Dr. Michael Breus is a clinical psychologist and both a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine. Dr. Breus is a widely recognized leader in the field of sleep and has partnered with SleepScore to help raise awareness of sleep disorders and the importance of quality sleep for all.
Insomnia, the most common sleep disorder, is the subject of today’s Q&A with Dr. Breus. Insomnia affects millions of people worldwide, and estimates indicate that 30% or more of adults in the U.S. experience insomnia at some point in a year. In answer to our question, he shared his thoughts on insomnia and how you can determine whether or not you actually have it.
Q: “I sometimes have trouble falling asleep. I’m not sure whether I should get help because I don’t know how bad things must be for it to be considered insomnia. How do I know if I really have insomnia?”
Dr. Breus: I think of insomnia by what I call the Rule of 3’s. If it takes more than 30 minutes to fall asleep, a person wakes more than 3 times a night (for more than a total of 30 min) more than 3 times a week, for more than 3 weeks, this is insomnia. Up to about 1/3 of the population has symptoms of insomnia. Those with insomnia typically experience:
- Poor concentration
- Decreased alertness and performance
- Muscle aches
- Depression during the day and night
- An over-emotional state (e.g., tense, worried, irritable and depressed)
Adding to all this, the growing expectation of getting a poor night’s sleep, as well as developing rituals and behaviors you think may help your sleep (e.g., going to bed earlier), may actually have the opposite effect, making the problem worse. While it may be very difficult to get to sleep at bedtime, you find yourself “out like a light” when watching TV, out to a movie, reading, or even driving. Such is the plight, misery, and danger of insomnia.
Insomnia may result from a variety of medical and mental health disorders, pain and even the treatments for these disorders. Sleep disorders and environmental factors also cause insomnia. Medical illnesses that often have night-time symptoms causing awakenings include:
- An enlarged prostate that frequently awakens men to urinate.
- Congestive heart failure and emphysema, which causes difficulty breathing.
- The tingling and discomfort of nerve syndromes like carpal tunnel or restless legs.
- The immobility from paralysis or Parkinson’s disease may cause awakenings.
- Hyperthyroidism, stroke, and alcoholism are other common illnesses that frequently cause sleep disturbances and insomnia.
Depressive illnesses are almost always associated with sleep disturbances. Those suffering from anxiety may be unable to sleep due to intrusive thoughts, an inability to relax, obsessive worrying and an “overactive” mind. Bipolar, panic, and psychiatric disorders are each associated with sleep disturbances as well.
Pain from arthritis, other rheumatologic diseases, cancer and various neurological disorders, like diabetic neuropathy are common causes of insomnia. Gastrointestinal disorders like acid reflux into the esophagus and stomach ulcers, as well as angina from cardiovascular disease, may cause chest pain and consequent awakenings during the night. In addition, cluster headaches may be precipitated during certain stages of sleep or occur from lack of sleep.
Treatment for the types of insomnia discussed above rests primarily with treating the underlying medical condition. These conditions, as with many others, interact with sleep in a complex manner, with each impacting the other. Exactly how all these factors interact is not completely known, but, being aware of the sleep component allows us to target each aspect individually and achieve vastly improved interventions and treatments. So, it is critical to understand and communicate to your doctor how your condition affects your sleep and that your sleep disturbances may exacerbate your medical condition. This will ensure that he/she may integrate your sleep problem into the overall treatment plan, and utilize a sleep specialist if needed.