4 Unusual Causes of Insomnia

Many people in Queens struggle with periodic or frequent insomnia. In most cases, insomnia is due to poor sleep hygiene, or secondary to depression or anxiety. Difficulty sleeping can often be fixed by avoiding caffeine late in the day, eliminating noise and other distractions from the sleeping area, and maintaining a regular sleeping schedule. When insomnia is largely due to depression or anxiety, treating the underlying psychological problem can often alleviate the problem. However, there are a few conditions that cause insomnia that are relatively rare, but can be serious and require different treatment approaches. Four of the rarer forms of insomnia in Queens are Periodic Limb Movement Disorder (PLMD), Non-24-Hour Sleep-Wake Disorder (non-24), Irregular Sleep-Wake Rhythm Disorder, and the rare but very serious Fatal Familiar Insomnia. 

#1: Periodic Limb Movement Disorder 

People with Periodic Limb Movement Disorder (PLMD) in Queens move their limbs involuntarily during sleep. These movements generally occur at periodic intervals around 20-40 seconds apart during early non-REM sleep phases, eventually subsiding due to the muscle atonia that accompanies REM sleep. PLMD can make it very difficult to get to sleep, and to remain asleep through the night. People with PLMD often experience excessive daytime sleepiness due to the poor quality of sleep during the night, and may be unaware of the cause unless a sleeping partner informs them of the limb movements. A polysomnographic sleep study is generally used to confirm a diagnosis of PLMD. The exact cause of this condition is not yet known; some of the risk factors that have been identified include being a shift worker, snoring, stress, caffeine consumption, and the use of benzodiazepine medications. There is no known cure for PLMD, although it often responds to anti-Parkinson medication or anticonvulsants.

  

#2: Non-24-Hour Sleep-Wake Disorder 

Non-24-Hour Sleep-Wake Disorder (Non-24) is a circadian rhythm disorder, arising when a person’s sleep-wake cycle becomes desynchronized from the light-dark cycles that normally regulate the person’s biological “clock”, extending the cycle over more than 24 hours. Most people who suffer from non-24 in Queens are blind, with the disorder resulting from the inability to perceive light input; however, it sometimes occurs in sighted individuals. Non-24 interferes with the regularity of the person’s sleep-wake cycle, and can impede their ability to function well during the day. Although insomnia is not necessarily a feature of non-24 in and of itself, it often occurs when people with non-24 attempt to follow a standard “9-to-5” schedule, resulting in cognitive dysfunction, low energy, and other symptoms of sleep deprivation. 

#3: Irregular Sleep-Wake Rhythm Disorder 

Irregular Sleep-Wake Rhythm Disorder (ISWD) is another circadian rhythm disorder that can cause insomnia in Queens. People with ISWD sleep irregularly from day to day, often in the form of several naps during the day in lieu of continuous nighttime sleep. Insomnia due to ISWD can impair a person’s occupational functioning and interfere with their ability to maintain an active social life. It most often occurs in conjunction with other neurological conditions, such as Alzheimer’s disease, other forms of dementia, or brain damage. ISWD treatment is often approached with melatonin supplementation and regular sleep times and meal times.  

#4: Fatal Familial Insomnia 

Fatal Familial Insomnia (FFI) is a very rare condition that, fortunately, has never occurred locally in Queens. As the name suggests, it is serious and often fatal. FFI is a rare autosomal dominant prion disease of the brain; this means that only one copy of the gene is necessary for a person to inherit the disorder, which is caused by a mutation to a prion protein. The age of onset is in adulthood, ranging from as young as 18 to as old as 50, and death usually occurs 7-36 months later. FFI proceeds in four stages:

·         1. The patient suffers increasing insomnia over several months.

·         2. Hallucinations and panic attacks, brought on by the lack of sleep, become noticable.

·         3. Rapid weight loss occurs along with inability to sleep

·         4. The patient develops dementia.

FFI is an extremely rare disorder; worldwide, only 25 families are known to carry the gene that causes

 it.

NEW YORK: NEUROFEEDBACK FOR INSOMNIA

Sleep State Misperception: When Insomnia Isn’t Really Insomnia

Many people in New York and elsewhere suffer from insomnia, the inability to fall asleep and to stay asleep that can severely affect the person’s ability to function during the day. However, there are some cases where a person may be convinced that they have insomnia, even though in reality the duration and quality of their sleep is absolutely fine. This is called sleep state misperception or paradoxical insomnia, and is recognized by the American Academy of Sleep Medicine as a legitimate sleep-related disorder. Although people with sleep state misperception are sleeping just fine, the idea that they are losing sleep can cause considerable anxiety and stress.

Signs and Symptoms

People with sleep state misperception underestimate the time they spend sleeping, and are often mistakenly under the impression that they were awake at times when they had actually been asleep. They often report to their healthcare providers that they are not sleeping much at all, requesting treatment for insomnia. However, when they are given a polysomnograph test—a clinical test incorporating EEG, EMG, and other measurements to evaluate for sleep disorders—it is revealed that there is nothing wrong with the quality or duration of their sleep. Although they sometimes do report excessive daytime sleepiness, which is typical of insomnia, evidence suggests that this effect is more likely to be “in their heads” or due to a cause other than lack of sleep.

Sleep State Misperception, Anxiety, and Stress

Even when polysomnographic studies indicate that they’re actually fine, a person with sleep state misperception may remain convinced that there is something wrong with their sleeping patterns. Often this causes considerable anxiety and stress. Sometimes doctors will prescribe the patient a sleep medication anyway, such as Lunesta or Ambien, but this can be dangerous because these drugs can be habit-forming and can also cause unwanted side effects. Chronic sleep state misperception is associated with increased risk of depression, anxiety, and substance abuse, which are often exacerbated by stress over the fact that doctors “can’t figure out what’s wrong” with the patient.

How Can Sleep State Misperception Be Treated?

Since people with sleep state misperception are not actually having trouble sleeping, treatment should theoretically differ from the typical treatments for actual insomnia. Some psychologists suggest that a major component of treatment for paradoxical insomnia should be cognitive restructuring. A person with sleep state misperception is not “malingering,”, or deliberately lying to deceive healthcare professionals; they are legitimately concerned that they are suffering from insomnia, and are generally surprised when sleep studies indicate that they are not. Although they are sleeping, some evidence also suggests that over arousal could be compromising the depth and quality of their sleep, contributing to the misperception that they have only slept for a few hours. Sleep state misperception may be best treated with cognitive behavioral approaches, including addressing underlying anxiety or depression that may contribute to the person’s worries about possible insomnia. Although research has yet to be conducted into using neurofeedback therapy for sleep state misperception, this may theoretically prove a fruitful field of research.

Mortality Risks of Medication for Insomnia Treatment

Beginning in the 20^th century, it became quite common in Port Washington to prescribe various sleep-inducing medications to patients who complained of subjective insomnia. Originally, the medications of choice were barbiturates and benzodiazepines. In later years, these classes of drugs were supplanted by non-benzodiazepine sedative-hypnotics, such as Ambien and Lunesta, which were recognized as carrying a lesser risk of addiction and overdose. In 2010, an estimated 6% to 10% of the national population was prescribed one of these drugs for treating their insomnia.

Although Ambien and Lunesta remain a popular choice for insomnia treatment in Port Washington, numerous studies have produced evidence of significant health and mortality risks associated with long-term use of these medications, especially in elderly patients. 

1979: Sedatives Recognized as Cancer Risk—A Fact Summarily Swept Under the Rug 

Back in 1979, the American Cancer Society’s landmark Cancer Prevention Study 1 came to the conclusion that, without a doubt, cigarettes cause cancer. You may not know, however, that the same study also concluded that long-term use of hypnotic medications were just as strongly associated with excessive deaths. Because the study was not initially designed to study these drugs, these results were conveniently ignored. Since then, numerous studies have affirmed that there are risks associated with long-term use of hypnotic medications.

These medications are much safer when used in the short term; the real risks are with long-term chronic use. 

Why Is Long-Term Chronic Use of Insomnia Medication So Risky? 

Scientists have not yet fully determined the causes of the mortality risks of long-term hypnotic use for insomnia treatment. Some of the effects that may contribute to the risks of chronic sedative-hypnotic use include:

·         Impaired coordination, reaction time, memory, and alertness, which may increase the risk of falls and accidents, especially with the elderly.

·         Medication for insomnia treatment may depress the respiratory system. This could aggravate sleep-related breathing disorders, especially in people with a history of COPD or heart problems.

·         People who have difficulty sleeping may additionally self-medicate using alcohol or other depressant drugs, which intensify the effects of sedative-hypnotics and benzodiazepines to an extent that can potentially be dangerous.

Are There Safer Alternatives to Medication for Insomnia in Port Washington? 

Researchers involved in studies confirming the mortality risks of long-term use of sleep medication recommend that the public be informed of the risks of hypnotic sleep medication, and that physicians should take care in prescribing these medications—especially to elderly patients. The researchers also recommend that physicians discuss non-pharmacological alternatives with their patients.

There are several alternatives to medications for insomnia in Port Washington, many of which are strongly supported by clinical studies of their effectiveness. Some alternative treatments that may be safer than sleeping pills include:

·         Cognitive-behavioral therapy - a form of psychotherapy that focuses on identifying thoughts and behaviors that contribute to problems like insomnia and anxiety. Many people in Port Washington have trouble sleeping because they’re stressed, have poor sleep hygiene habits, or because of other reasons that can be remedied through changes in behavior.

·         Herbs and supplements - such as melatonin and valerian root, are effective for many people without the risks and side effects associated with synthetic pharmaceuticals.

·         Neurofeedback therapy - now available in the Port Washington area, is one of the most promising alternatives to pharmaceuticals for insomnia treatment, as well as anxiety and a host of other brain-based conditions. Neurofeedback therapy uses EEG neuroimaging to identify and correct brainwave dysregulation in certain areas of the brain, which has been identified as a key factor in insomnia.

Long-term use of sleeping pills, including benzodiazepines like Xanax and non-benzodiazepine sedative-hypnotics like Ambien and Lunesta, has been shown to be associated with higher risk of mortality and may be dangerous. Better options for long-term insomnia treatment include CBT, herbal remedies, and neurofeedback therapy. These may be much safer and more appropriate choices of treatment for Port Washington insomniacs.

NEUROFEEDBACK FOR INSOMNIA