Insomnia

Staying up late of your own free will is one thing. But what if you're trying to get a good night's sleep and can't? Insomnia takes different forms. Onset insomnia refers to difficulty establishing sleep; common causes include anxiety and racing thoughts. Middle insomnia refers to middle-of-the-night awakening and an inability to return to sleep within a reasonable time. This type of problem is typical of people experiencing chronic pain, which may rouse them from the midst of slumber. Early morning awakening is frequently associated with depression. Whatever form insomnia takes, the net effect is the same: insufficient restorative sleep leading to daytime fatigue.

The detrimental effect of insomnia on memory function is twofold. Decreased sleep deprives you of adequate time for consolidation and diminishes daytime alertness, thereby undermining attentional function and new learning. All forms of insomnia become more common with age.

Occasional sleeplessness is common and does not require treatment. Feelings of excitement or apprehension (or both) the night before a big event may keep you awake. However, when sleep becomes regularly elusive, daytime functioning suffers. Insomnia can be both a cause and a symptom of depression.

Treatment of insomnia depends on the underlying cause and can include changing behaviors, the use of medication, or other medical procedures. Most sleep experts recommend beginning with a review of sleep hygiene, or presleep behaviors and other factors that influence sleep onset and maintenance, such as eating, ingesting alcohol or caffeine, and engaging in strenuous exercise in the hours prior to bedtime. Another important factor is maintaining a regular bedtime. If you go to bed very late one night, you'll find it more difficult to fall asleep at your normal bedtime the next night for the simple reason that you won't be tired enough.

Unfortunately, many medicines used to treat insomnia can also undermine memory. I advise patients to avoid long-term use of these sleep-aid drugs and instead to emphasize nonpharmacolog-

ical approaches whenever possible. Meditative self-relaxation techniques are highly effective for many people. I discuss specific strategies for combating insomnia in Chapter 9.

Sleeping Sound

Sleeping Sound

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