Sleepless in Seattle, Duluth, Toronto and Rome — Insomnia, and What You Can Do About It

 By Bob Aronson

Normally I hope my blogs are interesting enough to keep people engaged and awake while reading them.  In this case if you get sleepy, go with it because chances are that if you are reading this you are an insomniac.

I can fall asleep at the drop of a hat.  I wake up shortly after it has fallen.  Insomnia or the inability to sleep normally is a terrible malady and one which affects millions of people, especially transplant patients both pre and post surgery.  Often insomnia is the result of the drugs we take – but not always.

It’s always good to start with a definition of terms.  Exactly what is insomnia?  Well, I’m going to offer a couple of sources.  First the National Sleep foundation says there are at least five ways to describe insomnia: http://tinyurl.com/n8mjwsu

1. Acute insomnia is a brief episode of difficulty sleeping usually caused by a life event, such as a stressful change in a person’s job, receiving bad news, or travel. Often acute insomnia resolves without any treatment.
2. Chronic insomnia is a long-term pattern of difficulty sleeping. It is usually considered chronic if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer. Some people with chronic insomnia have a long-standing history of difficulty sleeping. Chronic insomnia has many causes.
3. Comorbid insomnia is insomnia that occurs with another condition. Psychiatric symptoms — such as anxiety and depression — are known to be associated with changes in sleep. Certain medical conditions can either cause insomnia or make a person uncomfortable at night (as in the case of arthritis or back pain, which may make it hard to sleep.
4. Onset insomnia is difficulty falling asleep at the beginning of the night.
5. Maintenance insomnia is the inability to stay asleep. People with maintenance insomnia wake up during the night and have difficulty returning to sleep.

The American Academy of Sleep Medicine elaborates even more.  They say there are the following kinds of insomnia. http://tinyurl.com/lus3682

1. General insomnia

A classification of sleep disorders in which a person has trouble falling asleep, staying asleep, or waking up too early. These disorders may also be defined by an overall poor quality of sleep.

2. Adjustment insomnia

This disorder, also called acute insomnia or short-term insomnia, disturbs your sleep and usually stems from stress. The sleep problem ends when the source of stress is gone or when you adapt to the stress. The stress does not always come from a negative experience. Something positive can make you too excited to sleep well.

3. Behavioral insomnia of childhood

This condition occurs when children don’t go to bed on time unless a parent or guardian enforces a bedtime. If the children are made to go to bed at a specified time, then they tend to fall asleep at a normal hour. If they are not given strict bedtimes, then they may linger awake for hours at night.

4. Idiopathic insomnia

Idiopathic insomnia is a lifelong sleep disorder that starts during infancy or childhood and continues into adulthood. This insomnia cannot be explained by other causes. It is not a result of any of the following other sleep disorders.

• Medical problems
• Psychiatric disorders
• Stressful events
• Medication use
• Other behaviors

It may result from an imbalance in your body, such as an overactive awakening system       and/or an underactive sleep system, but the true cause of this disorder is still unclear.

5. Insomnia due to a drug or substance

This type of insomnia is directly related to the use of any of the following substances:

• Medication
• Caffeine
• Alcohol
• A food item

Your sleep is disrupted by your use of the substance. This type of sleep problem may also   occur when you stop using a substance

6. Insomnia due to a medical condition. 

This insomnia is caused by a mental health disorder. The insomnia is a symptom of the   disorder. The course and severity of insomnia are directly linked to that of the mental health disorder, but the insomnia is a separate focus of treatment. This insomnia is a disorder only if it is severe enough to require separate treatment.

7. Insomnia nonorganic, unspecified. 

This type of insomnia suggests that known substances and other physical causes of  the insomnia have been ruled out. This means that the cause of insomnia is most likely due to an underlying mental health disorder, psychological factor, or sleep disruptive behaviors.

The name may also be used on a temporary basis while further evaluation and testing are completed. It is the name used when a person with insomnia does not meet the criteria for another type of insomnia.

8. Insomnia organic, unspecified. 

This type of insomnia is caused by a medical disorder, physical condition, or substance exposure. But the specific cause remains unclear. Further testing is required to discover the exact cause. The name may be used on a temporary basis while further evaluation and testing are completed.

9.  Paradoxical insomnia is a complaint of severe insomnia. It occurs without objective evidence of any sleep disturbance. Daytime effects vary in severity, but they tend to be far less severe than one would expect given the expressed sleep complaints.People with this disorder often report little or no sleep for one or more nights. They also describe having an intense awareness of the external environment or internal processes consistent with being awake. This awareness suggests a state of hyperarousal. A key feature is an overestimation of the time it takes them to fall asleep. They also underestimate their total sleep time.10.
10. Psychophysiological insomnia.

This insomnia is associated with excessive worrying, specifically focused on not being able to sleep. The insomnia may begin suddenly following an event or develop slowly over many years.

People with this sleep disorder worry too much about their insomnia and about being tired the next day. As a result, they learn to become tense and anxious as bedtime approaches. They may have racing thoughts that all relate to insomnia and trying to fall asleep. As they worry about falling asleep, they become more and more tense, which makes it less likely that they will be able to fall asleep.

While all transplant patients may suffer from some form of insomnia,
research clearly indicates that those who have kidney transplants are much more likely to have sleep problems.  This eye opening  article will give you some insight and solutions as well. “The Kidney Transplant Side Effect That No One Tells Chronic Kidney Disease Patients About”

December 07, 2013 Kidney Buzz http://tinyurl.com/m5bmhky

 And, there’s a lot more about kidney disease and sleep which can cause major health complications and even increase the risk of death.

Recommended Reading: Sleep Disorders are common in Individuals with Kidney Disease on Dialysis

A study published in Biomedcentral Nephrology Journal found that the most frequent sleep problem among people with a Kidney Transplant was difficulty staying asleep (49.4%), followed by problems falling asleep (32.1%). 62.9% of transplant patients had to wake up to urinate which was the most common sleep disturbance, and caused 27% of transplant recipients to have reduced daytime functionality.

Recommended Reading: Chronic Kidney Disease Patients Do Not Have To Suffer Sleep Loss

Another study first reported by Science Nordic and later published in the Journal of Sleep Research, further confirms that insomnia is linked with a wide range of health problems including higher risk for anxiety, depression, fibromyalgia (chronic widespread pain), whiplash, rheumatoid arthritis, arthrosis

(an age-related cartilage degeneration condition), severe headache, asthma, heart attack and osteoporosis. Researchers also found a less strong association between insomnia and obesity, hypertension and stroke.

Recommended Reading: The Natural Way For Chronic Kidney Disease Patients To Get A Good Night’s Sleep

 

Solutions….How to Get Some Sleep

“Ok,” you say, “That’s good, now what do I do about it?  How can I get a good  night’s sleep?”  And…that’s the $64 or $64,000 or $64,000,000 question depending on the era in which you grew up.  There are a lot of answers to that question and none of them work for everyone.   So let’s start with some advice from the National Institutes for Health NIH) http://tinyurl.com/mo6v483

How Is Insomnia Treated?

http://tinyurl.com/lyvl5or

Lifestyle changes often can help relieve acute (short-term) insomnia. These changes might make it easier to fall asleep and stay asleep.

Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it’s important to treat the underlying cause (if possible).

Lifestyle Changes

If you have insomnia, avoid substances that make it worse, such as:

• Caffeine, tobacco, and other stimulants. The effects of these substances can last as long as 8 hours.
• Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk with your doctor about which medicines won’t disrupt your sleep.
• Alcohol. An alcoholic drink before bedtime might make it easier for you to fall asleep. However, alcohol triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.

Try to adopt bedtime habits that make it easier to fall asleep and stay asleep. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath.

Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don’t eat heavy meals or drink a lot before bedtime.

Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet.

Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.

Cognitive-Behavioral Therapy

CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.

For example, relaxation techniques and biofeedback are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.

CBT also aims to replace sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable time.

CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.

CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you’re usually asleep.

This schedule might make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.

For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.

For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.

Prescription Medicines

Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.  There are so many drugs that can be prescribed we are not even going to attempt to list them.  Just know that your primary care physician or, better yet, your sleep specialist has a huge armory of drugs from which to draw, but they’ll want a “history” from you before they even begin to suggest remedies..  And…remember, those remedies may not be medicinal.

Talk to your doctor about the benefits and side effects of insomnia medicines. For example, insomnia medicines can help you fall asleep, but you may feel groggy in the morning after taking them.

Rare side effects of these medicines include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn’t work well, tell your doctor. He or she might prescribe a different medicine.  Also, if you are either pre or post transplant, tell the physician who’s treating you for sleep.  Some medications may not mix well with those you are taking for your condition.   And…as a precaution, never take any medication before you personally check with your transplant team.

Some insomnia medicines can be habit forming. Ask your doctor about the benefits and risks of insomnia medicines.

Over-the-Counter Products

Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.

The Food and Drug Administration doesn’t regulate “natural” products and some food supplements. Thus, the dose and purity of these substances can vary. How well these products work and how safe they are isn’t well understood.

Some OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them.

Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products will benefit you.

At the risk of sounding overly cautious you should take the same precautions with Over the Counter Drugs as you would with prescriptions.  Talk to your transplant team before you take anything.

Other quick tips

At night.

• Use the bed and bedroom for sleep and sex only
• Establish a regular bedtime routine and a regular sleep-wake schedule
• Do not eat or drink too much close to bedtime
• Create a sleep-promoting environment that is dark, cool and comfortable

• Avoid disturbing noises – consider a bedside fan or white-noise machine to block out disturbing sounds

During the day:

• Consume less or no caffeine, particularly late in the day
• Avoid alcohol and nicotine, especially close to bedtime
• Exercise, but not within three hours before bedtime
• Avoid naps, particularly in the late afternoon or evening
• Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor
• The prevalence of insomnia is higher among older people and women. Women suffer loss of sleep in connection with menstruation, pregnancy, and menopause. Rates of insomnia increase as a function of age but most often the sleep disturbance is attributable to some other medical condition.
• Some medications can lead to insomnia, including those taken for:

o   colds and allergies

o   high blood pressure

o   heart disease

o   thyroid disease

o   birth control

o   asthma

o   pain medications

o   depression (especially SSRI antidepressants)

• Some common sleep disorders such as restless legs syndrome and sleep apnea can also lead to insomnia.
• Sleep is as essential as diet and exercise. Inadequate sleep can result in fatigue, depression, concentration problems, illness and injury.

National Institutes of Health- (NIH) supported research is shedding light on how sleep and lack of sleep affect the human body. The NIH and its partners will continue to work together to advance sleep research. Read the full fact sheet…

Insomnia Clinical Trials  Clinical trials are research studies that explore whether a medical strategy, treatment, or device is safe and effective for humans. To find clinical trials that are currently underway for Insomnia, visitwww.clinicaltrials.gov.

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Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 4,000 member Organ Transplant Initiative (OTI) and the author of most of these donation/transplantation blogs. You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.