By Virginia Lester,
RN, MSN, ARNP

Insomnia occurs when a person has trouble falling and/or remaining asleep. Insomnia is not a disease, but rather a syndrome that is caused by poor or inadequate sleep. Insomnia is a very common problem. Approximately one-half of all adults in the U.S. report experiencing at least one symptom of insomnia a few nights per month or more in the past year. Approximately 10 percent of adults have a more persistent problem. Transient or short-term insomnia lasts one to three weeks and appears to resolve without intervention, while chronic insomnia lasts more than three weeks and may require some form of intervention.
Common symptoms of insomnia: Problems falling asleep or difficulty staying asleep or waking too early, feelings of fatigue, sleepiness; inability to concentrate, irritability, anxiety, depression or forgetfulness.

The main consequences of insomnia: Impaired cognitive functioning as in job performance and increased absenteeism; increased risk for accidents (two times the risk for automobile accidents); four-fold increase in new onset depression and other related psychiatric disorders.
There are many causes of insomnia, which varies from person to person. Transient or short-term causes include: Changes in sleeping environment, jet lag, work shift changes, excessive noise, room too warm, stress and recent illness, surgery or hospitalization. Chronic causes may include any of the above if they last for a long period of time and in addition: Chronic illness, pain and certain medications that act as stimulants, chronic use of alcohol, advanced ages, gender (women are more affected), movement and psychiatric disorders. Insomnia may often precede a diagnosis of a mental health problem.
Diagnosis of insomnia includes a detailed sleep history, medical history, personal habits, alcohol or drug consumption, pain and environment. Any physical or health problem must be carefully evaluated.

Information should include a sleep diary over a two to three week period that includes bedtimes, number of times up at night, number of naps and time of each, how long it takes to fall asleep and how rested or refreshed you feel in the morning. Cases that are difficult to diagnose may require sleep studies.

Initial treatment may consist of behavioral changes for improving sleep hygiene. The basic principles of sleep hygiene are: Establish a regular bedtime and regular wake-up time for every day of the week (do not deviate); use the bed only for sex and sleep; avoid eating or drinking too much before bedtime; avoid exercising vigorously, consuming alcohol and nicotine for three hours before bedtime; avoid napping especially late in the afternoon or evening; make sure bedroom is cool, dark and quiet. Relaxation and cognitive therapy have also been found to be helpful.

Yoga, meditation and relaxation tapes are also useful tools. Stimulus control therapy is based on the practice of sleep associated with the bedroom. If sleep does not occur in 20 minutes the person is to get up and perform a relaxing activity, until they feel sleepy. Then return to bed. If sleep does not occur, again get up and perform the same activity until sleep occurs. Cognitive behavior therapy helps people identify the feelings or behavior that prevent sleep and replace them with desirable thoughts, feelings and behavior. This technique often requires professional help to identify and correct.

These interventions require time and personal investment to be successful. The person must commit to life style changes and stick to them. Pharmacological interventions may be introduced if all of the above techniques have been attempted and failed. However, very few conditions actually require treatment with medication. Sweet dreams and don’t be caught sleepless in Point Roberts.

Also, don’t forget to have your Influenza vaccine immunization this year. We still have a few doses left at the clinic.

Medicare pharmacy information: Hoaglands Pharmacy has agreed to do a presentation on November 30 from 12:30 – 1:15 p.m. at the community center following the senior Wednesday lunch. I would urge any senior who must make a decision regarding their prescription coverage to attend this meeting.

This medicare option is extremely confusing and complicated and not the same for every person. Please try to attend.