By Cristina Mestre
In a new paper published today in the Journal of the American Medical
Association, Dr. Buysse reviews the assessment, diagnosis, and treatment of
insomnia in adults. Here he answers
some common questions about insomnia:
Q: What does it actually mean to have insomnia?
is characterized by difficulty initiating or maintaining sleep, often in
conjunction with fatigue or irritability during wakefulness. Sleep difficulty also occurs despite adequate
opportunities and conditions for sleep.
This differs from sleep deprivation, where adequate circumstances for
sleep are lacking (your upstairs neighbor is having a loud party, or you’re
staying up all night cramming for a test). While 35 to 50 percent of us have an
occasional bout of insomnia, 10 to 20 percent of us have chronic insomnia.
Q: How does a lack of sleep affect our bodies?
A: Insomnia is a risk factor for conditions such as coronary
heart disease and depression. It can
also interfere with social and work function, reduce productivity, increase
risk for other medical and mental health disorders, and increase health care
Q: Are there any risk factors for insomnia?
A: There are a few factors that will make you more likely to
have insomnia: female sex, older age, lower socioeconomic status, concurrent
medical and mental disorders, marital status (greater risk in
divorced/separated versus married or never married individuals), family history
of insomnia, and race (greater risk in African Americans than in Caucasians). Medical, environmental, and psychosocial
stressors can also initiate a pattern of poor sleep. Additionally, certain behaviors, thoughts and
beliefs about sleep can be factors for insomnia disorders.
Q: What treatment is best for those with insomnia?
A: A careful history of sleep behaviors, medical, and
psychiatric symptoms can often reveal clues for insomnia treatment. Effective behavioral (non-drug) treatments
are preferable, though medication treatments are also available. Hypnotic medications can also be effective
but need to be monitored closely. Finding
the best treatment depends on a patient’s specific symptoms, preferences and
doctor’s recommendations. So, talk to
Q: What is your advice for better sleep?
A: Contrary to what we might think, it’s actually best to
spend less time in bed if you can’t sleep.
Most people with insomnia benefit from “compressing” their sleep by
reducing the amount of time they spend in bed. This leads to quicker sleep
onset, and deeper, more continuous sleep. Similarly, if you wake up and don’t
fall back to sleep, get out of bed and do something else such as light reading,
and only go back to bed when you start to feel sleepy. Finally, keep a regular
wake-up time, no matter how much you slept the night before. A regular wake-up
time helps to set the body’s biological clock, and ensures you’ll be sleepy
enough to fall asleep the following night.