Most cases of insomnia can be traced to
one of the several common problems, including irregular sleep
schedules such as irregular bedtimes, irregular arising times, night
work; overuse of caffeine, diet pills or other stimulants; various
disease conditions for instance: endocrine gland disorders and
neurological disorder; or chronic abuse of drugs affecting the nervous
system, especially tranquilizers, sleeping pills, and can be side
effects of anti-arrhythmia drugs, anti-hypertensive medication,
steroids, hormonal preparations, asthma medications and alcohol.
Other "culprits" are daytime naps (especially by unemployed or older
people) and a completely sedentary daytime routine.
There are some people who are constantly
more alert than others. They tend to be sensitive individuals,
often perfectionists who ruminate about details long after the event.
Some of them take a long time to "wind down" each night. They
often take a while to fall asleep, but usually sleep soundly once they
do. They manifest particular electrical properties of the
nervous system, and their condition is known as "hyperarousal".
A sudden crisis, for instance a
financial reversal, divorce, court case and so on can obviously
interfere with sleep. Such "insomnia" should disappear when the
crisis is over. More commonly, chronic depression underlies
disordered sleep, especially when early morning awakening occurs.
Often these depressions are unrecognized because the patient does not
feel "sad". But early morning awakening combined with the
inability to enjoy customary pleasures, the appearance of irrational
fears, or even temperamental outbursts may indeed signify depression.
The types of depression associated with insomnia are often readily
relieved once the depression is recognized and treated.
Finally, one should always think of
physical problems such as pain, itching, fever, breathlessness;
underlying diseases such as thyroid, kidney, heart; and medications,
hormonal preparations or drugs for cardiac rhythm disturbances as
possible causes of disordered sleep. Many blame environmental
discomforts for their chronic insomnia, but these rarely underlie
insomnia, since most people can sleep well in a noisy city on a lumpy