Friday, December 10, 2010

Other causes of insomnia.

In my last post, I hypothesized that I suffer from non-24-hour circadian rhythm syndrome.  While this could explain why it is so difficult for me to keep a regular sleep schedule, it does not explain why I sometimes I cannot fall asleep at all, and why, without sleeping pills, I awaken every one to two hours throughout the night.  Also, very few people suffer from a non-24-hour circadian rhythm syndrome, so I have yet to explore the more common causes of insomnia.  In this post, I will investigate the more ordinary causes of insomnia.

One common cause of insomnia is sleep apnea, which is a fairly common disorder in which a person has one or more pauses in breathing or shallow breaths while he or she sleeps.  This condition is a chronic one, and the breathing pauses and/or shallow breathing often cause a person to move out of deep sleep and into light sleep, thus they are not getting restorative sleep much of the time.  This disorder is one of the most prevalent causes of insomnia and excessive daytime sleepiness.  Sleep apnea is caused by a blocked or narrowed airway while a person sleeps.  There are several reasons this can happen, including an individual’s throat muscles and tongue relaxing more than usual, oversized tonsils, being overweight (an excess of soft fat tissue can thicken the wall of the windpipe), or as a result of aging, because as a person gets older, the brain has a harder time signaling to keep his or her throat muscles stiff during sleep.  The best way to find out if you have sleep apnea is through a sleep study.  The treatments for sleep apnea include lifestyle changes, mouthpieces, breathing devices, and surgery.  Lifestyle changes include avoiding alcohol, quitting smoking, losing weight, and sleeping on your side instead of your back.  A mouthpiece can help people with mild sleep apnea, and is obtained through a dentist or orthodontist.  Breathing devices such as CPAP (continuous positive airway pressure) can help treat more severe sleep apnea.  A CPAP machine utilizes a mask that fits over someone’s mouth and nose, and gently blows air into their throat.  Lastly, surgery can be performed to widen breathing passages, shrink, stiffen, or remove excess tissue in the throat, or remove the tonsils if they are blocking the airway.  Luckily for me, I had sleep apnea ruled out with two overnight sleep studies.

Another common cause of insomnia is a condition called Restless Leg Syndrome (RLS), which is characterized by an overwhelming urge to move one's limbs to stop uncomfortable or strange sensations.  The symptoms can include pricking, crawling, aching, burning, pulling, itching, and tingly sensations, which keep someone from falling asleep.  To receive a diagnosis of RLS, a person must meet four criteria: undesirable sensations in the leg that occur before sleep onset, an irresistible urge to move the limbs, partial or complete relief of the symptoms upon movement of the limbs, and return of the symptoms upon cessation of the movements.   Treatments for RLS include iron supplements, avoiding caffeine, alcohol, and nicotine, and drugs such as levodopa, ropinirole, and pramipexole.  My past sleep studies have also ruled out Restless Leg Syndrome as a cause for my insomnia.

Lastly, it is very common for insomnia to be caused by stress, anxiety, or depression.    Stress is often caused by ongoing stressful life events, which leaves a person feeling like he or she is not in control.  Stressed individuals will often feel like they just cannot turn off their brain when it is time to go to sleep.  Treatments for stress-induced insomnia include exercise, a healthy diet, relaxation techniques, and sedating medications or supplements.  Anxiety is characterized by a person’s inability to shake his or her concerns.  Individuals suffering from anxiety can experience exaggerated worry and tension, irritability, sweating, trembling, and a rapid heart rate.  Anxiety is commonly treated using anti-anxiety medications, such as benzodiazepines, or through cognitive-behavior therapy.  A major depressive episode is characterized by feeling helpless, hopeless, and worthless, and keeps an individual from functioning normally.  There are numerous possible causes of depression, including substance abuse, certain medications, a traumatic event, serious illness, or simply genetics.  Treatments for depression include psychotherapy, electric shock treatment, cognitive-behavioral therapy, and a variety of medications, such as selective serotonin reuptake inhibitors (SSRIs) like Prozac or Zoloft, serotonin and norepinephrine reuptake inhibitors (SNRIs) like Cymbalta or Effexor, tricyclic antidepressants like Elavil and Tofranil, and monoamine oxidase inhibitors (MAOIs) like Nardil and Parnate. 

I think that aside from the possible non-24-hour circadian rhythm syndrome, stress, anxiety, and depression all contribute to my insomnia.  To help combat these problems, I go to a therapist, and take Cymbalta in the morning and Xanax (a benzodiazepine) at night.  I hope that as the years go on, better sleeping pills and other insomnia treatments will be developed.

Depression:  Overview & Facts.  (2010).  WebMD.   Retrieved December 9, 2010, from

Generalized Anxiety Disorder.  (2010, December).  National Institute of Mental Health.  Retrieved December 9, 2010, from

Natarajan, R. (2010). Review of periodic limb movement and restless leg syndrome. Journal of Postgraduate Medicine.  Volume 56, Number 2.  Retrieved December 9, 2010, from Academic Search Complete database.

Sleep Apnea: What Is Sleep Apnea?  NHLBI: Health Information for the Public.  (2010, August). Retrieved December 8, 2010, from

Image retrieved December 8, 2010, from

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