How much sleep do I need?
Most people average about 7-8 hours of sleep a night. But the amount of sleep needed to feel rested the next day varies from one person to the next. You might be able to function well on six hours of sleep, for instance, while someone else needs a full nine hours. Older people often sleep less at night than those who are younger. They usually make up for this with daytime naps.
What causes insomnia?
Insomnia can occur if your "biological clock" is disturbed, such as when you travel to another time zone or work different job shifts. Insomnia can also be a problem during times of stress. You may be worried about a personal relationship, money, or your job.
Some people with insomnia find it hard to fall asleep easily when they first go to bed at night. Others fall asleep easily but then awaken several times during the night and have trouble getting back to sleep. Still others sleep through the night but awaken much earlier than they planned in the morning and can't get back to sleep. Early morning awakening is commonly associated with "feeling low" or depression.
Medical problems can interfere with sleep. For example, if you accumulate fluid during the day (leg swelling), you will have to get up often during the night to urinate. Men with prostate problems often have fragmented sleep because of frequent urination during the night. People with lung problems often have trouble with shortness of breath at night interfering with their sleep. Many women experience hot flashes at night that interfere with sleep. Many medications can potentially interfere with sleep (like diuretics, asthma medicines, and some antidepressants).
Sometimes I wake up more tired than when I went to sleep. What causes this?
Some causes of nonrestful sleep are sleep apnea, noctumal myoclonus, and restless legs syndrome. Sleep apnea occurs when your air passages don't allow easy breathing. Snoring (typically so loud that it awakens others), morning headaches, and daytime sleepiness are common symptoms. Your sleep partner may tell you that you seem to gasp and stop breathing for 20-30 seconds at a time during the night.
Repeated leg jerks occurring during the night and preventing restful sleep are symptoms of nocturnal myoclonus. These motions may not wake you up.
In restless legs syndrome, you're likely to have a crawling or uncomfortable feeling in the legs and feet when trying to fall asleep. The feeling forces you to get up and walk around before you can fall asleep.
If you suspect that you have sleep apnea or nocturnal myoclonus, you may want to send you to a sleep disorders center for an overnight study to confirm the diagnosis. The simplest treatment for sleep apnea is weight loss and avoidance of alcohol (many people with sleep apnea are overweight).
What is the role of drugs in treating insomnia?
Generally, drugs are reserved for treating periods of insomnia lasting fewer than three weeks. I would not recommend long-term drug treatment unless I feel that depression is part of the problem. In some cases, however, a medicine like trazodone may be useful in longterm treatment of insomnia.
More recently, there has been a craze for melatonin, a hormone secreted by the pineal gland that helps to regular the sleep-wake cycle. So far there is no indication that melatonin is dangerous, even in large doses.
Would a nightcap help me sleep?
It's best to avoid alcohol before bedtime. Although it can make you feel relaxed and drowsy at first, you are likely to awaken during the night when its effects wear off. It is especially important to avoid alcohol if I prescribe a sleeping medication. Combining alcohol with most sleeping medications is extremely dangerous.