Text 15. Insomnia

Read the text and answer the question: What are the causes of insomina?

The definition of insomnia, according to the American Sleep Disorders Association (ASDA), is difficulty falling asleep or staying asleep. If it occurs every night or most nights for an extended time, it’s called chronic insomnia.

According to ASDA estimates more than 35 million Americans suffer from this long-lasting type of insomnia with 20 to 30 million others suffering shorter-term sleeplessness. Men and women of all ages experience insomnia, but it is more common in the elderly and in women, especially after menopause. The consequences of a " Sleepless Society" can be serious.

Like a headache or fever, insomnia may be a symptom of another problem. It can result from a stressful event like a test or meeting, or from a longer-lasting stressful circumstance, such as a sick child or troubled marriage. Even worrying about having a tough time falling asleep may itself prevent a person from drifting off.

Other common causes of nighttime wakefulness include environmental disturbances, such as noise from traffic or television, an uncomfortable temperature, or light from the sun or other source; use of alcohol or stimulants, such as caffeine or nicotine; and erratic hours, like those of shift workers and people whose air travel takes them across time zones.

Sometimes short-term insomnia may go away on its own or with simple changes in daytime or sleep-time habits. If these lifestyle changes don’t work, the careful use of sleeping pills approved by the Food and Drug Administration may help provide temporary relief from insomnia.

A doctor can help choose an appropriate medicine. One factor to consider is the drug’s half-life, or the time it takes to be cleared from the body. Drugs with shorter half-lives are less likely to have carry-over sedation that affects daytime functioning.

A second factor is the drug’s toxicity. Because of their lower risk of overdose, the newer benzodiazepines and benzodiazepine-like drugs are used more often to treat insomnia than barbiturates and other older drugs. Among the most commonly prescribed benzodiazepine sleep-aids are flurazepam (Dalmane), estazolam (ProSom), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion).

As a rule, these sleeping pills should be used only for short periods because of the risk of developing dependency and withdrawal symptoms when the drugs are stopped. So, while they may help with short-term insomnia induced by jet lag, shift work schedule changes, or short-term stress, they should generally not be used for chronic insomnia because of their potential addictiveness and because they can mask underlying medical problems.

Some other sleep-aids are available without a prescription, including diphenhydramine and doxylamine. These products contain a sedating antihistamine and, like prescription drugs, must be used with care. Even if taken at night, they can cause daytime drowsiness, which can make driving and other tasks risky.

Sleep Apnea: more than simple snoring. Unlike short-term sleeplessness, chronic insomnia is often a symptom of a serious underlying medical disorder. Depression and other psychiatric disorders account for many cases of insomnia, as do wholly physical illnesses, such as asthma, arthritis, Parkinson’s disease, kidney or heart disease, and hyperthyroidism.

Sleep apnea is among the most common and most dangerous types of sleep disorder. An estimated 18 million Americans have the condition, which is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking.

Obstructive sleep apnea is by far the most common type. Breathing is interrupted when air can’t flow into or out of the nose or mouth. The reason for the blockage could be an over-relaxation of the throat muscles and tongue, which partially blocks the airway or, in obese people, an excess amount of tissue in the airway. Those with receding chin lines are also at higher risk for developing obstructive sleep apnea.

In the less common form, central sleep apnea, breathing is stopped not because the airway is closed but because the diaphragm and chest muscles stop working.

Mild cases of obstructive sleep apnea can sometimes be treated by making simple behavioral changes, such as avoiding alcohol, tobacco, and sleeping pills; losing weight; and sleeping on one’s side. Also, oral devices to prevent obstruction of the airway by holding the tongue or jaw forward may help with mild cases.

The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping. A device supplies pressurized room air through a flexible tube attached to the mask. The pressurized air acts as a splint to prevent the airway from collapsing.

Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases.

The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997.

When to worry. Just as snoring isn’t always a sign of dangerous apnea, neither is a sleepless night or two necessarily a medical emergency. Sometimes sleep patterns differ based on simple factors like age and lifestyle.

Bob Rappaport, M.D., a sleep medicine specialist, neurologist encourages people to consider getting help if their sleeplessness persists and appears to be unrelated to life circumstances.

Sleep specialists provide some tips to help you reach dreamland:

· Avoid caffeine (including caffeine-containing drugs), nicotine, and alcohol for four to six hours before bedtime. The first two are stimulants that can make it difficult to sleep. And while alcohol may have a sedating effect at first, it tends to disturb sleep after several hours.

· Don’t exercise within four to six hours of bedtime. Working out earlier in the day, though, not only doesn’t hinder sleep, but can actually improve it.

· Perform relaxing rituals before bed, such as taking a warm bath, listening to relaxing music, or eating a light snack.

· Before going to bed, try to put your worries out of your mind and plan to address them another time.

· Reserve your bed for sleeping. To preserve the association between bed and slumber, don’t watch television or do work in bed.

· Go to bed only when sleepy. If you can’t fall asleep within 15 to 20 minutes, get out of bed and read a book or do another relaxing activity for awhile, rather than trying harder to fall asleep.

· Make sure your bed is comfortable and the bedroom is conducive to restful sleep – quiet and at a comfortable temperature, for example.

· Wake up about the same time every day, even on weekends, to normalize the sleep-wake schedule.

· Don’t take naps, or nap during the mid-afternoon for no more than 30 minutes.

Melatonin. Many Americans in search of more satisfying slumber are buying the hormone melatonin at their local health food stores. Melatonin-containing products are marketed as dietary supplements, which can be sold without FDA’s premarket review or approval. Researchers caution melatonin users about the absence of scientific studies to prove that melatonin is safe and helpful in treating insomnia.