Insomnia

Photograph by Charlyce Davis

 

It’s only 2am….

You’re already awake…

… And your reading this blog thinking …I need to sleep tonight

So you lay there, wishing for sleep.

Then it’s 3am

Then it’s 4am.

As you finally drift off to sleep….your alarm goes off, letting you know your day is about to start, sleep or not..

Insomnia. Oh lovely blessing of long, endless nights. If your finishing an amazing novel you may not mind taking 2-3 hours to get to sleep. If your next day is demanding or high stakes such as a job interview, you need the rest.

Insomnia is a BIG topic in my clinic. My personal estimation is that nearly ⅓ of patients that I see suffer from insomnia. The prevalence of insomnia disorder is approximately 10-20%, with approximately 50% having a chronic course.¹

Insomnia is defined as trouble falling asleep, staying asleep, or getting up too early.

Sleep is frequently disrupted at some point in our lives. Most humans will experience sleep disruption from either a self imposed cause (due to schedule changes, wanting to be productive, socializing) or from an external cause (a new baby). While it’s not ideal, most of us will be okay with one or two nights of short sleep as long as we can get to bed within a few nights.

I have personally dealt with sleep issues. During my residency, overnight call in the hospital meant a few hours of sleep, and possibly no sleep at all. Later, after a stressful breakup I frequently found myself waking up hours earlier than I needed. I know the terrible brain fog patients speak of when you need to be at your best but you can’t be.

When most patients tell me about the insomnia they are suffering, they typically have had either insomnia one month of severely interrupted sleep, a chronic course of poor quality sleep, or a several years long history of frequent bouts of poor sleep.

Thanks to development of prescription sleep aids with great marketing material, including beautiful butterflies drifting you off to sleep,

Photograph by Charlyce Davis

 

most patient anticipate that once they tell the physician they can’t sleep, they will be prescribed a medication that will eliminate the problem. Many patients are surprised that once they discuss their insomnia with me, I’m likely not to write a prescription.

Why would I avoid writing a prescription for a real medical issue? Medical research has shown that the best treatment for insomnia is behavioral treatment. The ACP recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I), as the initial treatment for chronic insomnia disorder². Furthermore, “many medications used regularly and long term for insomnia disorders have an FDA indication only for short-term, as-needed use, in part because hypnotics are associated with dementia, fracture, major injuries, and possibly cancer.”³

One of my aims with this blog is to take an honest look at health. Insomnia is one of the topics that I feel somewhat hypocritical due to the pressures and time constraints of modern health practice. Patients present to me with insomnia, and for years, I treated their insomnia completely differently from how I treated my own insomnia. I’m so happy to have this venue to spend more time on this important topic.

Over the next several post, I’m going to cover the topic of insomnia in more detail. I’m hoping that my blog as well as other sources can start to shift the conversation from insomnia as a condition that requires a multicomponent solution. Thank you so much for visiting my blog, and please stop by soon on my next entry on insomnia.

1.   Buysse DJ.   Insomnia. JAMA. 2013 Feb 20;309(7):706-16. doi: 10.1001/jama.2013.193. Review.
2.  Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine,165(2), 125. doi:10.7326/m15-2175
3. Wilt, T. J. (n.d.). Pharmacologic Treatment of Insomnia Disorder. Annals of Internal Medicine.

Author: Charlyce Davis

I am an Internal Medicine physician with 10 years of practice experience. I have become a student of Reiki and I have also studied yoga.

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