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                                                                                   Insomnia

                                               Andrew Ying-Siu Lee, MD,PhD.

       Sleep is essential to health, sense of well-being and performance.  Insomnia is difficulty initiating or

maintaining sleep, associated with symptoms as daytime sleepiness, snoring, apnea, hallucination, sleep

paralysis, abnormal behavior etc.

       Risk and predisposing factors of insomnia include: age, female, marital status, low income,

       limited education, work status and work-related stressors, health status (eg. neural, cardiovascular,

       gastrointestinal, respiratory, psychological or psychiatric disorder as depression, mood, stress,

       anxiety, substance abuse), behavioral and environmental factors (as stressful lifestyle, physical

       inactivity, irregular bedtimes, alcohol dependence, heavy caffeine use, smoking), seasonal change,

       social and occupational, circadian rhythm (shift work, travel etc.)

       Diagnosis of insomnia include: clinical interview (sleep history, drug use, medical history,

       psychiatric history, predisposing and precipitating factors,sleep-wake pattern, daytime symptoms,

       sleep environment and hygiene, lifestyle etc), self-report questionnaires and psychological testing.

       “Insomnia has many causes, but when it becomes a persistent problem, psychological and

         behavioral factors are almost always involved.”  Therapy of which include:

             (1)Sleep restriction and compression therapy:-

                  curtail time in bed to actual sleep time (no less than 5 hours) --> mild sleep deprivation -->

                  more efficient sleep

(2)Stimulus control therapy:-

                   reassociate bed/bedroom with sleep and reestablish sleep-wake schedule eg. go to bed

                   only when sleepy, get out of bed when unable to sleep, curtail all sleep-incompatible activities

                   (eg. eating, television, problem solving in bed), arise at regular time every morning regardless

                   of amount of sleep the night before, avoid daytime napping.

           (3)relaxation-based interventions:-

                   reduce stress, tension and anxiety by relaxation (eg. progressive muscle relaxation, meditation,

                   thought stopping )

           (4)Cognitive therapy:-

-         correct intrusive thoughts at bedtime, misconceptions about sleep, insomnia and the next-day consequences

-         alleviate insomnia-causing anxiety that arises from undue worrying and exaggerated fears related to sleep

-         interrupt the vicious cycle of distress over poor sleep-provoking dysfunctional cognitions, leading to more

      sleep disturbance

           (5)Sleep hygiene education:-

                    lifestyle (diet, exercise, substance use eg. caffeine, nicotine, alcohol), environmental factors (light,

                    noise, temperature,  regular  sleep schedule)

       If the above psychological and behavioral therapy is not successful, hypnotics may be used for a short period

of time.  Do not use hypnotics for long time so as to avoid side effects and drug dependence.

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