Insomnia.(Women's Health Adviser)

Sleep problems are common: Up to 30% of patients in primary care report occasional insomnia, and chronic insomnia is present in about 10%. The prevalence of insomnia increases with age.

Since insomnia is a reliable predictor of ill health--both physical and psychological--physicians should always ask patients about the quality of their sleep. Patients may report an inability to fall asleep, difficulty staying asleep, early awakening, or unrefreshing sleep.

Occasional sleep difficulty--between one night and a couple of weeks--is defined as acute insomnia. If sleep difficulties occur at least three nights per week for a month or more, the insomnia is chronic. However, even occasional insomnia should be addressed, because if left untreated, it can become chronic.

Patients who report insomnia should first be screened for sleep apnea, as this can be the primary cause of sleep problems. Once apnea is ruled out, the physician must consider a host of possible physical, environmental, and psychological causes.

The first step is to address the patient's sleep hygiene and environment. Restless, snoring bed partners can cause sleeplessness, as can pets and children who share the patient's bed. The bedroom should be a calm place of refuge, with appropriate levels of sound, light, and temperature.

Next, ask the patient about her stress level. If she feels the level is high and anxious thoughts trouble her at night, she may need help with stress management. Many patients can't sleep because they are uncomfortable at night. Often, treating the cause of nighttime discomfort, like heartburn, nausea, hot flashes, and chronic pain, will dramatically improve sleep duration and quality.

A few questions about substance use are in order during a discussion of sleep problems. Alcoholics and users of heroin, cocaine, and other stimulants often experience chronic sleep problems. Sleepless patients who aren't problem drinkers may imbibe alcohol at bedtime. While alcohol may hasten sleep onset, its depressant effect is short-lived, causing most patients to wake, often quite abruptly.