Dreaming of a Good Night's Sleep

By Mark Mahowald, M.D.
(Jan. 5, 2003; Updated Oct. 20, 2005)

There are nearly 100 identified sleep disorders. The field of sleep medicine has virtually exploded since mid-1970s, when researchers began taking a closer look at the functions and effects of sleep. Among the top complaints is insomnia.

Insomnia is part of the human condition. Everybody has an occasional sleepless night. But between 20 and 30 percent of the adult population complain of insomnia that is frequent enough to be bothersome to them. Insomnia has many different causes, but almost all forms of insomnia can be diagnosed and treated.

People with insomnia have trouble sleeping. They can't fall asleep. Or they can't stay asleep. Or they sleep fitfully. When they wake up, they don't feel restored and refreshed. Insomnia has nothing to do with how much sleep you getsrather, it's about getting the amount of sleep you as an individual need to wake up feeling rested. Someone who only gets four hours of sleep a night, for example, but doesn't feel bad during the day doesn't have insomnia, he or she is just a short sleeper. Conversely, someone who may require 10 hours of sleep, but is getting only eight hours may have insomnia. Adults require between four and 10 hours of sleep, and the amount probably is genetically determined.

Perhaps the most common form of insomnia is called acute situational insomnia. People have a terrible time sleeping because of some environmental situation such as stress, bereavement, pain, or even medications. If untreated, it can develop into learned or conditioned insomnia. People with learned insomnia become convinced that if they don't get a good night's sleep, something bad is going to happen to them. So they have this compulsion to sleep. They think, lOh my God, I'm going to fail the test tomorrow if I don't get sufficient sleep.n So they try to force themselves to sleep. But the truth is, you can't make yourself fall asleep. The very act of trying to do so actually arouses you, making it more difficult to sleep. If this continues for three or four nights, people with learned insomnia begin worrying about being able sleep already in the afternoon or early evening. When they do go to bed, they have the expectation that they hope they will sleep rather than knowing they will sleep. The bed becomes associated with anxiety about sleeplessness, and the individual develops a conditioned response. The insomnia eventually takes on a life of its own, eclipsing the initial cause. 

It's important to recognize, however, that in the majority of cases, insomnia isn't caused by psychiatric or psychological problems. People with insomnia tend not to mention it to their physicians because they're afraid that they'll be told that it all in their head. But there are a vide variety of ways to treat insomnia.

If you think you're suffering from insomnia, make an appointment to see your primary care physician. If that doesn't lead to treatment or referral and you remain concerned, then you might choose to contact a sleep center directly. Sleepiness can be dangerous, leading to driving accidents and workplace injuries. If insomnia is keeping you from getting enough sleep, that's a problem.