News at NCH
"Insomnia: Why Can't I Sleep?" by Allen Weiss, MD, CEO & President

Dr. ALlen Weiss, MD, MBA, FACP, FACR

Almost everyone has problems sleeping once in awhile. This occasional annoyance is not serious and usually relates to stress, anxiety or perhaps eating or drinking excessively before bedtime.

According to the American Academy of Family Practice, difficulty falling to sleep or staying asleep affects 30 to 50 percent of the general population. An estimated 10 percent, however, have chronic insomnia. It may be the body's way of saying something's not right.

As we age, insomnia becomes more common and affects a greater number of women than men. Infants sleep most of the day, but as we age, we need less and less sleep. Nonetheless, functioning well the day after a bad night's sleep is a real challenge.

Many emotional problems such as anxiety or depression are the earliest symptom of chronic insomnia. Recognizing and treating the mental illness is curative for the insomnia. If a person is suffering from insomnia and emotional disorders, treatment becomes more difficult as the two tend to exacerbate each other.

Chronic pain, heart disease, lung disease, prostate problems and degenerative diseases of the brain, such as Alzheimer's, also manifest themselves as sleeplessness. Changing time zones or work shifts similarly may cause insomnia. All age groups can be affected including menopausal women. Pregnant women may also have problems getting a good night's sleep.

Caffeine and alcohol act as stimulants and as such are bad for sleep. Even though the “night cap” seems to work immediately at bedtime, there is a paradoxical effect of it becoming a stimulant a few hours later. This causes sleep interruption and a sense of unrefreshed sleep.

A loud partner, too much noise or light in a room, or severe temperatures can also interfere with a good night's sleep. The treatment of any of the above is to remove the underlying cause.

What happens when you can't sleep well and it is a chronic problem? Daytime concentration, memory, motor coordination, spirits, and safety all worsen. If you try to sleep too much during the daytime then you compound the problem by not being able to sleep well at night because you are “too” rested, and a vicious cycle ensues.

Sleep problems that exist longer than a month need to be evaluated. Find the cause, don't just treat the symptoms. Causes may include the emotional problems discussed above, physical illnesses, poor sleep hygiene and/or environment.

Sleep labs are available which help to find a cause. Many people have sleep apnea which causes them to snore loudly and experience brief periods of interrupted breathing. Sleep labs invite insomniacs to spend a night on a monitor. This assay combined, with a history, physical examination and keeping a logbook of recent nights' sleep incidents, will aid in the diagnosis and treatment.

Understanding this common problem will help you avoid or cope with the suffering. Exercising early in the day and avoiding alcohol, caffeine or shift changes should be helpful. Pleasant dreams.




Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.