What is Insomnia?
It may result in an increased risk of motor vehicle collisions, as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month.
Insomnia can occur independently or as a result of another problem. Conditions that can result in insomnia include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, and drugs such as caffeine, nicotine, and alcohol.
Other risk factors include working night shifts and sleep apnea. Diagnosis is based on sleep habits and an examination to look for underlying causes. The sleep study may be done to look for underlying sleep disorders. Screening may be done with two questions: “do you experience difficulty sleeping?” and “do you have difficulty falling or staying asleep?”
Sleep hygiene and lifestyle changes are typically the first treatment for insomnia. Sleep hygiene includes a consistent bedtime, exposure to sunlight, a quiet and darkroom, and regular exercise. Cognitive-behavioral therapy may be added to this. While sleeping pills may help, they are associated with injuries, dementia, and addiction. These medications are not recommended for more than four or five weeks. The effectiveness and safety of alternative medicine are unclear.
How long does insomnia last?
Insomnia may be characterized based on its duration. Acute insomnia is brief and often happens because of life circumstances (for example, when you can’t fall asleep the night before an exam, or after receiving stressful or bad news). Many people may have experienced this type of passing sleep disruption, and it tends to resolve without any treatment.
Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months. Chronic insomnia disorders can have many causes. Changes in the environment, unhealthy sleep habits, shift work, other clinical disorders, and certain medications could lead to a long-term pattern of insufficient sleep. People with chronic insomnia may benefit from some form of treatment to help them get back to healthy sleep patterns. Chronic insomnia can be comorbid, meaning it is linked to another medical or psychiatric issue, although sometimes it’s difficult to understand this cause and effect relationship.
People with insomnia tend to have difficulty falling asleep (onset), staying asleep (maintenance), and/or they wake up too early in the morning. Treatment for insomnia can include behavioral, psychological, medical components or some combination thereof. You and your doctor will need to talk about your particular situation and history of insomnia, as well as its causes, to decide on the best treatment plan.
Types Of Insomnia
Insomnia includes a wide range of sleeping disorders, from lack of sleep quality to lack of sleep quantity. Insomnia is commonly separated into three types:
- Transient insomnia – occurs when symptoms last up to three nights.
- Acute insomnia – also called short-term insomnia. Symptoms persist for several weeks.
- Chronic insomnia – this type lasts for months, and sometimes years. According to the National Institutes of HealthTrusted Source, the majority of chronic insomnia cases are side effects resulting from another primary problem.
What Causes Insomnia?
Insomnia may be the primary problem, or it may be associated with other conditions.
Chronic insomnia is usually a result of stress, life events or habits that disrupt sleep. Treating the underlying cause can resolve insomnia, but sometimes it can last for years.
Common causes of chronic insomnia include:
- Stress. Concerns about work, school, health, finances or family can keep your mind active at night, making it difficult to sleep. Stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
- Travel or work schedule. Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
- Poor sleep habits. Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating or watching TV. Computers, TVs, video games, smartphones or other screens just before bed can interfere with your sleep cycle.
- Eating too much late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but insomnia may persist after the medical condition improves.
Additional common causes of insomnia include:
- Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
- Medications. Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy, and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
- Medical conditions. Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
- Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
- Caffeine, nicotine, and alcohol. Coffee, tea, cola and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes an awakening in the middle of the night.
Insomnia and aging
Insomnia becomes more common with age. As you get older, you may experience:
- Changes in sleep patterns. Sleep often becomes less restful as you age, so noise or other changes in your environment are more likely to wake you. With age, your internal clock often advances, so you get tired earlier in the evening and wake up earlier in the morning. But older people generally still need the same amount of sleep as younger people do.
- Changes inactivity. You may be less physically or socially active. A lack of activity can interfere with a good night’s sleep. Also, the less active you are, the more likely you may be to take a daily nap, which can interfere with sleep at night.
- Changes in health. Chronic pain from conditions such as arthritis or back problems as well as depression or anxiety can interfere with sleep. Issues that increase the need to urinate during the night ―such as prostate or bladder problems ― can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age.
- More medications. Older people typically use more prescription drugs than younger people do, which increases the chance of insomnia associated with medications.
Insomnia in children and teens
Sleep problems may be a concern for children and teenagers as well. However, some children and teens simply have trouble getting to sleep or resist regular bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning.
What Are Signs and symptoms
Insomnia itself may be a symptom of an underlying medical condition. However, there are many signs and symptoms that are associated with insomnia:
- Difficulty falling asleep at night.
- Waking during the night.
- Waking earlier than desired.
- Still feeling tired after a night’s sleep.
- Daytime fatigue or sleepiness.
- Irritability, depression, or anxiety.
- Poor concentration and focus.
- Being uncoordinated, an increase in errors or accidents.
- Tension headaches (feels like a tight band around the head).
- Difficulty socializing.
- Gastrointestinal symptoms.
- Worrying about sleeping.
Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed and may have a sensation of tiredness and sleepiness throughout the day.
Having problems concentrating and focusing on tasks is common for people with insomnia. According to the National Heart, Lung, and Blood Institute, 20 percent of trusted sources of non-alcohol related car crash injuries are caused by driver sleepiness.
Treatment of Insomnia
Some types of insomnia resolve when the underlying cause is treated or wears off. In general, insomnia treatment focuses on determining the cause.
Once identified, this underlying cause can be properly treated or corrected.
In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be used as therapies.
Non-pharmacological approaches include cognitive-behavioral therapy (CBT) in one-on-one counseling sessions or group therapy:
Medical treatments for insomnia include:
- prescription sleeping pills
- antidepressants
- sleep aids available online or over-the-counter
- antihistamines
- melatonin, which can be purchased online
- ramelteon
Home remedies of Insomnia
Home remedies for insomnia include:
- Improving “sleep hygiene”: Not sleeping too much or too little, exercising daily, not forcing sleep, maintaining a regular sleep schedule, avoiding caffeine at night, avoiding smoking, avoiding going to bed hungry, and ensuring a comfortable sleeping environment.
- Using relaxation techniques: Examples include meditation and muscle relaxation.
- Stimulus control therapy – only go to bed when sleepy. Avoid watching TV, reading, eating, or worrying in bed. Set an alarm for the same time every morning (even weekends) and avoid long daytime naps.
- Sleep restriction: Decreasing the time spent in bed and partially depriving the body of sleep can increase tiredness, ready for the next night.
Diagnosis of Insomnia
The asleep specialist will start by asking questions about the individual’s medical history and sleep patterns.
A physical exam may be conducted to look for possible underlying conditions. The doctor might screen for psychiatric disorders and drug and alcohol use.
The Stanford Center for Sleep Sciences and Medicine explains that the term “insomnia” is often used to refer to “disturbed sleep.”
For a diagnosis of insomnia, disturbed sleep should have lasted for more than 1 month. It should also negatively impact the patient’s wellbeing, either through the causing distress or disturbing mood or performance.
The patient may be asked to keep a sleep diary to help understand their sleeping patterns.
Other tests may include a polysomnograph. This is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted. This uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.
Risk factors of Insomnia
Insomnia can affect people of any age; it is more common in adult femalesTrusted Source than adult males. It can undermine school and work performance, as well as contributing to obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time.
Some people are more likely to experience insomnia. These include:
- travelers, particularly through multiple time zones
- shift workers with frequent changes in shifts (day vs. night)
- the elderly
- users of illegal drugs
- adolescent or young adult students
- pregnant women
- menopausal women
- those with mental health disorders
Good Sleep Habits for Beating Insomnia
Good sleep habits, also called sleep hygiene, can help you get a good night’s sleep and beat insomnia. Here are some tips:
- Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day, because naps may make you less sleepy at night.
- Avoid prolonged use of phones or reading devices (“e-books”) that give off the light before bed. This can make it harder to fall asleep.
- Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
- Get regular exercise. Try not to exercise close to bedtime, because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for at least three to four hours before the time you go to sleep.
- Don’t eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
- Make your bedroom comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If the light is a problem, try a sleeping mask. If noise is a problem, try earplugs, a fan, or a “white noise” machine to cover up the sounds.
- Follow a routine to help you relax before sleep. Read a book, listen to music, or take a bath.
- Avoid using your bed for anything other than sleep or sex.
- If you can’t fall asleep and don’t feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
- If you find yourself lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.
Frequently Asked Questions About Insomnia
What is insomnia?
Insomnia is a sleep disorder that refers to any difficulty sleeping, including problems falling asleep, staying asleep, or returning to sleep after waking even when you have the opportunity to do so.
Consequently, people with insomnia often do not get enough sleep, and the sleep they do get is not refreshing. The word insomnia itself comes from the Latin “in somus” (no sleep), and it is estimated this common disorder affects about 30% of adults.
What are the symptoms of insomnia?
The main symptoms of insomnia are difficulty falling asleep and staying asleep, waking during the night, and having problems falling back asleep or waking up earlier in the morning.
As a result, people with insomnia often do not sleep much, which can result in the following symptoms:
- Sleep is nonrestorative
- Fatigue
- Daytime tiredness
- Lack of energy
- Difficulty concentrating or thinking
- Mood changes
- Irritability
- “Acting out” with impulsiveness or aggression
- Accidents or mistakes
- Problems at work or school
- Difficulty with relationships
- Frustration about sleeping
Women suffer from insomnia more than men. True or false?
True. Women are more likely to suffer from insomnia than men. Hormones seem to be the culprit. Hormonal changes women experience during their menstrual cycle and menopause can impact their sleep. During perimenopause (the years before menopause), women often have hot flashes and night sweats that disturb sleep.
Pregnancy is another sleep disruptor for women. The changes are hormonal, emotional, and physical. Later in pregnancy women may waken during the night to urinate, or because of physical discomfort. Women are also more likely to develop medical conditions that cause secondary insomnia such as depression, anxiety, fibromyalgia, and sleep disorders such as restless leg syndrome (RLS).
Women are more likely to suffer from insomnia than men. Hormones seem to be the culprit. Hormonal changes women experience during their menstrual cycle and menopause can impact their sleep. During perimenopause (the years before menopause) women often have hot flashes and night sweats that disturb sleep.
Pregnancy is another sleep disruptor for women. The changes are hormonal, emotional, and physical. Later in pregnancy women may waken during the night to urinate, or because of physical discomfort. Women are also more likely to develop medical conditions that cause secondary insomnia such as depression, anxiety, fibromyalgia, and sleep disorders such as restless leg syndrome (RLS).
What is secondary insomnia?
Secondary insomnia is insomnia that is a result of another problem such as a medical condition or medication.
It is the most common form of insomnia, affecting about 80% of sufferers. Problems that may cause secondary insomnia include:
- Depression, anxiety, post-traumatic stress disorder (PTSD)
- Pain
- Illness, such as some heart and lung diseases
- Medications
- Caffeine, tobacco, alcohol
- Another sleep disorder, such as sleep apnea or restless leg syndrome
- Changes in sleep routine or shift work
- Poor sleep environment
What type of insomnia can last for weeks or months?
Chronic insomnia is defined as insomnia that occurs at least three nights per week for three months or longer. It affects 10% of people with insomnia. One possible cause for chronic insomnia is a poor sleep behavioral pattern, such as bedtime routines that do not cue your body to ready itself for sleep, or your sleep schedule does not sync with your biological clock.
Another possible cause for chronic insomnia is when it is secondary insomnia, caused by another chronic medical or psychological issue that is not well-managed. Insomnia that is short-term is called acute insomnia and it usually only lasts for a few days or a few weeks.
This type of insomnia is generally the result of life circumstances, usually stressful ones such as divorce, death of a loved one, job loss, or an upcoming major exam. It could also be due to physical pain or discomfort, about with a cold, some medications, or jetlag.
Acute insomnia may also be caused by the sleep environment being too hot or cold, too noisy, or not dark enough.
What is the medical term for life-long insomnia?
The medical term for lifelong insomnia is idiopathic insomnia. This rare form of insomnia begins in childhood and has no apparent cause. It is not the result of any known stressors, psychological factors, neurological disorders, medications, or other factors that would normally influence sleep.
It is believed that idiopathic insomnia is the result of an abnormality in the sleep-wake cycle. The area of the brain that promotes sleep seems to be underactive, and the area that promotes wakefulness is overactive. Most people with idiopathic insomnia adjust to the disorder and do not develop further medical issues.
What is sleep hygiene?
Sleep hygiene is the practice of promoting regular sleep habits.
Good sleep hygiene habits benefit everyone by promoting restful sleep and daytime alertness and preventing sleep disorders. The National Sleep Foundation recommends the following tips to improve sleep:
- Go to bed at the same time each night, and wake up at the same time each morning
- Keep your bedroom quiet, dark, and at a comfortable temperature that is not too hot or too cold
- Use your bed only for sleeping and not for watching TV, reading, or listening to music
- Keep the bedroom a ‘gadget-free’ zone, and remove the TV, computer, tablet, cell phone, and gaming consoles
- Don’t eat large meals close to bedtime.
Some prescription sleep medications may become habit-forming. True or false?
True. Prescription sleep medications can help you sleep, but they can be habit-forming. This means they may be addictive, and if you take them for a while you may end up being unable to fall asleep without them. Sleep medications are generally used only for short-term treatment of insomnia, but people who suffer from severe chronic insomnia may be prescribed medication for longer periods. Talk to your doctor about any sleep medicine you are prescribed, and be sure you understand the side effects and risks, which may include:
- You may become addicted
- They may mask underlying medical conditions that cause the insomnia
- There can be drug interactions with other medications you take
- They may cause daytime sleepiness or grogginess
- They can cause rebound insomnia, where your insomnia is worse after stopping the sleep medications than it was before you started taking them
The optimal room temperature for sleeping is about 65 degrees. True or false?
True. The National Sleep Foundation suggests a bedroom temperature of 60 to 67 degrees F (15.5 to 19.5 C) is optimal for sleep. As you are getting ready for your normal bedtime, your body temperature drops slightly to start the sleep cycle. If your room is at an ideal cool temperature this can facilitate you falling asleep.
If the room is much warmer or cooler it may cause restless sleep and interfere with rapid eye movement (REM) sleep, which is the stage of sleep where you dream.
The ideal sleep temperature for babies and toddlers is slightly higher, from 65 to 70 degrees F (18.3 to 21.1 C).
Insomnia can be a serious health problem. True or false?
True. Insomnia may pose serious risks to health. Poor sleep may be a sign of a more serious sleep disorder such as sleep apnea, a condition in which a person may stop breathing for short periods during the night. Sleep apnea can be fatal if untreated.
Daytime sleepiness that results from insomnia can also have significant consequences. People who get insufficient sleep can have more car accidents, even during the day. Lack of sleep also decreases our ability to handle daily stress, which can increase the risk of mental illness or substance abuse, including abuse of sleep medications.
It is important to deal with acute short-term insomnia when it starts, so it does not become a chronic problem. Talk to your doctor to learn about treatments for insomnia.
Prescription medications are the only available treatment options for insomnia. True or false?
False. There are numerous ways to treat insomnia, and prescription medications are just one option. Often, a doctor will recommend non-medical treatments first, such as:
- Relaxation training: including breathing exercises, meditation, guided imagery, and mindfulness
- Stimulus control: limiting activities in the bedroom to only sleep-related ones so you build an association between going to bed and sleeping
- Cognitive-behavioral therapy (CBT): behavioral modification including good sleep hygiene practices, and also retraining your thinking surrounding sleep
Medical treatments for insomnia include over-the-counter (OTC) and prescription sleep aids. Consult your doctor to determine the right one for you. Classes of prescription sleep medications include:
Benzodiazepine hypnotics: estazolam (ProSom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion), and diazepam (Valium)
- Non-benzodiazepine hypnotics: zolpidem (Ambien, Ambien CR, Intermezzo), pyrazolopyrimidine (Sonata), chloral hydrate (Notec), dexmedetomidine hydrochloride (Precedex), and eszopiclone (Lunesta) – Melatonin receptor agonists: ramelteon (Rozerem)
- Orexin antagonists: suvorexant (Belsomra)
Some people prefer natural remedies for sleep, such as melatonin, valerian root, chamomile, kava kava, passionflower, and hops. Talk to your doctor before using any herbal remedy as many can interact with medications you take.