Insomnia means sleep disorder (insufficient sleep) in which you cannot sleep well, or you may experience difficulty falling and staying asleep or waking up too early. This disorder affects millions of people across the globe and is triggered by a range of physical and psychological factors. Some of these factors include stress, jet lag, caffeine, genetics, and life-changing events like the death of a loved one.
Sometimes, insomnia is temporary. You may experience it briefly (acutely) when upset and anxious. However, in some cases, it is a long-term issue and is termed chronic insomnia.
Both forms of insomnia (acute and chronic) are quite common. Approximately one in three adults suffer from insomnia symptoms, and about ten percent of adults are diagnosed with the disorder.
Also, insomnia could be primary or secondary. Primary insomnia means sleep problems are not associated with any health conditions, and secondary insomnia is linked to various underlying medical conditions like cancer, depression, substance use like alcohol, arthritis, and heartburn.
This article comprehensively discusses various causes, symptoms, diagnoses, and treatment options for insomnia.
The Root Causes of Insomnia and How They Affect Sleep
There are several causes of insomnia. A combination of both physical and psychological factors leads to insomnia.
Physical factors that cause insomnia:
- Medical Conditions: Several medical conditions can have an impact on sleep patterns. For example, respiratory problems like sleep apnea, which causes sleep disturbances; gastrointestinal issues that keep you awake; fluctuating levels of hormones in women during menstruation, pregnancy, and menopause that trigger hot flushes and sweating can cause insomnia.
- Chronic Pain: Back pain and medical conditions like arthritis, where you experience chronic pain, can cause insomnia.
- Restless Legs Syndrome (RLS): It is a neurological disorder causing an irresistible urge to move your legs, especially when in bed trying to fall asleep, often accompanied by unpleasant sensations. This disrupts sleep and causes insomnia.
- Thyroid Disorders: Conditions like hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid) result in symptoms like night sweats, muscle pain, and fatigue that disrupt sleep.
- Medications: Selective serotonin reuptake inhibitors, Corticosteroids like dexamethasone, antidepressants such as Prozac®and Zoloft®, Decongestants for a stuffy nose like Sudafed, Beta-blockers like propranolol, Theophylline which is used to treat asthma and Nicotine replacement medications like Nicoderm CQ to help quit smoking can cause sleep disruptions. Other medications that can cause insomnia include statins, alpha-blockers and beta-blockers, cholinesterase inhibitors, nonsedating H1 agonists, and angiotensin-converting enzyme, or ACE inhibitors.
- Caffeine and Stimulant Use: Caffeine can delay your body clock timing by blocking adenosine (a sleep-inducing chemical) and making it extremely difficult to initiate sleep. Caffeine acts as a stimulant that promotes wakefulness and reduces the amount of deep sleep, causing insomnia.
- Alcohol and substance use: Alcohol tends to cause an increase in sleep latency, affect REM (Rapid Eye Movement), and inhibit neurotransmitters that activate wakefulness. Alcohol has a sedative effect in the early stages but results in disturbed, unrestful, and fragmented sleep.
- Irregular Sleep Schedule: Irregular sleep-wake rhythm disorder (ISWRD) shows irregular sleep and wakefulness duration symptoms. This is caused by not following a regular sleep pattern, disrupting the daily sleep-wake cycle, and causing insomnia.
- Environmental Factors: High-intensity artificial bright lights, extreme noise, uncomfortable bed and mattress, and electronic distractions can contribute to insomnia.
Psychological factors that cause insomnia
Several anxiety disorders like major depression, post-traumatic stress disorder, dementia, and schizophrenia also cause insomnia. Getting up from bed too early could be a sign of major depression. You could be experiencing insomnia with other mental health disorders.
All cases of insomnia are different. People can be impacted by insomnia differently. The concept of quality sleep is not the same for everyone. While the average good quality sleep for an adult is around eight hours, for some people, it is only five hours, and for some, it is ten hours more. So, what may appear as insomnia for one person may be quality sleep for another. However, some common symptoms of insomnia include:
- Difficulty falling or staying asleep
- Gastrointestinal issues
- Waking up too early in the morning
- Irritability, tension headaches, and depression
- Daytime fatigue or sleepiness
- Poor focus and concentration
- Feeling restless, irritated, aggressive, and impulsive
- Low energy and motivation
- Increased accidents and errors
- Depending on certain medications and alcohol to fall asleep
- Difficulty focusing on work, socializing, and studying
Complications of insomnia may include:
- Impact on memory and concentration
- Diabetes Mellitus (high blood glucose)
- Development of chronic diseases such as high blood pressure, Obesity, Coronary heart disease
- Risk of depression and anxiety
- Risk of poor immune system function
- Conditions that involve psychosis
Insomnia can happen to anyone at any age, but some factors increase the risk, and these include:
- Being aged
- Family history of insomnia
- Substance use like drugs and alcohol
- Going through life events
- Shift working
- Intense traveling across different time zones changes your biological clock and eventually affects your sleep patterns
- Menopause in females
- Having some underlying health conditions – both physical and mental health conditions
Diagnosis of Insomnia
Your General Practitioner or sleep consultant will conduct a comprehensive evaluation, including your sleep times, patterns, factors disrupting your sleep, and any health conditions contributing to insomnia.
A sleep diary helps your sleep specialist or doctor assess the sleep you are experiencing and what factors are disrupting your sleep. You can record when you go to bed, wake up, and the number of naps you take during the day. You can also record how you feel after consuming alcohol or caffeine and when you do physical activity or any exercise. A doctor can research, diagnose, and treat insomnia by tracking these variables.
Your general practitioner will assess your heart and lungs and look for risk elements like sleep apnea, bigger neck circumference tonsils, etc, to rule out other medical conditions that might disrupt your sleep.
Sleep Study (Polysomnography)
In this test, sensors are attached to your face, limbs, chest, scalp, eyelids, and just one finger. These sensors record and track the brain wave activity, oxygen levels, heart rhythms and breathing rates, and movement of muscles before and after sleep. This entire procedure is conducted in a sleep center; home kits are also available for this test at home. This procedure is non-invasive (non-surgical) and painless.
Actigraphy involves overnight sleep studies. A sensor is attached to your ankle or wrist for fourteen consecutive days, recording and monitoring your sleep-wakefulness patterns.
These include blood tests to figure out any underlying health conditions like thyroid, cancer, etc, that can exacerbate sleep problems
Types of Insomnia
- Acute insomnia is defined as a short-term and temporary sleep difficulty lasting from one night to a few weeks.
- Chronic insomnia is defined as insomnia that is caused due to extreme stress, habits that negatively impact sleep, and life-changing events. It can last three months (three or more days each week in continuity) or longer.
- Onset insomnia refers to hardship in initiating or falling asleep. The onset of several short-term stressors, caffeine use, and anxiety triggers it. However, it could also happen simultaneously with other sleep issues.
- Sleep Maintenance Insomnia refers to fragmented sleep, which is the inability to stay throughout the night. It involves getting up too early and struggling to return to bed.
- Behavioral insomnia refers to bedtime resistance or refusal. It is seen mostly in children and includes delayed sleep onset and long hours of awakening during the night
Comprehensive Treatments for Insomnia: Medication, Therapy, and Lifestyle Changes
There are several medications – both over-the-counter (OTC) and prescribed sleeping pills that help in falling asleep.
OTC sleeping pills contain antihistamines (diphenhydramine and doxylamine succinate), which are helpful to ease sleeplessness. However, sleep specialists advise not to rely on these for treating chronic insomnia because they elevate the risk of dementia.
For Prescription sleeping pills, you need a prescription from your general practitioner to buy these from the pharmacy. These prescription sleeping pills are stronger than the OTC ones.
Different prescription sleeping pills include:
- Antidepressants like Mirtazapine and trazodone help fall asleep
- Benzodiazepines like temazepam and triazolam are helpful for short-term treatment of insomnia (4 weeks). Long-term use of these should be avoided as these have adverse effects.
- Sedative hypnotics or Z-drugs (Ambien® and Lunesta®) are also used for short-term insomnia.
Cognitive Behaviour Therapy (CBT) is the first line of treatment if sleep hygiene habits and relaxation techniques have not helped you. It is an evidence-based treatment with a seventy-eight percent success rate. This therapy helps you identify the factors, thoughts, and behaviors that disrupt your sleep. Unlike sleeping aids, the therapy helps you to replace your sleep-disrupting elements with sleep-promoting thoughts and behaviors.
CBT addresses three factors that contribute to persistent insomnia:
- Conditioned arousal – the repeated linkage of sleep-related cues with wakefulness
- Recognizing and removing habits established to improve sleep but have stopped showing effectiveness.
- Alleviating sleep-related concerns and other sources of heightened arousal.
Very simple lifestyle changes could improve your sleep problems. A healthy diet, regular sleep schedule, avoiding gadgets and electronic devices like TV in the bedroom, limiting caffeine and alcohol intake, and practicing relaxation techniques could ease insomnia symptoms.
Managing Chronic Insomnia: Long-Term Strategies for Restful Nights
Sleep is an important component of your good health. For optimal health and well-being, it is recommended to incorporate the below strategies into your daily routine:
- Try to follow a consistent sleep schedule. Go to bed at the same time every day and wake up at the same time every morning
- Avoid sleeping/naps during the day as it disrupts your sleeping ability during the night
- Take a bath or shower to relax your body before going to bed. Taking a hot bath ninety minutes before going to bed helps older adults in deep sleep
- Exercise every day to improve your physical health. Physical activity releases endorphins and mood boosters, increases alertness, and releases dopamine in your body, producing a runner’s high and keeping you motivated during the day. Avoid exercising before going to bed
- Dietary habits
- Do not sleep on an empty stomach. Your hunger at night may disrupt your sleep. Eat a healthy snack before you go to bed
- Do not eat a heavy meal within three hours of going to sleep
- Avoid alcohol and caffeine consumption, especially after sunset
- Eat healthy food for overall well-being
- Well-being and relaxation
- Before sleeping, always do some breathing exercises to calm your body and brain
- Read a book or listen to some soft music to initiate sleep
- Optimize your bedroom. Keep your bedroom dark and cool and free of electronic devices. Eliminate any external light and noise and make your bedroom conducive to falling and staying asleep
- Incorporate mindfulness, meditation, and paced breathing into your sleep routine to minimize anxiety and promote relaxation
- Take a melatonin supplement. A melatonin supplement is a safe and easy way to improve sleep quality
Insomnia is a condition and not a health disease. Most people who experience short-term insomnia may feel fatigued, but this condition improves once they get quality sleep. However, chronic insomnia is serious and disruptive. While it is not dangerous in most situations, it can alter your quality of life in many ways, especially if some underlying health conditions trigger insomnia.
If your symptoms last for more than three weeks, it is important to consult your healthcare provider. Your doctor may suggest several treatment options, sleeping aids, medicines, and therapies for your sleep issue.
It is also important to understand that practicing good sleep hygiene, eating a healthy diet, engaging in physical activity, and following a regular bedtime and wake-up time can help you overcome insomnia.