Paul had trouble sleeping. "I spent hours watching reruns of 'The Avengers' or 'The Rockford Files.' Morning after morning, I'd wake up on the floor. Maybe I'd slept three hours. This went on for so long that eventually I didn't even bother with the bedroom anymore. I'd just pull a blanket over myself, grab a throw pillow from the couch and sack out in front of the TV set. It became the only way I could get any sleep at all. My wife was furious and told me I was avoiding her."
Paul is one of an estimated 65 million adults who suffer bouts of insomnia. But the problem runs far deeper than just a loss of needed sleep. Insomnia isn't a disease in and of itself. It's primarily a symptom, and consequently, treatment needs to be directed at whatever underlying condition has prompted it. For Paul and for millions of other Americans, that underlying condition is often depression.
According to a study published in the August 1999 issue of the journal Clinical Drug Investigation, about 32 percent of people seeking medical care for insomnia were diagnosed with depression. This finding comes as no surprise to David Neubauer, M.D., assistant professor of psychiatry and associate director of the Johns Hopkins Sleep Disorders Center. But it's a "which-came-first, the-chicken-or-the-egg" dilemma. "There's no question that insomnia by itself will lead to depression. But the opposite is also true. About 80 to 90 percent of depressed patients have insomnia," he says.
Either way, you can't get the relief you need unless you get a proper diagnosis. To do that, you need to see your doctor for an examination. Yet, the researchers found that fewer than 5 percent of people with difficulty sleeping actually seek care from their doctors. "They may think it's normal or are resigned to it, believing that nothing can be done about it," says Dr. Neubauer. "Or they may think it's just not very important, not like chest pain would be, for example, and therefore not worthy of bringing to their doctor's attention."
Big mistake. Relieve the depression and you most likely eliminate the insomnia. Today, doctors know that both depression and insomnia caused by depression can be treated with great success using a combination of counselling and antidepressant medicines such as Prozac, Zoloft, Paxil or Wellbutrin. There are even new and better medicines available to treat insomnia directly. Ambien and Sonata are very effective in promoting sleep and are not addictive. Both medications have fairly short duration of action, so they don't cause daytime sleepiness. Sonata's sedating effect is so short you can even take it in the middle of the night without waking up groggy the next morning, says Dr. Neubauer. However, these medicines usually need to be taken only as a temporary measure until the effects of the antidepressants kick in, in about two weeks, he says. Effective counselling can aid greatly in preventing a relapse and mitigating the social damage done to relationships during the state of depression.
Symptoms Of Insomnia
Not sure if your symptoms really qualify as insomnia? Here's what to look for:
* Experiencing a lack of refreshing sleep
* Having difficulty falling asleep
* Waking up frequently with trouble getting back asleep
* Waking up too early in the morning
* Having the above symptom(s) present on most nights
Symptoms Of Depression
To determine if your insomnia is caused by depression, your doctor will ask if you have some or all of the following symptoms:
* Persistent sad, anxious or "empty" mood
* Loss of interest or pleasure in activities, including sex
* Restlessness, irritability or excessive crying
* Feelings of guilt, worthlessness, helplessness, hopelessness or pessimism
* Sleeping too much or too little; early morning awakening
* Loss of appetite or weight; or overeating and weight gain
* Decreased energy, fatigue or feeling "slowed down"
* Thoughts of death or suicide; suicide attempts
* Difficulty concentrating, remembering or making decisions
* Persistent physical symptoms, such as headaches, digestive disorders or chronic pain, that do not respond to treatment
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(c) BER Fraser msw,csw. (1998) Reprint only with attribution and, if on-line, with appropriate link..