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James Walsh, PhD, St. Luke's Hospital

Insomnia takes many forms, has multiple causes

No sleep problem is as misunderstood as insomnia.

This is true even though it affects about 20 percent of adults in the United States. About 30 percent more women experience insomnia than men.

Some people with insomnia have difficulty falling asleep, and some fall asleep with little trouble but wake up frequently or for long periods of time during the night. Others sleep all night, but their sleep is not refreshing. Many people experience a combination of these problems. Regardless of the specific difficulty in sleeping at night, the common feature for all insomniacs is the tiredness, mental fatigue and lack of energy during the daytime.

No one knows for sure why insomnia is more common among women. Many researchers believe, however, that most of the gender difference is due to women's higher risk for depression and anxiety, which are risk factors for insomnia. Hormonal events such as premenstrual syndrome, menstruation, pregnancy and menopause often disturb sleep in women, but more women than men have insomnia even when you subtract the number of women with insomnia due to these conditions.

For years, insomnia was thought to be only a symptom of other medical conditions. But recent research has found that the brains and bodies of insomniacs are more active during sleep than those of good sleepers. An insomniac's brain wave activity during sleep has more wake-like patterns than good sleepers, and levels of alerting hormones such as cortisol are higher in poor sleepers.

This suggests that some people are biologically programmed to be poor sleepers for years or decades. Others may be at risk for fragile sleep for a few nights or weeks when faced with stress, pain or too much caffeine.

Because a number of factors generally contribute to insomnia, successful treatment - including medication and behavioral therapy - must address all of them. If you are suffering from insomnia, help is available so you can find techniques for a restful night's sleep that work best for you.

James Walsh, PhD, is the executive director and senior scientist at St. Luke's Sleep Medicine and Research Center. Call 314-205-6030 or visit his Meet the Team page.

This article was published in the St. Louis Post-Dispatch on March 11, 2010.