Humans spend 1/3 of our lives sleeping. This eight hours of every day has a function and is necessary for healthy mind body and emotions. The work that is done in your sleep includes repair of cells that are damaged, growth when we are young, release of anxiety through dreams and merely changing the brain waves to relaxation and lack of physical motion. When this process is denied us, we look feel and act ill.
Sleep is necessary for human life. The lifespan is shortened in people who have less than six hours of sleep a night.
For those of you who have always had good sleep, and who feel rested when you wake, take a moment to thank God, because there are thousands, maybe millions of people in the world who can’t sleep.
What causes this problem? One of the reasons we may have poor or abbreviated sleep is because we are aging. The loss of testosterone, estradiol in women and growth hormone in both sexes robs us of restful sleep. The symptoms all follow the same pattern: “I can fall asleep easily, but I wake up multiple times in the early morning and eventually can’t go back to sleep, or if I do, I wake up exhausted”. When these hormones (T for men and T & E2 for women) are adequately replaced, 90% of insomniacs begin to sleep restfully.
But what about those who are not over 40 or do not improve with hormone replacement? I divide these patients into those who cannot go to sleep and those who cannot stay asleep. For those who cannot stay asleep, which predominate this group, I start by replacing or balancing hormones, and then doing a sleep study. If that is negative then I evaluate for ADD and ADHD, Restless Legs and narcolepsy,. Many times those of us with these problems have too little norepinephrine, and when we are not treated, the behavior of hyperactivity continues into the night to keep us waking up with ideas swimming in our heads. The best treatment for this type of insomnia is treatment during the day with ADD ADHD stimulants. This gives these people more ability to concentrate during the day and allows them to relax their brain at night!
Anxiety/and depressive problems keep patients from staying asleep. These patients wake up and worry or think. Treatment for anxiety and depression which disturbs sleep during the day is to treat the problem during the day and assist in relaxation with clonazepam at bedtime.
Patients who can’t go to sleep are much rarer in the general population but they are very common in medical providers because those professions disturb sleep or cause you to work at night. These professions or stress cause a disturbance in your biphasic cortisol production, changing the elevation which is normal in the morning to elevation before bed. These patients need to take melatonin to try to reset their clock before bed and suppress the cortisol surges in the afternoon or evening to reset the day night clock. This takes years to reset but once in normal rhythm there is no problem with going to sleep.
The last problem that disturbs sleep is mania, which is a psychiatric illness that gives patients never ending energy for days at a time which makes them unable to sleep. This problem is conquered with treatment of the underlying disease, and sedatives.
Sleep is important and many things disrupt our sleep. There are more causes of insomnia I have not mentioned but they are more rare. Only when all these problems are ruled out will evaluation of the rare types of insomnia be required.