, alcohol, and nicotine; psychiatric conditions such as mood or anxiety disorders; stress; disturbed sleep cycles caused by a change in work shift; sleep-disordered breathing, such as snoring; periodic jerky leg movements (nocturnal myoclonus), which happen just as the individual is falling asleep; and repeated nightmares or panic attacks during sleep.

If a person worries whether he will be able to sleep, that too can cause insomia. The more one worries about falling asleep, the harder it becomes. This is called psychophysiological insomnia.

People who have insomnia do not start the day refreshed from a good night's sleep. They are tired. They may have difficulty falling asleep, and commonly lie in bed tossing and turning for hours. Or the individual may go to sleep without a problem but wakes in the early hours of the morning and is either unable to go back to sleep, or drifts into a restless, unsatisfying sleep. Thisis common in the elderly and in those suffering from depression.

The diagnosis of insomnia is made by a physician based on the patient's reported signs and symptoms. It can be useful for the patient to keep a daily record for two weeks of sleep patterns, food intake, use of alcohol, medications,and any other information recommended by the physician. If the patient has abed partner, information can be obtained about whether the patient snores oris restless during sleep. This, together with a medical history and physicalexamination, can help confirm the doctor's assessment.

A wide variety of healthcare professionals can recognize and treat insomnia,but when a patient with chronic insomnia does not respond to treatment, or the condition is not adequately explained by the patient's physical, emotional,or mental circumstances, then more extensive testing by a specialist in sleep disorders may be warranted.

Treatment of insomnia includes alleviating any physical and emotional problems that are contributing to the condition and exploring changes in lifestyle that will improve the situation.

Patients can make changes in their daily routine that are simple and effective in treating their insomnia. If they are unable to go to sleep, they shouldgo into another room and do something that relaxing, like reading. The patients should return to bed only when they feel sleepy. Patients should set the alarm and get up every morning at the same time, no matter how much they haveslept, to establish a regular sleep-wake pattern. Naps during the day shouldbe avoided, but if absolutely necessary, than a 30 minute nap early in the afternoon may not interfere with sleep at night.

Another successful technique is called sleep-restriction therapy, which restricts the amount of time spent in bed to the actual time spent sleeping. Thisapproach allows a slight sleep debt to build up, which increases the individual's ability to fall asleep and stay asleep. If a patient is sleeping five hours a night, the time in bed is limited to 5-5 1/2 hours. The time in bed isgradually increased in small segments,with the individual rising at the sametime each morning; at least 85% of the time in bed must be spent sleeping.

Medications given for insomnia include sedatives, tranquilizers, and antianxiety drugs. All require a doctor's prescription and may become habit-forming. They can lose effectiveness over time and can reduce alertness duringthe day. Over-the-counter drugs such as antihistamines are notvery effective in bringing about sleep and can affect the quality of sleep.

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