What is insomnia?

Because there is some reluctance to talk about the problem, often serious cases of insomnia go untreated. Researchers estimate that fewer than half of those who need help actually get it. Putting this in context, sleep disorders are more common than you might realise, affecting around 12% of the adult population in the developed world. These problems are both in getting to sleep and then remaining asleep for a reasonable period of time, and represent a significant burden on both the public and private health services.

Strictly speaking, we should not consider insomnia an illness or disease. It is really little more than a collection of symptoms that affect a reasonably significant percentage of the population to a varying degree of severity and over a varying length of time. Clinical researchers classify insomnia as being:

• transient;
• intermittent or short-term; and
• chronic.

Transient

At one time or another during our lives, the majority of us have probably experienced transient or short-term problems with sleep. Sometimes, there are no apparent reasons. Sleeplessness comes, it lasts for a week or so and then, just as mysteriously, it goes away. More usually, there are many probable causes. It may be that we are worried or anxious about something - there can be stress in our relationships or at work. There may have been a death in the family or some other emotionally disturbing event. We may be ill or experience pain from an injury which disrupts the usual sleep patterns, or it may be something as simple as moving to a new home or going to a holiday hotel. Sleeping in a new place or bed with different street or neighbourhood noises can disturb you. Adjusting to new time zones and jet lag has the same effect. But these are all "one-offs".

Intermittent

Insomnia gets to be more of a nuisance when the episodes begin to repeat themselves. To have one short-term bout is something we can live through and explain away. It was just dealing with one stressful trigger event. But when we find it difficult to fall asleep every night for a few consecutive days twice a month, this is more difficult to ignore. It worries us that there is a pattern. We wonder whether it is going to become a more permanent problem.

Many people react to the early more mild problems by experimenting. They try not going to bed until they feel tired, or they mix up the times they go to bed. Sometimes, they take a hot drink before lying down. Other times, they read a book. The difficulty is that not seeking out professional help runs the risk of this becoming a longer-term problem. You may be learning the habit of not sleeping.

Chronic

The insomnia is classified as chronic when you cannot get to sleep for at least three night in every week for a month (and then longer). Health professionals make this distinction:

1. There is usually another health problem. It can be a sign that a depressive illness is affecting us. The anxiety we feel is not mere worry that we cannot sleep. The impending depression or other psychiatric problems are preventing us from getting to sleep. But other physical difficulties can be the cause, including:

• asthma and other breathing difficulties;
• arthritis and other joint and muscular conditions, initially with only low-level pain;
• Parkinson’s and Alzheimer’s Disease;
• an overactive thyroid;
• menopause;
• cardiovascular - in more mild cases, this may be early angina or arrhythmia, but if these problems are untreated, more obvious heart diseases may develop.

With many of these conditions, treatment also solves the problem with sleep without the need to take sleeping pills. But this does not always work. In such cases, the use of Ambien or Ambien CR under controlled conditions becomes necessary.

2. This is called "primary insomnia". In a more limited number of cases, there is no other apparent disease or illness involved. You simply feel too awake. You mind is too active and you do not feel like sleeping. In younger children, this has been linked to Attention-Deficit Hyperactivity Disorder (ADHD), but there is no general agreement on why this condition should affect adults.

How does cognitive behavioural therapy help? One of the best alternatives to simple reliance on a drug like Ambien is cognitive behavioural therapy (CBT). CBT teaches you a new set of behaviours around the "activity" of sleep. You have to "relearn" the association between going to bed and falling sleep.

The habit of sleep Before you start taking Ambien or alongside a course of Ambien, you should change your habit patterns and practise relaxation techniques to help you get to sleep.