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Sleep Disorders

I Can`t Fall Asleep or Stay Asleep..

03/03/2009

Question:

Hello. I am 18 years old and I am having a very difficult time sleeping. There are a few things that I can think of that are contributing to this- one is in December my best friend died in a car accident. That is when I started having the problems sleeping. The second is I have been having heart palpitations for over a year now. I have been to the cardiologist for this and he said it is nothing to be worried about, but he suggested that I stop taking the sleep medicine I was taking. The medicine wasn`t helping me stay asleep, but it would help me fall asleep faster. I usually will go lay in bed at 10 or 11ish but never fall asleep until after 3. Once I fall asleep I wake up 2-4 times so I only get an average of 2 hours of sleep a night. I am tired all the time and feel like I am getting sick.. I have tried exercise before bed, warm milk, reading, and many other things, but none of it seems to work. Any suggestion?

Answer:

This sounds like it is very frustrating for you and you are smart to seek help. Insomnia is a very common in modern society with an estimated 1/3 of Americans suffering from insomnia at any one point in time. Fortunately, the majority of cases are short-term and resolve within weeks, rarely requiring prolonged therapy. However, up to 20 million Americans complain of problems with chronic insomnia that may significantly effects their life, so you are not alone.

Insomnia has multiple underlying causes. Identifying the underlying factors that are contributing to insomnia is extremely important to ensure appropriate treatment. Insomnia can usually be divided into two broad categories: trouble falling asleep at the start of the night (also known as sleep onset insomnia) and difficulty staying asleep during the night (also known as sleep maintenance insomnia). Some individuals may experience problems with both.

Factors affecting one’s ability to fall asleep at the start of the night, as you describe, are quite varied and may include one or more of the following; a poor sleep environment (i.e. the bedroom is too noisy, too bright or too warm), learned poor sleep habits (i.e. watching TV to fall asleep), excessive use of stimulants (both medications and common substances such as caffeine and nicotine), certain medications, stress or anxiety, pain, medical conditions that may make it uncomfortable or difficult to breath well when lying down, heartburn, restless legs syndrome (an irresistible need to move the legs when awake at night) and circadian rhythm disturbances (when the body’s biologic rhythms are out of synchrony or delayed). Occasionally some individuals will not have any of these underlying causes contributing to their insomnia and their condition is often labeled as “idiopathic insomnia” or insomnia for which a cause can not be found.

As you can see, insomnia is a complex problem with many potential underlying causes (and often more than one is present). However, in your case, I would be most concerned about the recent traumatic experience you had (death of your best friend) as your insomnia started after this. It’s important to get this sorted out soon since, if not addressed appropriately, the insomnia could be a long-term problem

In general terms, the approach to managing insomnia is 2 fold. One is with medication and the other is with behavioral changes. In your specific case, I think it would be very important to consider medications in the short-term as well as getting involved with some grief counseling. Coming to terms with the recent traumatic event is very important to helping you sleep better.

If you find there are also some sleep hygiene or behavioral issues impacting your sleep, there are some other general measures you can take. These include such things as making sure the bedroom is used for sleep only (sexual activity is an exception), avoiding lying in bed for hours, avoiding reading in bed / watching TV in bed / playing on the computer, and avoiding watching the clock. We want the bedroom to be associated with rapid sleep and in order to do that, you should use the bed for sleep only. If one wants to watch TV or read before sleep, do that in a different room and only go to the bedroom once ready to sleep. You should also go to bed only when sleepy not just tired. Some insomniacs go to bed because it they feel it is bedtime or they feel they should sleep but they are not actually sleepy.

Practicing good sleep hygiene is important to any case of insomnia and you should make sure you are doing this. However, as mentioned above, it would be a good idea for you to seek help from a physician who can prescribe an appropriate sleep aid for you and refer you for counseling.

The heart palpitations are not likely connected to your insomnia and probably do not play a role other than maybe inducing some anxiety about it. However, if your Cardiologist feels they are not significant, then I would not be concerned about these.

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Response by:

Meena S Khan, MD Meena S Khan, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
Clinical Assistant Professor of Neurology
College of Medicine
The Ohio State University