Trouble Sleeping? Primary Insomnia Better Understood
< Nov. 05, 2008 > -- A specific neurochemical imbalance found in adults with primary insomnia makes it more difficult for their brains to settle down for sleep, a new study says.
Many adults suffering from insomnia complain of a 'racing mind' and an inability to shut down at night. Researchers now suggest this experience is not just "in your head," but a result of a decrease in the neurochemical gamma-aminobutyric acid (GABA).
According to a medical journal Sleep, people with primary insomnia for more than six months have 30 percent less GABA, a chemical that slows overall activity in many brain areas.
"GABA is reduced in the brain of individuals with insomnia, suggesting overactivity is present not only at the level of excessive thoughts and emotions, but can also be detected at the level of the nervous system," principal investigator John Winkelman, MD, PhD of Brigham and Women's Hospital in Boston, says.
In many cases, secondary insomnia - the most common type - occurs in conjunction with another illness or disorder, either physical or mental, or as a side effect of certain medications or substances. However, primary insomnia occurs without a coexisting condition, persists for one month or longer, and effects approximately a quarter of the adult population.
The finding suggests that primary insomnia is a manifestation of hyperarousal, a neurobiological state, that Dr. Winkelman says helps validate an often misunderstood complaint of insomnia.
"Recognition that insomnia has manifestations in the brain may increase the legitimacy of those who have insomnia and report substantial daytime consequences," he says. "Insomnia is not just a phenomenon observed at night, but has daytime consequences for energy, concentration and mood."
Lower brain GABA levels also have been found in people with major depressive disorder (MDD) and anxiety disorders. It is also noted that primary insomnia shares many features with these conditions and is a critical risk factor. As a result, the study raises the possibility that GABA deficiencies seen in people with mood and anxiety disorders may be tied to sleep disturbances.
The study further states that many of the hypnotic medications most effective in treating insomnia are benzodiazepine receptor antagonists (BzRAs), which increase activity at the GABA neurons. GABA is considered to be one of the factors that help promote sleep and is also involved in cognitive, memory and psychomotor functions.
Standard treatment options for insomnia generally include lifestyle changes, cognitive-behavioral therapy, and sleep medicines, or hypnotic medications.
According to a new clinical guideline published by the American Academy of Sleep Medicine in the Journal of Clinical Sleep Medicine, hypnotic treatment should be supplemented with behavioral and cognitive therapies whenever possible in the evaluation and management of chronic insomnia in adults.
Always consult your physician for more information.
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Sleep is not just resting or taking a break from busy routines - it is essential to physical and emotional health. Adequate sleep may also play a role in helping the body recover from illness and injury. Inadequate sleep over a period of time is associated with obesity, diabetes, heart disease, and depression.
But, the emotional and mental benefits of sleep are also significant. Even occasional sleeping problems can make daily life feel more stressful and less productive. And, some people with chronic insomnia are more likely to develop psychiatric problems. In a recent survey, those who said they had trouble getting enough sleep reported impaired ability to perform tasks involving memory, learning, logical reasoning, and mathematical calculations.
Further, loss of sleep is believed to contribute to strained relationships at home, and unfulfilled potential on the job, and can also be dangerous, leading to serious or even fatal accidents.
The amount of sleep needed varies from person to person. Generally, most healthy adults need no more than 7 to 9 hours of sleep a night. If you have some of the following problems, you may need more sleep, or a better quality of sleep:
- trouble staying alert during boring or monotonous activities
- tendency to be unreasonably irritable with co-workers, family, or friends
- difficulty concentrating or remembering facts
There are many types of sleep problems that can interfere with quality of life, personal health, and can endanger public heath. These problems range from staying awake, sleepwalking, bedwetting, nightmares, insomnia, restless legs syndrome, snoring, and sleep apnea syndrome.
For those who suffer from sleep disorders, help is available from many sources. Sleep problems can be treated or managed by different medical specialties. For example, pulmonary medicine will offer help to people who suffer from sleep apnea, and neurology will provide treatment for narcolepsy.
However, other medical specialties also offer treatment for sleep disorders. Many rehabilitation facilities and anesthesiology departments sponsor comprehensive sleep disorder programs, as do mental health centers. The American Board of Sleep Medicine establishes standards and certification for physicians and scientists who wish to become certified in sleep medicine.
Talk with your physician about which sleep disorder program is right for you.
Always consult your physician for more information.
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