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Dealing with Insomnia

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Summary Holcomb (2007) divides her article “Putting INSOMNIA to rest” into four main sections. The first section provides information on insomnia. The second section describes some causes and risk factors that are associated with insomnia. The third section explains types of treatments for people with insomnia. The last section gives a questionnaire that can help evaluate if someone may have insomnia. In the first section, Holcomb (2007) states “80% of patients with insomnia never tell their healthcare provider” (p 29). This number is significant because it is estimated that around 50 to 70 million Americans are affected by insomnia. As Holcomb describes, insomnia can affect all age groups, but it is more common in females and increases with age, stress, and medical conditions. According to Holcomb, Insomnia is defined as having trouble falling asleep, staying asleep, or wakening up refreshed. Insomnia can be either acute or chronic. Acute insomnia occurs in around 30% to 50% of adults and is described as insomnia lasting less than four weeks. Chronic insomnia occurs in around 10% to 30% of adults, lasts longer than four weeks, and is associated with daytime sleepiness. These number could be higher however, as Holcomb explains, because many people with insomnia do not tell anyone. In the second section of “Putting Insomnia to Rest,” Holcomb describes causes and risk factors of insomnia. Stress is one of the most common risk factors, which can also lead to anxiety and depression. Other risk factors include gender, age, medical conditions, and changes in working shifts. Medical conditions that are risk factors for insomnia include asthma, allergies, heartburn, chronic pain, and uncontrollable bladder. Lifestyle habits can also be risk factors for insomnia. Drinking caffeine can make it difficult to fall asleep. Drinking alcohol can block transition into REM sleep. Eating before sleep can result in the loss of sleep quality. Light, temperature, noise, and restless partners can also affect aspects of sleep. In the third section, Holcomb describes treatments for insomnia. The best treatments for patients with insomnia come relatively natural, such as changing a lifestyle or behavior. Changes in lifestyle have shown to lessen insomnia in most patients. A list of suggested lifestyle changes is provided by Holcomb (p 30). These lifestyle changes help to keep circadian rhythms on a regular schedule. Behavior modification strategies include cognitive therapy, relaxation training, sleep restriction, and stimulus control. Cognitive therapy helps explain insomnia and why it is happening to patients. Relaxation training helps to calm and relax muscles of the body. Sleep restriction helps the body adjust to a regular schedule. Stimulus control teaches patients to use the bed only for sleep and sexual activities. As Holcomb describes, many medications are also used for the treatment of insomnia. These include over the counter (OTC) medications and prescription medications. OTC medications appear to be safe for short-term use, but long term use can harm melatonin receptors in the brain that help with the functioning of sleep. Long term use can also cause anxiety, dependency, and sometimes a return of an insomnia cycle. Prescriptions medications are often better than OTC medications, as they can be modified, Holcomb explains. They can be designed to release at two different times of the night. At sleep onset, chemicals can be released to help the patient fall asleep. At a later time in the night, another chemical can be released to help the patient stay asleep or fall back asleep if awakened. There are many different types of prescription medicines. In the fourth section, Holcomb describes a questionnaire that can help individuals figure out if they are suffering from insomnia. Questions are based on how long it takes individuals to fall asleep, how well they sleep, and factors that may affect the way they sleep. With the help of questionnaires such as this, Holcomb identified that most people suffer from insomnia because of functioning at home or work.

Evaluation Insomnia affects millions of people around the world, even if they do not know it. According to Wade and Tavris, “insomnia affects most people one time or another, and many people all of the time” (p 179). Most people with insomnia try to address the problem with sleeping pills. The sleeping pill industry has become one of the largest industries in America. Research has shown that billions of dollars have been geared toward the research of sleeping pills and the effects they have on the human body The Harvard Health Letter (2004) addresses insomnia and the search for the perfect sleeping pill. The search for a sleeping pill that does not have any side effects or consequences has been going on for a long time. Barbiturates were first thought to be the answer for the perfect pill, but they caused many problems. These problems include lethal overdose, addiction, and threatening when mixed with other drugs. All barbiturates cause sleepiness, but the FDA has only approved 5 as sleeping pills. Non-barbiturates (Z drugs), such as Ambien and Sonata, were also thought to be the answer for the perfect pill. Z drugs are faster acting and do not stay in the body as long as barbiturates. They help with the difficulty of falling asleep, but not with the difficulty of staying asleep. Many people with insomnia taking Z drugs awaken shortly after falling asleep. The search continues today for the perfect sleeping pill and new pills are tested daily. Walter Buboltz, Franklin Brown, and Barlow Soper have researched sleep difficulties in college students over the last 25 years. Their research coincides with the research of Holcomb, emphasizing the role of stress in college students with sleep difficulties. According to Buboltz, Brown, and Soper, increased tension, irritability, and confusion that college students encounter can lead to sleep difficulties (p 131). Buboltz, Brown, and Soper conducted an experiment to further study sleep difficulties. This experiment consisted of 191 students, 95 men and 96 women. The participants were to fill out a sleep quality index report, which is an 8 item paper that emphasizes general sleep difficulties. Some of the items on this paper included: the time it took and any difficulties they had falling asleep, if they were disturbed or woke up during the night, if they occurred morning tiredness or woke up too early, and if they used or currently were using sleep medications. The results of this experiment also coincide with the research of Holcomb. Buboltz, Brown, and Soper discovered that women on average suffered more from sleep difficulties than men. They found that 30% of women reported suffering from some form of insomnia, compared to 18% of men (p 132). Holcomb describes insomnia as a symptom that occurs mainly in adults. According to Judith Owens in “Pharmacotherapy of Pediatric Insomnia,” many children suffer from insomnia as well. Causes of insomnia in children may differ from causes of insomnia in adults, however. Insomnia in adults in most commonly associated with stress, as Holcomb explained. According to Owens, insomnia in children is associated with the child refusing to go to bed, trying to stay awake and nighttime awakening that needs a parent’s attention (p 99).
Application
I believe many students can benefit from this article. Students could learn about some of the causes and risk factors of insomnia. Often times, these causes and risk factors also affect students’ performance inside the classroom. They could identify certain lifestyle changes that could be made to lessen the effects of insomnia. Students could learn about the various sleeping pills that they may already be taking or are having thoughts about taking to help with any sleep difficulties they face. The more information students receive about insomnia, the more likely they are to go to a professional to get additional help with their difficulties. I believe future research on insomnia will focus mainly on the use of sleeping pills. I agree with Holcomb, however, that there are better ways to deal with insomnia. I think future research should focus more on sleeping habits and hygiene. The list of lifestyle support for insomnia treat that Holcomb provides in this article is very informative. Anyone that is having problems sleeping could read this list and identify changes that can be made in their lifestyles. As a current student in college, this article was too close for comfort. I currently am a full time student and work a full time job. Most days I will leave my house around 8:00 in the morning for school and won’t return from work until 11:00 at night. Throughout the day I am faced with many deadlines that I struggle to meet. My sleeping schedule is constantly changing along with my work and class schedule. I lay in bed for over an hour almost every night before I fall asleep and wake up more often than not while I sleep. All these factors combine to form a lot of stress on me and my body. Just like most people, as Holcomb described, I do not seek help, think I need help, or seek further information on my sleeping difficulties. This article, however, makes me think differently.

References

(2004). Sleeping pills without regrets. Harvard Health Letter, 29, 1-3.

Buboltz, W., Brown, F., & Soper, B. (2001). Sleep habits and patterns of college students: a preliminary study. Journal of American College Health, 50, 131-135.

Holcomb, S. (2007). Putting INSOMNIA to Rest. Nurse Practitioner, 32, 28-34.

Owens, J. (2009). Pharmacotherapy of Pediatric Insomnia. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 99-107.

Wade, C., Tavris, C. (2008). Invitation to Psychology, 4th edition. Upper Saddle River, NJ: Pearson.

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