American Medical Association Family Medical Guide - American Medical Association [445]
Q & A
Sleep
Q. I read somewhere that many famous people, such as Thomas Edison, got by on very little sleep. There is so much to do and so little time. How can I make a few hours of sleep work for me?
A. You can’t. Cutting down on your sleep will make you less productive, not more. Sleep is necessary to refresh your tired brain, organize the day’s experiences, and stimulate hormones that build and repair body tissues. It has been said that Edison slept 6 hours a night, but the untold part of the story is that he was able to fall asleep quickly and took naps frequently throughout the day, possibly up to two 2-hour naps a day—a total of 10 hours a day.
Q. I’m a 20-year-old college student and I frequently pull all-nighters to study for early-morning tests. My roommate told me that I’m not doing myself any good and, I have to admit, my grades don’t reflect the amount of time I spend studying. What am I doing wrong?
A. Staying awake longer than normal can impair your memory. Essentially, learning is about forming permanent memories. People remember more of what they have learned if they have sufficient sleep right after studying. A few hours won’t do. In the last few hours of dream sleep, the brain concentrates on strengthening and reinforcing the connections between nerve cells that make up a new memory. A good night’s sleep helps the brain organize and retrieve information.
A number of factors can cause insomnia. Many people experience short-term or intermittent insomnia when they are under increased stress, have jet lag (see next page), or sleep in a noisy environment. The side effects of some medications also can cause insomnia. Certain conditions, such as depression (see page 709) or anxiety (see page 718), seem to make people more susceptible to insomnia. Although the disorder affects people of all age groups, it occurs more often in women (especially after menopause) and older people.
The causes of chronic insomnia are often complicated, involving a number of underlying physical or psychological disorders. Depression is one of the most frequent causes of long-term insomnia. Other disorders, such as arthritis (see page 996), kidney disease, heart failure (see page 570), asthma (see page 640), multiple sclerosis (see page 696), Parkinson’s disease (see page 691), and hyperthyroidism (see page 901), also are common causes of insomnia. Other sleep disorders, such as sleep apnea (see page 636) and restless legs syndrome (see next page), can also cause insomnia.
Your risk of having insomnia increases if you smoke (because nicotine is a stimulant that disrupts sleep) or if you consume too much alcohol or caffeine, or use other stimulants before bedtime. Shift work or other activities that promote irregular sleep patterns also can affect your ability to fall asleep and stay asleep. Excessive worrying (including worrying about not being able to sleep) can contribute to insomnia. Making lifestyle changes is often enough to improve your sleep.
Symptoms
The difficulty sleeping that is characteristic of insomnia falls into three main classes—short-term, intermittent, and chronic. Short-term or transient insomnia usually lasts only a few weeks or less. Short-term insomnia that occurs from time to time is said to be intermittent. Chronic or long-term insomnia happens on most nights and persists for a month or longer.
Diagnosis
If you have insomnia, your doctor will take a detailed health history (see page 130), including a sleep history. You may be asked to keep a sleep diary to find out how much sound sleep you get each night. The doctor may also ask your sleep partner about the quality of your sleep and how long you sleep each night.
Treatment
Short-term and intermittent