By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER'S INSOMNIA MIGHT BE DUE TO DEPRESSION OR OTHER DISEASE

Question: I have trouble sleeping at night. I get to sleep easily, but I wake up in the middle of the night and can't get back to sleep. This has been going on for a couple of months now. It doesn't happen every night, but it happens more nights than not. What is causing this and what can I do about it?

Answer: It sounds like you have insomnia. From a medical standpoint, insomnia is a rather broad term that covers both difficulty in initiating sleep and in maintaining sleep. Specifically, a person with insomnia frequently suffers from at least one of the following: trouble falling asleep, difficulty getting back to sleep after waking up during the night or too early in the morning, and un-refreshing sleep.

Insomnia can be either primary or secondary. Primary insomnia is not caused by any other health problem or condition. Secondary insomnia is caused some other factor. This might include health conditions such as emphysema, a bout with poison ivy or clinical depression. It could also be as a result of the treatment for another health condition; a common example of this is a medication that has insomnia as a side effect. Or, secondary insomnia can be simply the result of some bad habit like drinking too many caffeinate beverages, consuming too much alcohol, or exercising too close to bedtime.

Acute insomnia -- which lasts less than three weeks -- is often the result of current "life situations." In these cases the insomnia usually goes away by itself when the stressful situation is resolved. If it lasts longer than that or comes and goes over a long period of time, you may have chronic insomnia. This can be a symptom of depression or can be related to another health condition like menopause.

You need to see you doctor, but in the meantime here are a few self-help measures you can try:

Avoid caffeine and nicotine -- they are stimulants and can keep you awake;
Avoid alcohol -- it might help you fall asleep, but it can wake you up in the middle of the night;
Give yourself at least three hours between exercise and bedtime;
Try to go to sleep and wake up at the same time every day -- even on the weekend; and
If you aren't able to sleep after a reasonable length of time, get out of bed until you begin to feel drowsy.
It's also important to create a good sleep environment. This means not only a comfortable mattress and pillow but also a cool temperature, a relatively dark room and a lack of distracting noise. Some noise -- like the sound of raindrops, ocean surf, or so-called "white noise" -- can help induce sleep. Machines that simulate these sounds are available.

You need to see your doctor to find out if an underlying medical condition is causing your insomnia. One of the first things that he or she will want to consider is the possibility that your are depressed. If so, successful treatment of the depression -- often with medication -- will resolve the insomnia. If you aren't depressed, there are other drugs that can be used to help you sleep, but most aren't good for long-term use. If your doctor recommends behavioral therapy -- such things as relaxation techniques or reconditioning -- be patient. It may take up to a month before you see results.

Family Medicine(r) is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.