Can't Sleep? Why Insomnia Shouldn't Be Ignored

Video: Sleep Apnea

Your husband snores. Your kids are up half the night. You're worried about a big presentation at work. It's no surprise you have insomnia; the real shocker would be not feeling tired at the start of the day. A 2007 National Sleep Foundation survey found that nearly two thirds of women said they got a good night's sleep only a few nights a week; 29 percent took sleeping pills or other sleep aids regularly. Eighty percent said they don't slow down when they're tired. Most just prop their eyes open and get through the day. (This year, the economy may be making matters even worse. The sleep foundation's latest survey, released today, found that nearly a third of Americans are losing sleep because they're worried about the economic crisis and its implications for their personal finances.)

While soldiering on sleepily may be the only solution at times—new parenthood and sleep deprivation often go hand in hand, for instance—there are medical options and other ways to address many sleep problems. Unfortunately, you can't count on a primary-care doctor to know how to help. "You'll confront a bunch of doctors who either don't know about sleep problems or have an understanding that is antiquated," says Andrew Krystal, director of the sleep research lab and insomnia program at Duke University Medical School. Finding a knowledgeable provider is key, he says.

There's good reason not to ignore insomnia: It often signals other medical or psychiatric problems, particularly in women, and a savvy practitioner may diagnose and treat an underlying problem that would otherwise escape detection. Evidence also suggests that people who consistently get too little sleep may be at risk of heart disease, diabetes, and obesity. Women are about twice as likely as men to suffer from major depression during their lives, and it's nearly always accompanied by difficulty sleeping. Women also suffer from anxiety disorders more frequently than men, and lack of sleep can become a focus of anxiety. That can create a vicious cycle of sleeplessness and worry that leads to chronic insomnia, says Barbara Phillips, director of the sleep center at the University of Kentucky. Premenstrual dysphoric disorder, a severe form of premenstrual syndrome that afflicts up to 8 percent of women, brings sleepless nights for some as well.

Perhaps the most often missed medical condition that can cause insomnia in women is obstructive sleep apnea. OSA occurs when people stop breathing momentarily during sleep because their airway becomes blocked when muscles in the throat relax. They may briefly wake up dozens of times a night to breathe, though they generally won't realize it. A contributor to heart disease, sleep apnea has many causes, including anatomical problems in the jaw or throat, obesity, and muscle laxity, which increases with age. Before menopause, women are half as likely to have sleep apnea as men; once past that stage, the sexes get it in equal numbers. Declining levels of estrogen and progesterone may be partly to blame for the age-related jump. Research shows women who are using hormone replacement therapy are less likely to have it.

Doctors who are accustomed to diagnosing sleep apnea in men—in whom the most common symptom is snoring, not insomnia—may miss the signs in women. As a result, women with sleep apnea and insomnia are sometimes misdiagnosed as depressed when, in fact, they are not, says Meir Kryger, chairman of the National Sleep Foundation. In such cases, antidepressants are unlikely to improve symptoms of either sleep apnea or the accompanying insomnia, he says.

Treating an underlying condition won't necessarily cure a sleeping problem, even if that condition was the insomnia's original cause, researchers have learned. That's another reason experts stress the importance of seeking help. If you have sleeping difficulties for more than a month, consider seeing a doctor, preferably at a clinic that specializes in sleep disorders. (To find one in your area, you can go to sleepcenters.org.) A specialist may do a complete work-up and identify medical problems that have been keeping you from getting the restful shut-eye you need. If you turn out to have sleep apnea, a doctor may fit you with a device that delivers pressurized air through the nose and helps keep your airway open.

For other problems, a sleep specialist may work with you to change behaviors that can perpetuate insomnia. The practitioner may urge you to get out of bed whenever you're unable to sleep, for example, or may temporarily limit the number of hours you spend in bed to help you develop more consolidated, stable sleep patterns. He or she may prescribe sleeping pills as well. Both strategies work: Studies show that on average, 2 out of 3 people experience significant improvement in their sleep after either taking a sleep medication or being treated with cognitive behavior therapy, a form of talk therapy, says Duke psychologist Jack Edinger. The difference, of course, is that sleeping pills work only as long as you continue to take them. The benefits of behavioral change, on the other hand, can last a lifetime.

Additional reporting by Lindsay Lyon.

Clarified on 3/5/09: This is an updated version of a previously published story.