Michael J. Thorpy, MD: Vikas, insomnia is often seen by people as just a nighttime problem. But it’s more than that, isn’t it? It’s a 24 hour problem; it is a problem of night and day. Why do we think of it more as a 24 hour problem rather than a nighttime problem?
Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE: There are several reasons. The first is that in general, if you don’t sleep well at night, if you have difficulty falling asleep and staying asleep, if you wake up too early, a poor night’s sleep will result in decreased performance. during the day. Patients with insomnia are 3 times more likely to lack concentration during the day than people who sleep well at night. They are twice as likely to suffer from low energy levels, and there is a higher degree of mood disturbances in patients who suffer from insomnia. In general, especially in patients with chronic insomnia, if you don’t sleep well night after night, you start to worry about your sleep throughout the day. “Is tonight going to be the night I go to get some sleep?” This lends itself to another night of bad sleep. It can be perpetuated beyond.
Michael J. Thorpy, MD: You are so right. There are a lot of people who wake up in the morning and think, “If I don’t sleep well tonight, I won’t be able to do the things I want to do the next day. They start to worry about it in the morning. They have symptoms related to it all day long because of it.
Karl Doghramji, doctor of medicine: Michael, if I could just amplify that too. Clinically, I find that some patients who appear to have insignificant difficulty with sleep itself, waking up a few times or perhaps having a very short sleep latency, complain of insomnia. When I ask them why they are so concerned about a few awakenings, they say, “It’s because I feel miserable during the day. This seems to be the common complaint with insomniacs. This is not what happens at night; that’s what they feel during the day.
Michael J. Thorpy, MD: Fatigue, fatigue, and difficulty doing things during the day are often the main complaints, not nighttime complaints.
Nathaniel Fletcher Watson, MD: If we take this into consideration, it’s interesting that so many clinical trials of drugs and treatments for insomnia barely address daytime functioning. That is changing with the release of some of the newer drugs and some clinical trial activity, but it’s remarkable how myopic we are as a field focused on nighttime, sleep latency, and waking up after the start of the drug. sleep, sleep efficiency and the number of awakenings, but not daytime functioning problems such as drowsiness, mood or cognition problems. Hopefully that will change as we go along.
Erinn E. Beagin, MD: This is something I ask my patients. They will come in and say, “I can’t sleep 8 hours. I’ll say, “How many do you get? “” I sleep 5 hours. But when I was in the military, I used to go to bed at 11 p.m. and get up at 4 a.m. Question # 1 I ask is, “Are you tired during the day? How do you feel during the day? And they say, “I’m going through. I have no problem. For this patient, that is reassuring, but you are absolutely right. It’s the people who come in and say they can’t function the next day that concern me much more.
Transcription edited for clarity.