This article (part 3 of 3), outlines essential criteria for insomnia and may help you decide if you need professional help with treating your sleep problems. According to the United States Department of Health and Human Services in the year 2007, approximately 64 million Americans regularly suffer from insomnia each year. Insomnia is 41% more common in women than in men. (source: wikipedia)

“Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

* Difficulty falling asleep
* Waking up often during the night and having trouble going back to sleep
* Waking up too early in the morning
* Feeling tired upon waking

Types of Insomnia

There are two types of insomnia: primary insomnia and secondary insomnia.

* Primary insomnia: Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem.

* Secondary insomnia: Secondary insomnia means that a person is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).

Acute vs. Chronic Insomnia

Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.

Causes of Insomnia

Causes of acute insomnia can include:

* Significant life stress (job loss or change, death of a loved one, divorce, moving).
* Illness.
* Emotional or physical discomfort.
* Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep.
* Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep.
* Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example).

Causes of chronic insomnia include:

* Depression and/or anxiety.
* Chronic stress.
* Pain or discomfort at night.

Symptoms of Insomnia

* Sleepiness during the day.
* General tiredness.
* Irritability.
* Problems with concentration or memory.

Diagnosing Insomnia

If you think you have insomnia, talk to a professional- start with your primary care physician. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

Treatment for Insomnia

Acute insomnia may not require treatment. Mild insomnia often can be prevented or cured by practicing good sleep habits (see part 2 of 3 of this series). If your insomnia makes it hard for you to function during the day because you are sleepy and tired, your health care provider may prescribe sleeping pills for a limited time. Rapid onset, short-acting medications can help you avoid effects such as drowsiness the following day. Avoid using over-the-counter sleeping pills for insomnia since they may have undesired side effects and tend to lose their effectiveness over time.

Treatment for chronic insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy. Behavioral approaches help you to change behaviors that may worsen insomnia and to learn new behaviors to promote sleep. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful.” (source: Webmd.com)

Nothing is more frustrating than not being able to sleep. Tossing and turning, even though your body is exhausted, your mind remains active and you’re painfully aware of how soon you’ll need to awaken for the next day. Or maybe you’re plagued by daytime sleepiness, such that at any given time you are fighting the urge to close your eyes and doze off. An earlier article (part 1 of this series on Sleep habits) reviews how much sleep people need based on age. If you haven’t already, take this two minute, 10 question Sleep Hygiene Test to determine the quality of your sleep habits.

Are you suffering from sleep deprivation? Sleep experts say that if you feel drowsy during the day, even during boring activities, you likely haven’t had enough sleep. If you regularly fall asleep within 5 minutes of lying down or closing your eyes, you are probably suffering from severe sleep deprivation, or possibly a sleep disorder. Another marker of sleep deprivation is when a person begins experiencing microsleeps, (3-14 seconds of sleep in an awake person) because the body is desperate for rest. More often than not this person is not aware they are experiencing these episodes of microsleep.

Aside from chronic sleepiness, how is my health affected by poor sleep habits? Sleep deprivation can have serious effects on your health in the form of physical and mental impairments. Regularly not getting enough sleep impairs our ability to think clearly, effectively manage stress and moderate our emotions, maintain a healthy immune system/fight diseases and disrupt hormonal levels such that your body feels increased hunger without satiety, which leads to weight gain regardless of diet and exercise.

How can people begin improving their sleep habits? Sleep hygiene tips from the American Sleep Association.

Maintain a regular sleep routine

* Go to bed at the same time. Wake up at the same time. Ideally, your schedule will remain the same (+/- 20 minutes) every night of the week.

Avoid naps if possible

* Naps decrease the ‘Sleep Debt’ that is so necessary for easy sleep onset.
* Each of us needs a certain amount of sleep per 24-hour period. We need that amount, and we don’t need more than that.
* When we take naps, it decreases the amount of sleep that we need the next night – which may cause sleep fragmentation and diffulty initiating sleep, and may lead to insomnia.

Don’t stay in bed awake for more than 5-10 minutes.

* If you find your mind racing, or worrying about not being able to sleep during the middle of the night, get out of bed, and sit in a chair in the dark. Do your mind racing in the chair until you are sleepy, then return to bed. No TV or internet during these periods! That will just stimulate you more than desired.

* If this happens several times during the night, that is OK. Just maintain your regular wake time, and try to avoid naps.

Don’t watch TV or read in bed.

* When you watch TV or read in bed, you associate the bed with wakefulness.
* The bed is reserved for two things – sleep and hanky panky.

Do not drink caffeine inappropriately

* The effects of caffeine may last for several hours after ingestion. Caffeine can fragment sleep, and cause difficulty initiating sleep. If you drink caffeine, use it only before noon.
* Remember that soda and tea contain caffeine as well.

Avoid inappropriate substances that interfere with sleep

* Cigarettes, alcohol, and over-the-counter medications may cause fragmented sleep.

Exercise regularly

* Exercise before 2 pm every day. Exercise promotes continuous sleep.
* Avoid rigorous exercise before bedtime. Rigorous exercise circulates endorphins into the body which may cause difficulty initiating sleep.

Have a quiet, comfortable bedroom

* Set your bedroom thermostat at a comfortable temperature. Generally, a little cooler is better than a little warmer.
* Turn off the TV and other extraneous noise that may disrupt sleep. Background ‘white noise’ like a fan is OK.
* If your pets awaken you, keep them outside the bedroom.
* Your bedroom should be dark. Turn off bright lights.

If you are a ‘clock watcher’ at night, hide the clock.

Have a comfortable pre-bedtime routine

* A warm bath, shower
* Meditation, or quiet time

References: American Sleep Association., webmd.com, psychologytoday.com

For most of us, the words ‘sleep deprived’ describes virtually everyone we know. Sleep deprivation is so common these days it’s essentially become part of American culture, from youth to middle and late adulthood. Demanding academic and/or work schedules, caring for loved ones, social plans that carry on late into the night, and early morning exercise regimes keep us barely alert without an end in sight. It’s become the new normal to live with the effects of poor sleep habits, but how is it affecting our health and well-being in the long run? This series of articles aim to help people:

1. determine the quality of your sleep habits with a 2 minute, 10 question Sleep Hygiene Test (for the record, I scored a 69, so I hope to improve my sleep habits right along with you!)
2. discover how much sleep you should be getting, on average for your age (part 1)
3. learn how to identify key signs that you are suffering from sleep deprivation (part 2)
4. learn helpful tips for improving your sleep hygiene (part 2)
5. how to determine if you’re suffering from a sleep disorder such as insomnia (part 3)

How much sleep do we really need? The amount of sleep we need varies. Infants generally need about 16 hours a day, while adolescents need about 9 hours on average, to function optimally. Adults generally need about 7 to 8 hours a night of sleep. A very small segment of people can function normally with as few as 5 hours, though others may need 10 hours of sleep each day. Women in the first 3 months of pregnancy often need several more hours of sleep than what is normal for them. People tend to sleep more lightly and for shorter time periods as they age, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 report having sleep problems, such as insomnia, and deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may be the result of medical problems common in elderly people, and/or from the medications and treatments for those problems.

Parts 2 and 3 of this article will be published soon, so please stay tuned to learn how your sleep habits are affecting you, and how to make healthy changes in your sleeping routine.

Do other people describe you as a ‘pack rat’? Do your friends and family repeatedly comment on your inability to get rid of things, or show concern about the cluttered state of your office, home or car? Or perhaps you collect vast volumes of digital files on your computer beyond the point of usefulness, and feel incapable of deleting anything. If so, this article may help you clarify whether you have a pathological problem with hoarding.

What is Compulsive Hoarding? It is a mental disorder marked by an obsessive need to acquire (and failure to use or discard) a significant amount of possessions, even if the items are worthless, hazardous, or unsanitary. Compulsive hoarding causes significant clutter and impairment to basic living activities, including mobility, cooking, cleaning, showering, and sleeping.” (Wikipedia)

How to diagnose. Hoarding in the latest DSM-IV-TR appears only in the description of obsessive-compulsive personality disorder (OCD), and is not included in as an independent clinical disorder. Under the OCD differential diagnosis ‘hoarding’ should be diagnosed when it is categorically “extreme.” Therefore clinicians should diagnose “extreme” hoarding as OCD, and less than “extreme” hoarding may be a part of a different diagnosis, such as obsessive-compulsive personality disorder.

A primary anxiety in hoarders occurs when they are threatened by forced clearing of their possessions. They literally feel unable to discard their collections, regardless of the harm or dysfunction their behavior has caused.

In its worst forms, compulsive hoarding can cause fires, unclean conditions (e.g. rat and roach infestations, injuries from tripping on clutter and other health and safety hazards, according to Sanjaya Saxena, MD, director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego. The hoarder may mistakenly believe that the hoarded items are very valuable, or the hoarder may know that the accumulated items are useless, or may attach a strong personal value to items that they recognize would have little or no value to others.

Levels of hoarding. Although not commonly used by clinical psychologists, criteria for five levels of hoarding have been set forth by the National Study Group on Chronic Disorganization (NSGCD) entitled the NGSCD Clutter Hoarding Scale. Using the perspective of a professional organizer, this scale distinguishes five levels of hoarding with Level I (Roman numeral one) being the least severe and Level V (Roman numeral 5) being the worst. Within each level there are four specific categories which define the severity of clutter and hoarding potential.

* Structure and zoning;
* Pets and rodents;
* Household functions; and
* Sanitation and cleanliness.

Level I Hoarder

Household is considered standard. No special knowledge in working with the Chronically Disorganized is necessary.
Level II Hoarder

Household requires professional organizers or related professionals to have additional knowledge and understanding of Chronic Disorganization.
Level III Hoarder

Household may require services in addition to those a professional organizer and related professional can provide. Professional organizers and related professionals working with Level III households should have significant training in Chronic Disorganization and have developed a helpful community network of resources, especially mental health providers.
Level IV Hoarder

Household needs the help of a professional organizer and a coordinated team of service providers. Psychological, medical issues or financial hardships are generally involved. Resources will be necessary to bring a household to a functional level. These services may include pest control services, “crime scene cleaners,” financial counseling and licensed contractors and handy persons.
Level V Hoarder

Household will require intervention from a wide range of agencies. Professional organizers should not venture directly into working solo with this type of household. The Level V household may be under the care of a conservator or be an inherited estate of a mentally ill individual. Assistance is needed from many sources. A team needs to be assembled. Members of the team should be identified before beginning additional work. These members may include social services and psychological/mental health representative (not applicable if inherited estate), conservator/trustee, building and zoning, fire and safety, landlord, legal aid and/or legal representatives. A written strategy needs to be outlined and contractual agreements made before proceeding.

Subtypes and related conditions

Book hoarding. Bibliomania is an obsessive–compulsive disorder involving the collecting or hoarding of books to the point where social relations or health are damaged. One of several psychological disorders associated with books, bibliomania is characterized by the collecting of books which have no use to the collector nor any great intrinsic value to a more conventional book collector. The purchase of multiple copies of the same book and edition and the accumulation of books beyond possible capacity of use or enjoyment are frequent symptoms of bibliomania.

Digital hoarding*. Digital hoarding involves collecting files on one’s computer beyond the point of usefulness. Often, files can be acquired through the Internet at no monetary cost, leading to extraordinarily large collections. Examples are music collections, often beyond what one enjoys or can listen to and television shows, movies and computer games. Hoarders, or “digital pack rats” often resort to buying optical media or new hard drives to store their collections, rather than deleting what they may never use.

Digital hoarders find it just as difficult to press delete as traditional hoarders find throwing items in the trash can or taking things to the dump. They have the same feeling of clutter and chaos, and feel that they might find the item useful “someday,” and similarly spend large amounts of time acquiring and organizing their collections. However, unlike physical clutter, automated systems exist to organize digital clutter. Scientific American remarked that humanity’s propensity for data collection is growing at a rate faster than their ability to store it.

*Digital hoarding is not a currently recognized subtype of compulsive hoarding by the DSM.

Animal hoarding. Animal hoarding involves keeping larger than usual numbers of animals as pets without having the ability to properly house or care for them, while at the same time denying this inability. Compulsive animal hoarding can be characterized as a symptom of obsessive–compulsive disorder rather than deliberate cruelty towards animals. Hoarders are deeply attached to their pets and find it extremely difficult to let the pets go. They typically cannot comprehend that they are harming their pets by failing to provide them with proper care. Hoarders tend to believe that they provide the right amount of care for their pets. The American Society for the Prevention of Cruelty to Animals provides a “Hoarding Prevention Team,” which works with hoarders to help them attain a manageable and healthy number of pets.

Animal hoarders display symptoms of delusional disorder in that they have a “belief system out of touch with reality”. Virtually all hoarders lack insight into the extent of deterioration in their habitations and the health of their animals, refusing to acknowledge that anything is wrong. Delusional disorder is an effective model in that it offers an explanation of hoarder’s apparent blindness to the realities of their situations. Another model that has been suggested to explain animal hoarding is attachment disorder, which is primarily caused by poor parent-child relationships during childhood. As a result, those suffering from attachment disorder may turn to possessions, such as animals, to fill their need for a loving relationship. Interviews with animal hoarders have revealed that often hoarders experienced domestic trauma in childhood, providing evidence for this model. Perhaps the strongest psychological model put forward to explain animal hoarding is obsessive–compulsive disorder (OCD).

References

1. Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, Baker SK, Baxter LR Jr: Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry 2004; 161:1038–1048
2. Wikipedia, the free online encyclopedia.
3. DSM-IV-TR
4. Cumpulsive hoarding and the meaning of things, by Randy Frost & Gail Steketee, Houghton Mifflin Harcourt.

Today’s cultural era of instant gratification has shaped our expectations of just about everything, including our personal relationships. The question of when to have sex in a new relationship continues to perplex many of us. Why? Most of us have learned the hard way, that sex has a way of complicating relationships, and never more so than when it is with a new person.

Joan Allen, a relationship expert and author of Celebrating Single and Getting Love Right: From Stalemate to Soulmate says “wait as long as you can.” Her rationale for this statement may seem like obvious and sound advice to some of us, but to others it may sound old-fashioned. It also seems the younger you are, the more likely you are to “go with the heat of the moment” by allowing physical attraction to be the leading factor in deciding when to have sex. Not surprisingly, as we gain age and experience many of us have had too-soon sexual encounters that have lead to undesirable consequences or unhealthy relationships. “You might find that you don’t even like the person,” says Allen. When sex occurs too soon “It becomes much more difficult to objectively see each other’s character traits” says Susanne Alexander, a relationship coach and author of Can We Dance? Learning the Steps for a Fulfilling Relationship. “Some couples then slide into engagement and marriage only to discover they have missed seeing major aspects of each other.”

Practically speaking, many people desire casual sexual relationships only, with no implied or intended commitment to their sexual partner. Regardless of the level of commitment, sexual partners can only benefit from talking about where they see their relationship going and how sex might change things — before they begin engaging in sexual acts with each other.

“There needs to be a conversation up front. The woman may assume sex implies a commitment; the man may not see it that way,” says Allen. “If you just want a one-night stand, you owe it to your partner to tell them ‘it’s just sex I’m after,'” says Cheryl McClary, PhD, JD, professor of women’s health at University of North Carolina-Asheville. A sexual partner may not be happy to hear this, but hopefully it will minimize the misunderstandings and conflicts that are inevitable without this conversation.

Just as important is an up-front conversation about sexually transmitted diseases (STDs). “The risks of STDS have got to be discussed and prevented from spreading,” says relationship expert Joan Allen. “I say definitely use condoms, even if you’re in a committed relationship,” she adds.

US HIV/AIDS statistics:

* Roughly one million people living with HIV/AIDS in the United States.
* Since the start of the AIDS epidemic, 1.5 million Americans have been infected with HIV and more than 524,000 have died of AIDS.
* At least 40,000 people are infected each year.
* African Americans account for 48% of new HIV infections.
* AIDS is the leading cause of death for African American women aged 25 to 34 and HIV rates among Hispanic women are increasing.
* The number of women living with HIV has tripled in the last two decades.
* At least half of all new infections are among people under the age of 25.
* Washington, DC has the highest HIV/AIDS prevalence rates in the United States – one in 20 people are living with HIV or AIDS.