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What is insomnia?

Insomnia is a sleep disorder defined as repeated trouble falling asleep, staying asleep, dissatisfaction with sleep quality or waking too early in the morning and being unable to fall back asleep. Episodes may come and go, be short term or be long-lasting (chronic). Sleep quality is as important as the amount of sleep you get. People with insomnia can feel dissatisfied with their sleep and may have trouble functioning during the day. About 10% of the US population suffers with insomnia.

Symptoms include trouble falling asleep, trouble maintaining sleep, and early morning awakening with problems falling back to sleep. People with insomnia may wake up feeling exhausted and may have trouble functioning during the day. Insomnia can cause a variety of other symptoms, including irritability, moodiness, fatigue, and difficulty concentrating.

There are many potential causes of insomnia, including stress, anxiety, depression, medical conditions, medications, and environmental factors. Insomnia can also be caused by poor sleep habits or having an irregular sleep schedule. Sleep abnormalities are often found in early dementia and may accelerate cognitive decline. People with respiratory conditions, painful conditions and neurological illnesses are at risk for insomnia.

Pregnant people experiencing hormone changes in the third trimester often suffer with insomnia. Women going through menopause often have poor sleep quality. Long- term sleep disturbances in postmenopausal women are closely related to cardiovascular disease, and metabolic disorders. 40%-60% of women report sleep problems during perimenopause and postmenopausal, usually associated with hot flashes, and night sweats and increase the risk of depression.

Some people may have a genetic predisposition to insomnia, which means that they are more likely to experience the condition due to family history.

It is diagnosed when insomnia (including difficulty getting to sleep or staying asleep) results in daytime dysfunction, when the person has adequate opportunity to sleep. It is short term if symptoms last less than three months and chronic if symptoms occur three or more times a week for three months or longer.

The diagnosis relies on the patient’s history of sleep, and medical or psychiatric conditions and substance use. Dr. Poulakos will take a complete medical history and ask you to keep a two-week sleep diary including sleep habits, a log of sleep and wake patterns, and the presence or absence of symptoms of sleep disorders such as obstructive sleep apnea. He will also ask you to complete questionnaires about your sleep problem including a general medical and psychiatric questionnaire, and a sleepiness assessment. He may order a sleep assessment.

Insomnia is often precipitated by a significant life stressor like acute pain or trauma and may end when the stressor resolves. However, significant daytime sleepiness could be the result of narcolepsy, or a sleep-related breathing disorder and can increase the risk of falls.

Insomnia can be a primary sleep disorder, a symptom of another sleep disorder like snoring, sleep apnea, restless leg syndrome, periodic leg movements during sleep or comorbid with medications, substance use, over the counter drugs and dietary supplements. 39%-55% of patients with sleep apnea have symptoms of insomnia. 30% of the elderly already diagnosed with insomnia have been found to have obstructive sleep apnea.  30% of people with insomnia also have restless leg syndrome three or more nights per week; and 85%-95% of patients with restless leg also have also have periodic leg movements during sleep.

Insomnia is also a risk factor for anxiety, depression, diabetes, hypertension, substance abuse disorders and suicidal tendencies. When your sleep is compromised and you are exhausted and can’t find sleep, contact Dr. Poulakos at his Greenwich Village office.

Dr. Poulakos offers evidence-based, individualized treatment using medication and psychotherapy, and state-of-the-art therapies. When people are directly involved in creating their own treatment plan including wellness goals and support services, they experience improved outcomes. He is a caring and compassionate doctor who will work with you to find solutions that meet your unique needs.

At a Glance

Dr. Paul Poulakos

  • Attending Psychiatrist at Mount Sinai Beth Israel Medical Center
  • Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai
  • Past Clinical Assistant Professor of NYU Langone Medical Center
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