My patient came in for his annual exam and everything checked out fine. He hesitated when I asked if there was anything else that he wanted to talk about. After a few more questions he admitted that while he wasn't having any problem getting to sleep, he was waking up after about 3 hours. The stress caused by both the lack of sleep and wondering whether or not he would get any sleep had put him into a state where he wasn't getting more than 3 hours of shuteye a night. After talking for a while we figured out that he was moderately depressed and that one of the symptoms was his insomnia: treating the depression allowed him to get a good night's sleep again.

Intro
Getting adequate amounts of restful sleep is crucial to your overall health. It allows your body to rest and rejuvenate, while reducing fatigue and stress. It also helps you feel emotionally refreshed. Proper sleep may help you recover from illnesses, while increasing your ability to concentrate, accomplish tasks and handle irritating or upsetting situations.

Unfortunately, people with insomnia can't get a good night's rest. Perhaps they can't fall asleep, can't sleep through the night, or they wake up much earlier than they'd planned. This lack of sleep can leave them feeling unfocused, tired and cranky. Worse, it can lead to anxiety about falling asleep, which may only exacerbate their condition.

Approximately a quarter of adults and half of senior citizens have insomnia. For people with HIV, side effects of antiretroviral medications, which include nausea, diarrhea, sleeplessness or body aches, can cause insomnia. Although insomnia can affect anyone, it occurs more often in women, people with a history of depression and those over sixty years old.

What is it?
Insomnia is defined as poor quality or inadequate sleep that results from disrupted sleep, trouble falling asleep, or waking up too early and not getting back to sleep.

There are three classifications of insomnia: transient (or short-term, from one night to a few weeks), intermittent (short-term insomnia that comes back now and again) and chronic (occurs almost every night for a month or longer).

During a normal night's sleep, your body experiences two distinctly different phases of sleep, which run in cycles: Rapid Eye Movement (R.E.M.) and non-R.E.M. During R.E.M., your dream phase, your eyes move and your blood pressure and heart rate rise to levels normally found when you're awake. R.E.M. sleep is believed to be the phase during which your memories are consolidated. By contrast, during non-R.E.M. sleep, your blood pressure and heart rate lower. This phase helps restore your body's energy.

If you suffer from insomnia, your sleep cycles may be interrupted and/or you may have an inadequate amount of sleep, leaving you prone to fatigue and feeling irritable and distracted.

Causes of insomnia may be associated with several psychological and physical conditions, as well as diet and exercise. Psychological causes include anxiety, depression and stress. Physical ailments associated with insomnia include breathing disorders, kidney dysfunction, anemia and diabetes. A poor diet, consumption of caffeine and alcohol, smoking cigarettes and lack of exercise may also contribute to trouble sleeping.

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Symptoms
If you're getting poor-quality or inadequate sleep that results from trouble falling asleep, waking up too early and not getting back to sleep, or waking up many times throughout the night, you may have insomnia.

Diagnosis
Your doctor diagnoses insomnia by evaluating your medical and sleep histories. A sleep history is a detailed "diary" in which you keep track of your sleeping patterns, your quality of the sleep, your consumption of caffeine and alcohol and the amount of cigarettes you smoke.

How is it acquired?
Unlike many other medical conditions, both physical and psychological factors can contribute to insomnia. Therefore, specific causes vary by individual. However, the following factors have been shown to contribute to or cause insomnia:

Short-term contributing factors may include:
� Jet lag
� Stress
� Environmental noise
� Extreme temperatures
� Side effects from medications

Longer-term contributing factors may include:
� Depression
� Kidney disease
� Heart trouble
� Narcolepsy (spontaneously falling asleep)
� Asthma
� Sleep apnea (stop breathing in your sleep)

Behavioral factors that can contribute to insomnia in general include:
� Consuming too much alcohol. (While drinking too much alcohol may make you fall asleep or pass out initially, there is actually a "rebound effect," and you may wake up in the middle of the night and have trouble falling back asleep.)
� Consuming too much caffeine
� Smoking cigarettes before going to bed
� Worrying about whether or not you will fall asleep
� Having a disruptive sleep schedule
� Taking naps during the day

How to treat it?
The first step to treating insomnia is for you and your doctor to identify and address any underlying psychological or physical factors that may contribute to your sleeplessness. To do this, your doctor may ask you to keep a diary, in which you log your sleeping patterns, your quality of sleep, your consumption of caffeine and alcohol and the amount of cigarettes you smoke.

You may want to talk to your doctor about trying natural products and supplements. Certain types of teas may also help you sleep. Your doctor may recommend relaxation therapy techniques, or may prescribe sleeping pills, usually only for a short period of time to alleviate your symptoms. If you have chronic insomnia, your doctor may recommend a specialist or look into sleeping clinics -- there are several throughout the country.

Avoid behavior that may exacerbate insomnia, such as consuming caffeine or alcohol or smoking cigarettes close to bedtime.

Some tips that may help relieve insomnia include:
� Don't bring reading materials into bed with you -- they can keep you awake. Turn your bedroom into your sleep sanctuary, a relaxing place to get quiet rest.
� Get lots of sunlight during the day and avoid bright lights in the evening.
� Try a warm glass of milk or a hot bath right before bed (or both!).
� Build enough hours of sleep into your schedule, and stick to it.
� If you can't fall asleep, don't stress about it. Get out of bed, listen to relaxing music, and try keep your mind off of work or other daily responsibilities.

Prevention
The best way to prevent insomnia is to know the physical, psychological and dietary factors that may contribute to it and do your best to avoid them. Consult your doctor when you begin to notice symptoms of insomnia. Putting it off help won't cure your condition.