Insomnia 101: Understanding Sleep Difficulties

By: Cristina Mestre

Needing sleep is something we all have in common, says Dr. Daniel Buysse, professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh School of Medicine and the Pittsburgh Sleep Medicine Institute. Yet chronic insomnia is one of the most prevalent health concerns in the U.S., affecting between 10 to 20 percent of us. 

In a new paper published today in the Journal of the American Medical Association, Dr. Buysse reviews the assessment, diagnosis, and treatment of insomnia in adults.  Here he answers some common questions about insomnia:
Q: What does it actually mean to have insomnia?
A: Insomniais characterized by difficulty initiating or maintaining sleep, often in conjunction with fatigue or irritability during wakefulness.  Sleep difficulty also occurs despite adequate opportunities and conditions for sleep.  This differs from sleep deprivation, where adequate circumstances for sleep are lacking (your upstairs neighbor is having a loud party, or you’re staying up all night cramming for a test). While 35 to 50 percent of us have an occasional bout of insomnia, 10 to 20 percent of us have chronic insomnia.

Q: How does a lack of sleep affect our bodies?

A: Insomnia is a risk factor for conditions such as coronary heart disease and depression.  It can also interfere with social and work function, reduce productivity, increase risk for other medical and mental health disorders, and increase health care costs.

At the University of Pittsburgh, we’re also researching sleep issues in veterans, the role sleep plays in the functioning of married couples and the risk of developing heart disease, how sleep in early pregnancy may be a risk factor for pregnancy complications, older adults with insomnia versus older adults who sleep well, insomnia and depression in adults, and how sleep patterns affect emotions, thinking and mood in adolescents.
Q: Are there any risk factors for insomnia?
A: There are a few factors that will make you more likely to have insomnia: female sex, older age, lower socioeconomic status, concurrent medical and mental disorders, marital status (greater risk in divorced/separated versus married or never married individuals), family history of insomnia, and race (greater risk in African Americans than in Caucasians).  Medical, environmental, and psychosocial stressors can also initiate a pattern of poor sleep.  Additionally, certain behaviors, thoughts and beliefs about sleep can be factors for insomnia disorders.
Q: What treatment is best for those with insomnia?
A: A careful history of sleep behaviors, medical, and psychiatric symptoms can often reveal clues for insomnia treatment.  Effective behavioral (non-drug) treatments are preferable, though medication treatments are also available.  Hypnotic medications can also be effective but need to be monitored closely.  Finding the best treatment depends on a patient’s specific symptoms, preferences and doctor’s recommendations.  So, talk to your doctor!
Q: What is your advice for better sleep?
A: Contrary to what we might think, it’s actually best to spend less time in bed if you can’t sleep.  Most people with insomnia benefit from “compressing” their sleep by reducing the amount of time they spend in bed. This leads to quicker sleep onset, and deeper, more continuous sleep. Similarly, if you wake up and don’t fall back to sleep, get out of bed and do something else such as light reading, and only go back to bed when you start to feel sleepy. Finally, keep a regular wake-up time, no matter how much you slept the night before. A regular wake-up time helps to set the body’s biological clock, and ensures you’ll be sleepy enough to fall asleep the following night.