Understanding Insomnia


What Is Insomnia?

Insomnia is a common condition in which you have trouble falling or staying asleep. This condition can range from mild to severe, depending on how often it occurs and for how long.

Chronic, or long-term, insomnia means having symptoms at least 3 nights per week for more than a month. Insomnia that lasts for less time is known as short-term or acute insomnia.

Some people who have insomnia may have trouble falling asleep. Other people may fall asleep easily but wake up too soon. Others may have trouble with both falling asleep and staying asleep.

As a result, insomnia may cause you to get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up. The condition also can cause excessive daytime sleepiness and a lack of energy. It can make you feel anxious, depressed, or irritable.

You may have trouble focusing on tasks, paying attention, learning, and remembering. This can prevent you from doing your best at work or school.

Insomnia also can cause other serious problems. For example, you may feel drowsy while driving, which could lead to an accident.

There are two types of insomnia. The most common type is called secondary or comorbid insomnia. This type of insomnia is a symptom or side effect of some other problem.

More than 8 out of 10 people who have insomnia are believed to have secondary insomnia. Certain medical conditions, medicines, sleep disorders, and substances can cause secondary insomnia.

In contrast, primary insomnia isn’t due to a medical problem, medicines, or other substances. It is its own disorder. A number of life changes can trigger primary insomnia, including long-lasting stress and emotional upset.

Secondary insomnia often resolves or improves without treatment if you can stop its cause—especially if you can correct the problem soon after it starts. For example, if caffeine is causing your insomnia, stopping or limiting your intake of the substance may cause your insomnia to go away.

Lifestyle changes, including better sleep habits, often help relieve acute insomnia. For chronic insomnia, your doctor may recommend a type of counseling called cognitive-behavioral therapy or medicines.
What Causes Insomnia?

There are two types of insomnia—secondary and primary. Secondary insomnia is the symptom or side effect of another problem. This type of insomnia often is a symptom of an emotional, neurological, or other medical or sleep disorder.

Emotional disorders that can cause insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer’s disease and Parkinson’s disease are examples of common neurological disorders that can cause insomnia.

A number of other conditions also can cause insomnia, such as:

* Conditions that cause chronic pain, such as arthritis and headache disorders,
* Conditions that make it hard to breathe, such as asthma and heart failure,
* An overactive thyroid,
* Gastrointestinal disorders, such as heartburn,
* Stroke,
* Sleep disorders, such as restless legs syndrome and sleep-related breathing problems, and
* Menopause and hot flashes

Secondary insomnia also may be a side effect of certain medicines. For example, certain asthma medicines, such as theophylline, and some allergy and cold medicines can cause insomnia. Beta blockers also may cause the condition. These medicines are used to treat heart conditions.

Commonly used substances also may cause insomnia. Examples include caffeine and other stimulants, tobacco or other nicotine products, and alcohol or other sedatives.

In contrast, primary insomnia isn’t a symptom or side effect of another medical condition or substance. This type of insomnia usually occurs for periods of at least 1 month.

A number of life changes can trigger primary insomnia. It may be due to major or long-lasting stress or emotional upset. Travel or other factors, such as work schedules that disrupt your sleep routine, also may trigger primary insomnia.

Even if these issues are resolved, the insomnia may not go away. Trouble sleeping may persist because of habits formed to deal with the lack of sleep. These habits may include taking naps, worrying about sleep, and going to bed early.

Researchers continue to try to find out whether some people are born with a greater chance of having primary insomnia.
Who Is At Risk for Insomnia?

Insomnia is a common disorder. One in 3 adults has insomnia sometimes. One in 10 adults has chronic insomnia.

Insomnia affects women more often than men. The condition can occur at any age, but older adults are more likely to have insomnia than younger people.

People who may be at higher risk for insomnia include those who:

* Have a lot of stress,
* Are depressed or who have other emotional distress, such as divorce or death of a spouse,
* Have lower incomes,
* Work at night or have frequent major shifts in their work hours,
* Travel long distances with time changes,
* Have certain medical conditions or sleep disorders that can disrupt sleep, or
* Have an inactive lifestyle.

Young and middle-aged African Americans also may be at increased risk for insomnia. Research shows that, compared to Whites, it takes African Americans longer to fall asleep. They also have lighter sleep, don’t sleep as well, and take more naps. Sleep-related breathing problems also are more common among African Americans.
What Are the Signs and Symptoms of Insomnia?

The main symptom of insomnia is trouble falling and/or staying asleep, which leads to lack of sleep. If you have insomnia, you may:

* Lie awake for a long time before you fall asleep,
* Sleep for only short periods,
* Be awake for much of the night,
* Feel as if you haven’t slept at all, and/or
* Wake up too early.

The lack of sleep also can cause other symptoms. You may wake up feeling tired or not well-rested, and you may feel tired during the day. You also may have trouble focusing on tasks and feel anxious, depressed, or irritable.

Insomnia may affect your daily activities and cause serious problems. For example, you may feel drowsy while driving. Driving while sleepy leads to more than 100,000 car crashes each year. In older women, research shows that insomnia raises the risk of falling.

If insomnia is affecting your daily activities, see your doctor. Treatment may help you avoid symptoms and problems related to the condition. Also, poor sleep may be a sign of other health problems. Finding and treating those problems could improve both your health and your sleep.
How Is Insomnia Diagnosed?

Usually, your doctor will diagnose insomnia based on your medical and sleep histories and a physical exam. He or she also may recommend a sleep study. For example, you may have a sleep study if the cause of your insomnia is unclear.

To find out what’s causing your insomnia, your doctor may ask whether you:

* Have any new or ongoing health problems,
* Have painful injuries or health conditions, such as arthritis,
* Take any medicines, either over-the-counter or prescription,
* Have symptoms or a history of depression, anxiety, or psychosis, or
* Are coping with any very stressful life events, such as divorce or death.

Your doctor also may ask questions about your work and leisure habits. For example, he or she may ask about your work and exercise routines; your use of caffeine, tobacco, and alcohol; and your long-distance travel history. Your answers may give clues about what’s causing your insomnia.

Your doctor also may ask whether you have any new or ongoing work or personal problems or other stresses in your life. Also, he or she may ask whether you have other family members who have sleep problems.

To get a better sense of your sleep problem, your doctor also will ask you details about your sleep habits. Before your visit, think about how to describe your problems, including:

* How often you have trouble sleeping and how long you’ve had the problem,
* When you go to bed and get up on workdays and days off,
* How long it takes you to fall asleep, how often you wake up at night, and how long it takes to fall back asleep,
* Whether you snore loudly and often or wake up gasping or feeling out of breath,
* How refreshed you feel when you wake up, and how tired you feel during the day, and
* How often you doze off or have trouble staying awake during routine tasks, especially driving.

To find out what’s causing or worsening your insomnia, your doctor also may ask you:

* Whether you worry about falling asleep, staying asleep, or getting enough sleep,
* What you eat or drink, and whether you take medicines before going to bed,
* What routine you follow before going to bed,
* What the noise level, lighting, and temperature are like where you sleep, and
* What distractions, such as a TV or computer, are in your bedroom.

To help your doctor, consider keeping a sleep diary for 1 or 2 weeks. Write down when you go to sleep, wake up, and take naps. For example, you might note: Went to bed at 10 a.m.; woke up at 3 a.m. and couldn’t fall back asleep; napped after work for 2 hours.

Also write down how much you sleep each night, as well as how sleepy you feel at various times during the day.

You can find a sample sleep diary in the National Heart, Lung, and Blood Institute’s “Your Guide to Healthy Sleep,” which you can find on the NHLBI Web site at www.nhlbi.nih.gov.

In addition to taking detailed medical and sleep histories, your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You also may need blood tests to check for thyroid problems or other conditions that can cause sleep problems.

Your doctor may recommend a sleep study called a polysomnogram, or PSG, if he or she thinks an underlying sleep disorder is causing your insomnia.

A PSG usually is done while you stay overnight at a sleep center. A PSG records brain electrical activity, eye movements, heart rate, breathing, muscle activity, blood pressure, and blood oxygen levels.
How Is Insomnia Treated?

Lifestyle changes often can help relieve acute, or short-term, insomnia. These changes may make it easier to fall asleep and stay asleep.

If you have insomnia, avoid substances that make it worse, such as caffeine, tobacco, and other stimulants taken too close to bedtime. Their effects can last as long as 8 hours.

Certain over-the-counter and prescription medicines, such as some cold and allergy medicines, can disrupt sleep. Talk to your doctor about which medicines won’t disrupt your sleep.

Although an alcoholic drink before bedtime may make it easier for you to fall asleep, alcohol triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.

Try to adopt good bedtime habits that make it easier to fall asleep and stay asleep. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath.

Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don’t eat heavy meals or drink a lot before bedtime.

Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure your bedroom is dark and quiet and the temperature is cool and comfortable.

Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.

If you have chronic, or ongoing, insomnia, a type of counseling called cognitive-behavioral therapy, or CBT, can help relieve the anxiety linked to this condition.

CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.

For example, relaxation training and biofeedback at bedtime are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.

CBT also works on replacing sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable time.

CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.

CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you’re usually asleep.

This schedule may make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.

For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.

For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.

Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it’s important to treat the underlying cause, if possible. Your doctor also may prescribe medicine to help treat your insomnia.

Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.

Talk to your doctor about the benefits and side effects of insomnia medicines. For instance, insomnia medicines can help you fall asleep, but some people may feel groggy in the morning after taking them.

Rare side effects may include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn’t work well, tell your doctor. He or she may prescribe a different medicine.

Some insomnia medicines may be habit forming. Talk to your doctor about the benefits and risks of insomnia medicines.

Some over-the-counter products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.

The Food and Drug Administration doesn’t regulate “natural” products and some food supplements. Thus, the dose and purity of these products can vary. How well these products work and how safe they are isn’t well understood.

Some over-the-counter products that contain antihistamines are marketed as sleep aids. Although these products may make you sleepy, talk to your doctor before taking them.

Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products can benefit you.

WatchPAT™ Spearheads Breakthrough Of At-Home Testing For Sufferers Of Sleep Apnea


At Home Sleep Apnea Test

It is estimated that over 28 million Americans suffer from obstructive sleep apnea (OSA), with approximately 20 million more going undiagnosed and untreated. The health-related cost burden for undiagnosed OSA in the United States a dangerous condition that can lead to a variety of heart ailments, stroke, and death is estimated at $3.4 billion.

The latest figures compiled by Frost & Sullivan in 2008 show revenues in the U.S. sleep apnea diagnostic and therapeutic market totaling approximately $1.35 billion, with a 16.2% growth rate.

WatchPAT, produced by medical device manufacturer Itamar-Medical, Ltd., is the industry leader for at-home OSA testing. WatchPAT is approved, available for all physicians as a diagnostic tool, and is poised to continue market domination once the CPT (Current Procedural Terminology) code for at-home diagnosis goes into effect January 1, 2011.

“With the new CPT code going into effect, millions of Americans suffering from sleep apnea can now benefit from easy, low cost access to in-home sleep testing using our WatchPAT device,” notes Dr. Dov Rubin, President and CEO of Itamar-Medical. “Patients can now take the test in the comfort of their own bed, affording them timely diagnosis and treatment for sleep apnea, which is linked to other ailments such as heart disease, hypertension, and obesity.”

Rubin also adds, “Internists, cardiologists, and family physicians can now order the tests and get reimbursed. Using Itamar-Medical’s WatchPORTAL technology, physicians can download the information instantaneously at no extra charge and obtain a diagnosis in consultation with a local sleep physician or via Itamar’s nationwide network of experts, with results wirelessly delivered back to a smartphone.”

WatchPAT sleep tests outnumber the nearest competitor by 5:1, making it by far the most used at-home sleep apnea testing device of its kind. While sleep lab PSG (polysomnography) testing has been the standard of care for OSA diagnosis, it is anticipated that many labs will also be offering home testing in order to expand their services. In a July 2010 Wells Fargo Securities survey of national sleep centers, analysts reported that 21% of sleep centers currently offer home sleep testing for Medicare patients and 23% offer home testing for privately insured patients, both 20% jumps from a previous survey.

Additionally, another 29% of sleep centers plan to offer home tests in the next six months, a 19% increase since their previous survey. Moreover, 38% of the respondents indicated that they plan to increase involvement in home testing, up from 32% from the prior survey.

Govt. warns about baby sleep positioners


U.S. Govt. (FDA and Consumer Product Safety Commission) warns about baby sleep positioners

ABC is reporting that Baby sleep positioners — mats with barriers to prevent a baby from rolling over — carry a risk of suffocation and death, and should not be used under any circumstances, the FDA and Consumer Product Safety Commission (CPSC) warned.

The advisory was prompted by reports of 12 deaths among infants from 1 to 4 months of age received by the CPSC over the past 13 years, in addition to dozens of additional nonfatal cases in which babies awoke in unsafe positions after being placed in a sleep positioner.

Parents are being urged to stop using infant crib positioners


News reports reflect that U.S. federal government is urging parents to stop using “crib positioners” designed to protect babies from Sudden Infant Death Syndrome, or SIDS.

Doctors say babies should sleep on their back, which is what infant sleep positioners cushions claim to help do.

SIDS expert Dr. Henry Krous says those devices do not actually keep a baby safer while sleeping.

“To the contrary, they look like something that the baby could roll over and then the baby could get itself in a dangerous position,” he explains.

That’s exactly what the warning from the FDA and Consumer Product Safety Commission tells parents.

It was issued in the wake of the deaths of a dozen infants over a 13 year span, and many more complaints.

The warning says: “Using a positioner to hold an infant on his or her back or side for sleep is dangerous and unnecessary” and “To date, there is no scientifically sound evidence that infant sleep positioners prevent SIDS.”

“It’s a pity that they don’t get tested in some real way. And I am sure these are not the last ones. I can’t imagine that new ones won’t be designed and put on the market in the future,” says Dr. Krous.

He says babies should sleep on their back, on a firm surface without any overstuffed materials.

The best advice, he says, is the easiest to follow.

“The simple thing is don’t use the devices at all. That’s the safest thing. It’s the cheapest thing, and it’s the most effective thing.”

There’s no recall now, but FDA officials say we should expect one in the future.

Somaxon lands big partner for launch of new sleep drug


Somaxon lands big partner for launch of new sleep drug Says UNION-TRIBUNE

Somaxon’s efforts to launch its new insomnia drug received a big boost Wednesday when consumer products giant Procter & Gamble said it would help the San Diego company sell Silenor to thousands of U.S. doctors and pharmacies.

Shares of Somaxon, which jumped nearly 60 percent in early trading, finished the day up 97 cents, or 29 percent, at $4.34.

Somaxon and Procter & Gamble plan to begin marketing the treatment in September.

The tiny biotechnology firm headquartered in the Torrey Hills area of San Diego won approval in March from the Food and Drug Administration to sell its histamine-blocking drug as a sleep aid.

Somaxon executives and investors believe the new treatment will do well in the highly competitive sleeping pill arena because it’s designed to help people stay asleep — as opposed to falling asleep initially — which could give it a niche.

A combined sales force of 215 representatives will target 35,000 physicians who prescribe about 40 percent of all insomnia medications and 25,000 pharmacies, the companies said.

“This represents a doubling of our call-on universe of high prescribing physicians, which we believe positions us well for the early uptake of Silenor in the market,” Somaxon Senior Vice President and Chief Commercial Officer Jeffrey Raser told stock analysts during a conference call following the announcement.

Procter & Gamble will focus on marketing the drug to primary care physicians and drugstores, while Somaxon mainly will handle specialists who treat sleep disorders.

The Cincinnati-based company will receive fixed fees for the work and royalties based on U.S. sales of the drug under the agreement, which expires on Dec. 31, 2012 but includes a renewal option.

Procter & Gamble’s payout from the agreement should be limited to no more than 15 percent of net U.S. sales revenue from Silenor, said Richard Pascoe, president and chief executive of Somaxon.

“We retain essentially the lion’s share of the economics,” he said during the conference call. “This is the best possible outcome for Somaxon.”

The deal also places Procter & Gamble first in line to negotiate for the rights to develop and market an over-the-counter version of Silenor in the United States.

Procter & Gamble is best known for its consumer products, such as Tide detergent and Crest toothpaste, as well as its stable of over-the-counter treatments that include the heartburn drug Prilosec OTC, Pepto-Bismol for an upset stomach and Vicks cold and flu treatments.

The company abandoned its push into the pharmaceutical market last August when it sold its prescription drug business for $3.1 billion to Warner Chilcott of Ireland.

However, Procter & Gamble retained about 15 percent of its pharmaceutical sales force, which continued to market over-the-counter products to doctors and drugstores, Pascoe said. Those remaining sales representatives will now pitch Silenor as their main offering, he said.

Proctor & Gamble likely was drawn to the arrangement with Somaxon by the possibility of adding Silenor to its over-the-counter portfolio once the patent expires on the new drug, said Ali Dibadj, a stock analyst with Sanford C. Bernstein in New York.

“Over-the-counter drugs is certainly an area where (Procter & Gamble) has looked to expand,” he said.

Somaxon would have to win FDA approval before the drug could be sold without a prescription.

Pascoe would not say whether company officials at this point have talked about that possibility with agency officials.

Sleep Apnea Research


New sleep apnea research reported from University of California, Department of Psychiatry

Investigators publish new data in the report ‘Obstructive sleep apnea and age: a double insult to brain function.’ According to recent research from the United States, “Healthy aging is associated with cognitive deficits similar to those found in obstructive sleep apnea (OSA). As in OSA, older adults show compensatory cerebral activation during cognitive demands in the face of neurocognitive decline.”

“The current study examines whether the combination of increasing age and sleep apnea will lead to a stronger compensatory response than either factor alone, or overwhelm the brain’s capacity to compensate. A total of 14 treatment-naive patients with sleep apnea (aged 25-59 yr) and 14 age-matched healthy control subjects were each divided into two age groups of young (<45 yr) and middle-aged (>or=45 yr). All underwent a sleep study, followed the next morning by a functional magnetic resonance imaging session that included a sustained attention and a verbal encoding task. A priori contrast analyses compared middle-aged patients with OSA to young patients, young control subjects, and middle-aged control subjects. Middle-aged patients with OSA showed reduced performance for immediate word recall and slower reaction time during sustained attention compared with the other three groups (middle-aged control, young sleep apnea, and young control). For both tasks, decreased activation was detected for middle-aged sleep apnea relative to the other groups in task-related brain regions. These results suggest that the presence of both sleep apnea and increasing age overwhelmed the brain’s capacity to respond to cognitive challenges with compensatory recruitment and to maintain performance,” wrote L. Ayalon and colleagues, University of California, Department of Psychiatry (see also Sleep Apnea).

The researchers concluded: “The findings that sleep apnea impairs performance and brain function at a younger age than what might ordinarily be expected underscore the importance of early diagnosis and treatment of sleep apnea.”

Ayalon and colleagues published their study in American Journal of Respiratory and Critical Care Medicine (Obstructive sleep apnea and age: a double insult to brain function? American Journal of Respiratory and Critical Care Medicine, 2010;182(3):413-9).

For additional information, contact L. Ayalon, University of California, Dept. of Psychiatry, San Diego, CA USA.

Vanda Pharma commences Tasimelteon Phase III Sleep trial


Vanda Pharma commences Tasimelteon Phase III trial

Vanda Pharmaceuticals has commenced the evaluation of efficacy and safety of Tasimelteon in a Phase III clinical trial, in patients with non-24-hour sleep wake disorder (N24HSWD).

Tasimelteon binds to high affinity melatonin receptors located in the brain that are known to regulate circadian rhythms, or sleep/wake cycles.

Vanda Pharma president and CEO Mihael Polymeropoulos said that Tasimelteon has the potential to be the first in the class of circadian regulators, drugs that may offer clinical benefits to patients with aberrant timing of the sleep/wake cycle.

Vanda Study 3201, assessing the efficacy and safety of 20mg Tasimelteon versus placebo in totally blind individuals with N24HSWD, is a 6-month treatment with an optional open-label extension.

Vanda Study 3201 is designed to meet the primary endpoint which is an improvement in Total Sleep Time (TST) during the night.

Additionally, the study is expected to measure parameters of daytime sleep and laboratory measures of the synchronisation between the internal body clock and the 24-hour environmental light/dark cycle.

Vanda expects to report top-line results for this trial in the fourth quarter of 2011.

Medigas launches Medigas Express website – Quick and easy way to a better … – DigitalJournal.com (press release)


Medigas launches Medigas Express website – Quick and easy way to a better night’s sleep

Canada NewsWire


HAMILTON, ON, Aug. 18 /CNW Telbec/ – Obstructive sleep apnea (OSA) is estimated to occur in 1 of 20 adults, and in twice as many men as women. OSA, a condition in which breathing stops for periods of time during sleep, is caused by a collapse of the upper airway resulting in a block to the flow of air into and out of the lungs.

OSA is diagnosed by a sleep study test (polysomnography), usually done at night using electronic equipment that records sleeping brain activity, monitors breathing and how well the body rests. Once diagnosed, a physician writes a prescription for Continuous Positive Airway Pressure (CPAP), the most common form of treatment of OSA. Through a small airflow generating machine, pressurized air is delivered to the nose or face through a mask-like interface to act as a splint to keep the upper airway open.

Local company Medigas, the home healthcare division of Praxair Canada Inc., has been providing physicians and their patients with home oxygen therapy, sleep therapy and home medical equipment for over 40 years.

Today, with the recent launch of Medigas Express (www.medigascpap.com), it is easier than ever for sleep therapy customers to purchase replacement CPAP masks and related supplies. The bilingual (French/English), easy to navigate site features a wide range of products, detailed product descriptions, and a registration feature that simplifies re-ordering.

“Since CPAP therapy came to Canada, our growing chain of retail locations have been a great resource for thousands of sleep apnea suffers to purchase CPAP supplies,” said Jan Forrest, National Marketing Manager for Medigas. “With the recent launch of Medigas Express, those who have been diagnosed with OSA are now just a few clicks of a mouse away from getting a better night’s sleep.”

For general information on Medigas and OSA, go to www.medigas.com. To purchase CPAP accessories and supplies, go to www.medigascpap.com.