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Suffering from Insomnia: The Likeliest Candidates

Almost anyone can suffer from an occasional bout of insomnia, but statistically speaking, certain groups come in for more than their share of problem sleep. Women, older people, and people suffering from depression have insomnia more frequently. The following sections explain why.

Why women have insomnia more frequently than men

Research shows that after a woman has a baby, she automatically develops a more acute sensitivity to the sounds her baby makes, enabling her to wake up quickly if she hears a disturbing noise such as a cough or a cry. Unfortunately, even long after their children are grown and have moved away, women retain this heightened sensitivity to nighttime noise. If you don't believe it, clinical studies have found that women who have never had children sleep better, even in their 50s and 60s, than women who had children.

Add to this sensitivity the constant hormonal changes going on in a woman's body every month. Women who suffer from premenstrual syndrome, or PMS, may have a tough time sleeping when their bodies are awash in hormones. During her period, a woman's pain from menstrual cramps or lower back pain and breast tenderness may combine to make finding a comfortable sleep position difficult.

Menopausal women may have a hard time sleeping as well because they sometimes have to contend with drenching nighttime sweats. The good news is that by the time women enter the post menopausal phase of life, when all the hot flashes and hormonal swings are finally over, men tend to catch up to them in terms of sleeplessness. In fact, post menopausal women who don't have insomnia usually sleep longer and better than men of the same age who don't have insomnia.

Growing older with insomnia

As people age, both the quality and quantity of their sleep tend to deteriorate. Researchers aren't quite sure why this happens, but they suspect age-related changes in sleep phases and patterns may be to blame. They do know that the amount of time spent in light sleep increases as people get older. The accumulation of various medical conditions may play a role, especially if they're associated with pain. An alternative explanation is that the biological sleep-wake control system centers become less effective through cell loss or transformation, just as an elderly person's memory and physical abilities decline.

One study, which unfortunately only used men as subjects, showed subjects lose 80 percent of their deepest, most restorative sleep as they age from 16 to 50. (Now you know why your grandfather wakes up at 5:30 a.m.) Other studies have shown that after age 44, both REM sleep and the total number of hours of sleep decrease, while awakening during the night (usually to use the bathroom) increases. Yet another study indicated an overall weakening of the sleep-wake rhythm as people age.

Some sleep medications aren't appropriate for older adults because they increase daytime sleepiness and the risk for falls and fractures, which is especially true if the drug is long-acting (meaning that it remains in the body and brain longer). Even though a person takes the medicine at bedtime, the medicine may still be affecting the person the next morning or afternoon. If an older person who takes one of these medications needs to use the toilet in the middle of the night, his or her coordination may be impaired, which can lead to falls. Ask your doctor for guidance in choosing an appropriate OTC or prescription sleep aid, depending on your own medical history.

In addition, neurological conditions such as Parkinson's disease, Alzheimer's disease, and some forms of dementia can cause sleep disruptions. Older people are also more likely to take a prescription drug or combination of drugs that may cause sleeplessness. They also experience a higher incidence of depression and other emotional problems that may contribute to insomnia.

Just because you're growing older, you don't have to live with poor sleep. Consult your doctor. Many effective treatments are available that can help you get back to sleeping better and longer.

According to the National Sleep Foundation's 2000 Sleep in America poll, a real disconnect exists between patients and their doctors concerning sleep problems, particularly insomnia. Although 62 percent of American adults reported they experience sleep problems at least a few nights a week, and 58 percent said they suffer from insomnia, physicians taking the same poll reported that only 16 percent of their patients suffer from a sleep disorder, and just 14 percent have insomnia. Physicians also said they don't consider the diagnosis and treatment of insomnia as an urgent health problem.

Insomnia and depression

Insomnia is so much a part of "the blues" that problems with sleep are actually described as one of the major identifying symptoms for diagnosing depression. In fact, more than 90 percent of all patients with depression report that they have difficulty falling asleep, staying asleep, or both. The problem is particularly severe for patients with recurring depression.

Early identification and treatment of insomnia in a depressed patient is important. Proper treatment not only helps the insomnia, but resolving sleep problems also seems to help patients do a better job of sticking with their treatment plans. Alleviating insomnia also improves overall functioning and performance for depressed patients.

Tell your doctor if you're depressed and having trouble sleeping. You should avoid certain popular antidepressants, including some of the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). They stimulate serotonin receptors in the brain and change sleep patterns, producing insomnia. However, antidepressants like mirtazapine and nefazodone that block the stimulation of serotonin receptors actually help people with depression get to sleep more quickly, and sleep better and longer.

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