Insomnia

1. Insomnia A Presentation By: Jennifer Glover Cathleen Gallagher Margaret Gaines Paul Garrett Matthew Gayford

2. What Causes Us To Be Sleepy? • If the average amount of sleep is not met, a sleep debt is created. • All lost sleep accumulates progressively as a larger and larger sleep indebtedness. • The size of your sleep debt is zero, sleep is impossible. • If your sleep debt is very low, only a small amount of stimulation is required to keep you awake. • If your sleep debt is very large, no amount of stimulation can keep you awake (Dement, 2).

3. What is Insomnia? • The perception of inadequate or poor-quality sleep accompanied by significant distress or impaired function. • Chronic if it occurs on most nights and lasts a month or more (National Institute of Health). • You might suffer from insomnia if: • It takes you more than 30 to 45 minutes to get to sleep • You wake up during the night • If you wake up early and cannot get back to sleep • You wake up feeling un-refreshed in the morning • You can only get to sleep with the aid of sleeping aids or alcohol (Alpha Sleep, 1999)

4. What Causes Insomnia? • Most reasons for insomnia are subtly woven into the fabric of your life (Dryer, 17) • Changes in sleep patterns because of different work hours or travel. • Depression, anxiety, worries, or stress • Use of caffeine or other stimulants • Use of alcohol or other sedatives which are depressants of the central nervous system but can alter normal sleep patterns, especially if used long-term • Sleeping or napping during the day (Alpha Sleep, 1999) • Death of a loved one, job loss or failing in school (Kirkwood Community College, 1).

5. Types of Insomnia • There are five types of insomnia, including: • Initial Insomnia, where an individual finds difficulty in falling asleep • Mental Insomnia, where an individual wakes up frequently from sleep • Terminal Insomnia, characterized by waking up early and not being able to get back to sleep • Hypersomnia, where one has trouble staying awake during the regular day • Parasomnia, shown through abnormal behaviors occurring during sleep (Morin, 3)

6. Treatment Modalities • Treatment of insomnia includes alleviating any physical and emotional problems that are contributing to the condition and exploring changes in lifestyle that will improve the situation (Barstow, 3). • There are a myriad of treatments available for insomniacs, which fall into three major categories • Drug Therapy • Cognitive-Behavioral Therapy • Alternative Treatments

7. Treatments: Drug Therapy • Sedative-Hypnotic Medications (aka Sleep-Meds) • Benzodiazepines can be used on an “as-needed” basis • These reduce the length of time to fall asleep • Medications include Dalmane, Doral, Halcion, Prosom, and Restoril • These were formerly the most used treatments. Issues with abuse, dependence, memory impairment, and a next-day hangover have lead to cautions with prescription. • Non-benzodiazepines, such as benzodiazepine receptor agonists • Zoldipem, which is associated more with the effects that persist later into the night • Zaleplon, which may be taken at bedtime or later, as long as there are four hours of more time left to sleep (American Insomnia Association.org)

8. Treatments: Prescription Drug Therapy • Sedative-Hypnotic Medications (Continued) • Eszopiclone is a new drug that recently completed testing at Duke University. • It has displayed “improvement in the patients’ ability to fall asleep, stay asleep, in the quality of their sleep, without evidence of loss of effect over time.” • “The data further demonstrates that improvements in sleep were associated with consistent improvements in the patients’ ratings of their capacity to function well during the day,” (Koepke, 1).

9. Treatments: Prescription Drug Therapy • Sedating Antidepressants are prescription medications that have been developed for the treatment of depression, but are known to have sedative side effects. • The most common of these are • Desyrel • Elavil • Sinequan • A major concern is the association with more troubling, adverse effects than prescription sedative-hypnotic medications (AmericanInsomniaAssociation.org, 4).

10. Treatments: Over-the-Counter Drugs • Over-the-counter medications can be purchased from a pharmacy without a prescription. • These include medications such as Nytol, Sleep-Eze, Sominex, and Benadryl. • Undesirable side effects include vivid dreams and next day “hang-over” effects (AmericanInsomniaAssociation.org, 3).

11. Treatment: Cognitive-Behavioral Therapies • This component is aimed at achieving two goals: • To strengthen the association between sleep behaviors and such stimuli as the bed, bedtime, and the bedroom surroundings (Sammons, 120). • This is designed to eliminate both overt and covert sleep—incompatible activities. • To consolidate sleep over shorter periods of time spent in bed. • This curtails the amount of time spent in bed. (Morin, 110) • Behavioral therapy can be an alternative to medication for the treatment of persistent primary insomnia, a sleep disorder that affects up to 5 percent of Americans (Koepke, 1).

12. Treatment: Alternative Therapies • Medicinal Herbs • Valerian extracts cause both CNS depression and muscle relaxation. • Ginseng has an inhibitory effect on the CNS and may modulate neurotransmission. • Kava Kava possibly acts on GABA and benzodiazepine binding sites in the brain. • Passion flower is associated with significantly prolonged sleeping time in rats, and may be applicable to humans. • Hops, when infused in tea, are reported to have a calming effect within 20-40 minutes of ingestion (Attele, 1-6).

13. Treatment: Alternative Therapies • Physiological Agents • Melatonin increases sleep quality when compared with baseline and placebo in night-shift workers • Tryptophans reduce sleep latency by increasing subjective “sleepiness” and also decreasing waking time. • Other Approaches • Acupuncture therapy can affect the regulation of sleep-wake cycles and possibly reharmonize a disturbed sleep-wake cycle. • Low energy emission therapy, in healthy volunteers, 15 minutes of LEET treatment induced EEG changes, and was associated with objective and subjective feelings of relaxation (Attele, 7).

14. Insomnia & College Students • College students who have difficulty falling asleep are the largest group of the growing community with sleep disorders – 77 percent – according to a national study. • College students often face insomnia because of the varying sleep schedules between weeknights and weekend nights. • Sunday is “insomnia night” and Mondays can be problematic while the body is trying to readjust to the weekday sleep schedule, he said. Wednesday is the most efficient day of the week for sleeping (Hanek, 1). • Drinking coffee to improve alertness, taking naps to make up for last sleep, and drinking alcohol to promote sleepiness are common strategies students use to counter their varying sleep schedules. These are poor sleep-hygiene practices (Brown, 3).

15. Insomnia & College Students • Solutions • If you can’t sleep within 20 minutes, get up and do something else. • Learn to work on difficult tasks when you feel most productive and awake. • Allocate schedule to do things you enjoy. • Employ relaxation techniques. • Use down-time before bed (Maynard, 1).

16. Conclusion • Insomnia is a growing problem with America, especially across college students. • Insomnia can be problematic if not dealt with. • Although many treatments are available, few people seek treatment. • Proper sleep hygiene is integral to daily life.

17. Bibliography Barstow, David. “Insomnia”. Main Search Index. Online. Internet Explorer. 12 Nov. 2003. Available: http://www.ehendrick.org/healthy/000764.htm Dryer, Bernard, M.D., Ellen S. Kaplan. Inside Insomnia. Villard Books. New York. 1986. “Insomnia”. Alpha Sleep Diagnostic Centers. Online. Internet Explorer. 26 Oct. 2003. “Many College Students Suffer from Insomnia” The Daily Illini Online. Online. Internet Explorer. 26 Oct. 2003. Available: http://dailyillini.com/apr01/apr10/news/stories/news07.shtml “Treatment Options: Medication and Behavior Treatments” Americans Insomnia Association. Online. Internet Explorer. 12 Nov. 2003. Available: http://www.americansomniaassociation.org/treatment.htm

18. Bibliography • “Insomnia rate highest amoung college students”. The Daily Illini Online. Online. Internet Explorer. 12 Nov. 2003. Available: • http://dailyillini.com/jan03/jan29/news/printer/campus01-printer.shtml • Sammons, Morgan T. and Norman B. Schmidt. Combined Treatments for Mental Disorders. Washington DC: American Psychological Association, 2001. AmericanInsomniaAssociation.org.2002 11/12/2003. http://www.americaninsomniaassociation.org/causes.htm • Brown, Franklin C., Walter C. Buboltz Jr., and Barlow Soper. “Relationships of Sleep Hygiene Awareness, Sleep Hyiene Practices, and Sleep Quality in University Students.”Behavioral Medicine. 28.1 (2002):33. Academic Search Elite. EBSCOHost.11/01/03 • “Sleepless at Stanford”. Stanford University of Excellence. Online . Internet Explorer. Sept.1997. • http://www.stanford.edu/~dement/sleepless.html

19. Bibliography • “Insomnia: Are you lacking a good night’s sleep?” Kinkwood Community College. Online. Internet Explorer. • http://www.sleeping-tips.com/lacking-sleep-research-college.htm Horin, Charles M. Insomnia: Psychological Assessment and Management.New York. New York, The Guilford Press, 1993. www.americansinsomniaassociation.org.”Medications,”2002. 11/12/03. Attele, Anoja S.,DDS, Jing-Tian XIE, MD, and Chun-Su Yuan, MD, PhD, “Treatment of Insomnia:An Alternative Approach.” www.throne.com.11/12/03 Koepke, Tracey. “Behavioral Therapy Effective in Treatment of Insomnia,” 4/11/2001. www.dukemednews.duke.edu 11/12/03 Koepke, Tracey. “New Drug Proves Helpful for Treating Long- Term Insomnia,” 10/20/2003. www.dukemednews.duke.edu. 11/12/03