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• Irregular or continually disrupted sleep-wake schedules

• Expecting to have difficulty sleeping and worrying about it

• Ingesting excessive amounts of caffeine

Insomnia is diagnosed through a medical and sleep history intake. Usually, the patient or the patient’s bed partner completes a diary regarding the quality and quantity of sleep. In addition, specialized sleep studies may be needed to diagnose other sleep-related disorders such as sleep apnea (the cessation of breathing while sleeping) or narcolepsy (excessive daytime sleepiness, lack of REM sleep, and transient sleep like states during the daytime).

Initial treatment of insomnia involves identifying the cause, whether physical or mental. Depending on this diagnosis, additional medical intervention will be necessary to alleviate the underlying disorder. Medical problems typically cause insomnia due to physical discomfort, which may or may not be relieved, depending on the nature of the problem; surgical pain is amenable to medications that blunt the brain’s recognition of pain, whereas insomnia due to asthma may be curtailed by removing nocturnal symptoms. Although not the focus of this chapter, the resolution of insomnia by treating the underlying disorder stands to reason as the most efficacious approach. The highlights in this chapter can be utilized to resolve insomnia that originates from any number of causes, whether primary or secondary. These approaches are more favorable than the use of medication designed to bring about sleep; medications are addictive, have a rebound effect, and are typically only prescribed in small doses for short periods of time for the aforementioned reasons—they are not curative. Treating insomnia with another popular standby, alcohol, is strongly discouraged. Alcohol is commonly thought by the general public to help with sleeping. However, alcohol consumption can diminish the quality of sleep by disrupting the sequence and duration of the various sleep states, altering total sleep time and sleep latency (time to fall asleep). Consumed near bedtime, alcohol may decrease the time it takes for one to fall asleep. However, when consumed within an hour of sleep, it appears to cause disruptions in the second half of the sleep period.4 Sleep may be more fitful, charachterized by frequent awakening from dreams and difficulty falling back asleep. As one continues to rely on alcohol at bedtime, the sleep-inducing effects may decrease while sleep-disrupting effects increase.5 Seniors are more at risk from these effects, as alcohol is not metabolized as quickly in them compared to younger people, leading to higher blood/brain alcohol levels from the same amount consumed.

The effects of alcohol on sleep (wakefulness during the second half of sleep) can be induced by consuming a moderate dose of alcohol as much as six hours prior to bedtime.1 At this point, all alcohol has been eliminated from the body, which suggests a long-term change in bodily sleep regulation and mechanisms. Alcohol consumption in pregnant women has even been shown to induce sleep disruptions in the newborn baby.6 Measurements of brain activity showed that the infants of mothers who consumed at least one drink per day during the first

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