Insomnia

Are you struggling to even keep your eyes open as you read this? Is fatigue and tiredness a common issue plaguing your day-to-day life? Do you notice that going to bed, instead of being restful and relaxing, is instead stressful and worrying because you’re not getting the hours of sleep that you need?

If you answered yes to these questions, you might be struggling with insomnia. However, not all sleep-related difficulties are truly insomnias. Understanding the nature of this problem can be a critical step to getting relief. In this article, we’ll go into more detail about what insomnia is as well as its symptoms, causes, diagnosis, and treatments.

What is Insomnia?

Insomnia is a general term that describes sleep problems that can include difficulty falling asleep, the inability to stay asleep over the course of the night, or early morning awakening. Because of the variation in how this is experienced and its causes, it is not uncommon to see the term “insomnias” used to reference the diversity of issues related to this kind of sleep disruption.

Insomnia can be an acute, short-term issue or a chronic, long-term problem. If the problem lasts for less than three months, it is generally considered short-term. Chronic insomnia persists for more than three months and multiple times (3 or more) per week.

Between these two types, the American Academy of Sleep Medicine estimates that up to 35% of adults complain of insomnia.

What Are the Symptoms of Insomnia?

The symptoms of insomnia can be felt when you’re trying to sleep and/or during the day. Excessive Daytime Sleepiness (EDS) is when you find that you are fatigued and tend to drift off to sleep during the day. EDS can be a clear indication of insomnia.

Other symptoms of insomnia are related to the functional difficulties related to sleeping problems. For example, symptoms can include the inability to actually fall asleep when you first try to go to bed, waking up in the middle of the night without the ability to fall back asleep, or awakening early in the morning without feeling refreshed.

As this indicates, it’s important to remember that there’s no one way to experience or deal with insomnia. It can present in various ways that may be related to its diverse causes.

What Are the Causes of Insomnia?

Insomnia affects a significant portion of the population. It tends to be more common in women and in people over 65, but it certainly can have an impact on people of all demographics.

Causes of insomnia are numerous and can be internal or external. Examples of some of the most well-established causes of insomnia include:

Lifestyle habits and sleep hygiene

Research about sleep has identified that there are certain habits and lifestyle choices that can influence how easy it is to fall asleep and stay asleep. Below is a list of things that may contribute to insomnia. Some of these habits are general while others fall specifically into the category of sleep hygiene:

  • Variable bedtimes: people who have little or no consistency in when they go to bed are more prone to have issues falling asleep.
  • Napping: sleeping during the day, especially in the afternoon or later, can disrupt sleeping at bedtime.
  • Poor sleep setting: if there’s too much noise or light, if the bedroom temperature is too extreme, or if a mattress isn’t comfortable, it can prevent successful sleeping.
  • Night shifts: working late and being on a nocturnal schedule can have significant consequences for establishing a steady sleep routine.
  • Lack of exercise: studies have shown that regular exercise can help promote good sleep, yet many people fail to get sufficient exercise.
  • Too much screen time: using mobile phones, laptops, or tablets in bed can prevent the body from naturally preparing itself for sleep.

Anxiety about sleep

When sleep problems start, sometimes it can form a downward, self-fulfilling spiral in which worrying about falling asleep actually makes it harder to fall asleep. This is sometimes referred to as psychophysiologic insomnia, and it can cause insomnia to continue even after other issues (such as stress or physical conditions or problems with sleep hygiene) are resolved.

Physical conditions

Insomnia can come about because of some physical conditions, disorders, or other problems, including the following:

  • Pain: any health issue that causes pain may make it hard to fall asleep or stay asleep. For example, arthritis pain may make it hard to get comfortable, and joint stiffness in the night may cause someone to wake up through the night.
  • Seizures: health conditions that cause seizures may disrupt sleep, making it hard to stay asleep through the night.
  • Frequent urination: conditions that cause frequent urination, for example benign prostatic hyperplasia (BPH) in men, can force someone to have to wake up many times in the night with the need to go to the bathroom.
  • Pregnancy: pregnancy affects the production of hormones in the body, and the increased level of progesterone can make it harder for pregnant moms to fall asleep.
  • Sleep apnea: obstructive sleep apnea (OSA) is a condition that causes breathing disruptions and brief pauses in breathing that can induce a person to wake up many times through the night.

Mental health issues

In addition to physical issues, mental disorders can also have a direct impact on sleep and can cause insomnia. Some of these mental issues include:

  • Depression: research has clearly demonstrated that insomnia is more common in people with depression and that untreated depression makes it much harder to get quality sleep.
  • Bipolar disorder: people who are bipolar have also been found to have greater likelihood of insomnia.
  • Stress: excessive stress such as from work or family preoccupations can cause major problems with insomnia. Normally the resolution of these problems can lead to improved sleep, but sometimes there are lingering effects (such as with psychophysiologic insomnia).

Drug-related insomnia

Insomnia can be a consequence of using some types of drugs and medications. Examples of some of these include:

  • Alcohol: one of the effects of alcohol consumption, especially later in the day, is to make it harder to get a good night’s sleep.
  • Caffeine: because of its stimulant effects, caffeine, including from coffee and soft drinks, can disrupt sleep.
  • Nicotine: this drug from tobacco, including cigarettes and smokeless tobacco, can cause wakefulness and sleep interruptions.
  • Prescription drugs: a significant number of prescription drugs can cause insomnia. These include many antidepressants (such as Prozac and Zoloft), dopamine agonists, diuretics, cold medicines, steroids, anticonvulsants, amphetamines, appetite suppressants, oral contraceptives, chemotherapies, hypnotics, sedatives, and others. Insomnia can in some cases be a withdrawal symptom of some drugs when their use is discontinued.

What Are the Health Risks of Insomnia?

The most common health risk associated with insomnia is excessive daytime sleepiness. This fatigue can reduce one’s overall wellness, mood, and productivity. It can also dramatically increase the risk for auto collisions or other types of accidents and injuries.

Sleep also plays a critical role in allowing the systems of our body to recover and keep us healthy. As a result, a lack of sleep can spill over to affect our minds and bodies in ways that are not always immediately apparent. However, there are indications that insomnia and ongoing sleep disruptions can thus make people more susceptible to other serious health issues including obesity, diabetes, anxiety, and cardiovascular issues.

How Are Insomnias Diagnosed?

Because insomnia often occurs as a consequence of other things, diagnosing it typically starts with a medical history and physical exam. A doctor will want to know about any medications that you’re taking and any other health problems that may be affecting you. The doctor will also likely ask about the details of your sleep problems such as when they started and how often they are affecting you. This may involve tracking your sleep in a sleep journal.

This process is normally sufficient to diagnose insomnia, but if the doctor suggests that there are other health problems that are influencing your sleep, then additional tests may be ordered to conduct a full evaluation.

How Are Insomnias Treated?

There is no one single treatment for insomnia. The treatment usually depends on the reason why a person is experiencing difficulties sleeping. In each case, a doctor will recommend specific steps to try to help you start sleeping soundly. Examples of insomnia treatments include:

  • Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT is a type of therapy that is used for many psychological conditions. It is a type of talk therapy that attempts to help a patient understand and address issues like depression or anxiety that might be affecting sleep. CBT-I focuses specifically on this sleep-related aspect. CBT-I usually requires numerous visits with a trained mental health professional, and research has found it to be a highly effective method for many patients.
  • Sleep hygiene modification: steps for treating insomnia often incorporate changes to a patient’s routine around sleep. For example, sleep restriction therapy works by standardizing times for going to bed and waking up each day. Other modifications can include reducing screen time, eliminating naps, decreasing noise or light in the bedroom, and similar changes.
  • Managing other health conditions: if insomnia is being caused because of an underlying health problem, then one aspect of treatment is to work to eliminate that underlying problem. This can involve medications, physical therapy, or other care that is tailored to the needs of any individual patient.
  • Use of medications: there is a wide variety of medication available to try to treat insomnia. Some of these medications are available over-the-counter (OTC) while others require a prescription. Many of the drugs used for insomnia can be habit forming or may have other side effects that make it inadvisable to continue their use for the medium-to-long term. As a result, use of medication may be combined with the other treatments mentioned above in order to achieve a more durable remedy for insomnia.

What Medications Are Available for Insomnias?

There are many different types and classes of medications that are available for treating insomnia. While not an all-inclusive list, most of the most common drugs are listed below.

Over-the-counter (OTC)

Melatonin
Antihistamines
Diphenhydramine (Benadryl)
Triprolidine (Actifed, Actidil, Myidil)
Doxylamine (Unisom)

Benzodiazepines

Alprazolam (Xanax)
Lorazepam (Ativan)
Clonazepam (Klonopin)
Diazepam (Valium)

Benzodiazepine receptor agonists

Zolpidem tartrate (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)

Melatonin receptor agonists

Tasimelteon (Hetlioz)
Agomelatine (Valdoxan, Thymanax, Melitor)
Amelteon (Rozerem)

Orexin receptor antagonists

Suvorexant

Herbal therapies

Valerian
Lavender
Chamomile
Passionflower
Kava

It is important to talk with a doctor before considering using any medication for insomnia, including those that are sold over-the-counter. A doctor is in the best position to ensure that a medication is appropriate for you and can help review any potential side effects as well as proper dosage and usage.

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