What is Insomnia?
Insomnia is the most common sleep disorder that causes sufferers to have trouble falling asleep or staying asleep. There are several different classifications of insomnia:
- Acute - a short period of insomnia, usually caused by a life change or stressful event
- Chronic - a long-term pattern of insomnia
- Comorbid - insomnia that occurs along with another condition such as depression or anxiety
- Onset - difficulty falling asleep
- Maintenance - difficulty staying asleep
- Primary - not due to any medical, psychiatric, or environmental cause; accounts for 10% of all insomnia cases
- Secondary (or comorbid insomnia) - a side effect of another problem, accounting for around 90% of all insomnia cases
- Transient - lasts for up to 3 nights
- Acute (or adjustment insomnia) - lasts for days and weeks
- Chronic - lasts for a month or more
According to the American Academy of Sleep Medicine, 30-35% of adults have brief bouts of insomnia, 15-20% have acute insomnia, and 10% have chronic insomnia.
Insomnia is more common for the following people:
- Women who are going through menopause, pregnancy, and the normal menstrual cycle experience with changes in hormones. It's especially common for women during menopause, as hot flashes disrupt sleep.
- Shift workers go to bed and wake up at different times throughout the week, and have to sleep when it's light out. Both negatively impact your circadian rhythm.
- Older people are more likely to suffer from health issues and psychological disorders that interrupt sleep.
- People with high stress due to death of a loved one, job change, moving, etc.
- Those with low income.
- Those who take naps longer than 15 minutes.
- People who have an inactive lifestyle.
- Those with a physical or psychological issue or disease are more likely to have problems getting to sleep and staying asleep.
Causes of Insomnia
Insomnia can be caused by medical conditions, poor sleep hygiene, medications/drugs, psychiatric conditions, and/or biological factors.
Here are some common medical conditions that can cause insomnia:
- Alzheimer's disease
- Chronic pain
- Drug use or withdrawal
- Gastrointestinal problems
- Neurological conditions
- Parkinson's disease
- Post-traumatic stress disorder (PTSD)
- Restless legs syndrome (RLS)
- Sleep apnea
Poor Sleep Hygiene
Sleep hygiene refers to all your lifestyle habits that influence the quality and duration of your sleep, which includes your diet, exercise, light exposure, your stress levels, and your bedroom and sleep environment. Experts recommend developing good sleep habits, such as going to bed and waking up at the same time every day, not exposing yourself to blue light within 90 minutes of bedtime, etc. For a full list of good sleep hygiene guidelines, visit our sleep tips page.
There are several types of medications for the following conditions that can cause insomnia:
- High blood pressure
- Heart disease
- Cold and allergies
- Thyroid disease
- Birth control
There are certain types of medications that can also cause insomnia:
- ACE inhibitors
- Alpha blockers
- Cholinesterase inhibitors
One common cause of insomnia is depression. Symptoms of depression, such as low energy and hopelessness can be linked with insomnia, and one can make the other worse. For example, if you experience anxiety, the anticipation of not sleeping at night can increase anxiety, which will make insomnia worse.
Insomnia can also be caused by anxiety disorders (generalized anxiety, panic attacks, obsessive-compulsive disorder), substance abuse, and mood disorders such as mania.
If you think you suffer from insomnia, speak to your doctor and remember that insomnia could be a symptom of another issue. Symptoms of insomnia include:
- Taking a long time to fall asleep
- Waking up often during the night
- Waking up early and being unable to fall back asleep, even though the sufferer is still tired
- Feeling tired during the day
- Anxiety about sleep
- Depression, irritability, lack of self-control
- Decreased focus
- Lack of coordination
- Poor memory
- Low sex drive
The health risks of insomnia include:
- Higher risk of accidents (car, bike, operating heavy machinery).
- Increased risk of mental health issues, primarily depression and anxiety.
- Increased risk of several conditions, including stroke, diabetes mellitus, obesity, asthma, seizures, high blood pressure, heart disease, inflammation, and a weakened immune system.
- Shorter life span.
- Insomnia negatively impacts the quality of life of most sufferers with higher rates of absenteeism from work, more relationship problems, lack of energy and focus, decreased memory, and less self-control.
If you've been experiencing symptoms of insomnia that last for less than a month, you can learn how to manage them by following the guidelines for good sleep hygiene. If it's more than a month, you may want to speak to a sleep physician at an accredited AASM sleep center.
Before your appointment, the doctor may ask you to keep a sleep diary for two weeks where you will record when you fall asleep, how often you wake up during the night, and when you wake up. During the appointment they will ask if you are using any medications, to provide details about your family medical history, and if you're experiencing any anxiety, depression, or stress. They may administer a blood test if they suspect any physical causes of insomnia. If they suspect sleep apnea or another sleep disorder, they may recommend an at-home sleep test or an overnight stay in a sleep facility.
Treatments depend on whether someone suffers from primary or secondary insomnia. According to the National Heart, Lung, and Blood Institute, primary insomnia isn't understood very well and major life events that are stressful can trigger primary insomnia. Secondary insomnia is much easier to treat as it usually involves making lifestyle changes. Lifestyle changes often can help relieve acute (short-term) insomnia. These changes might make it easier to fall asleep and stay asleep.
If you suffer from insomnia, there are probably several things you could change that would have a positive impact on your sleep.
Many sleep experts agree that the most important thing you can do is to go to bed and wake up at the same time every day (including weekends). Your circadian rhythm is your internal clock based on your brain's response to sunlight. This is why shift workers are more prone to insomnia, and the reason why you shouldn't expose yourself to bright lights within 90 minutes of bedtime. If you have a blue light blocker on your phone, have it set to turn on automatically a few hours before bed. You can also install f.lux on your computer which will automatically reduce the blue light on your screen at night based on your location and time of day.
It's also important to look at what you're consuming throughout the day that can impact your sleep. Caffeine and nicotine can stay in your system for several hours and affect your sleep at night. Alcohol may help you fall asleep more quickly, but reduces the quality of your sleep. Some cold medicines and prescription drugs can also affect your sleep.
The general rule for food is not too little and not too much before bed. A small snack of protein and carbohydrates can be helpful, and it's best to avoid sugar at night.
It may help you to have a calming nightly routine that prepares your brain for sleep. Reading, stretching, massage, and/or meditating are all activities that help your system to slow down and will let your brain know that it's almost time to sleep.
Your room temperature should be cool at night, for most people between 60 and 68 degrees. And your room should be very dark and very quiet. If it isn't dark, look into room-darkening shades. If you live in a noisy area, you can download a white-noise app for your phone, purchase a white noise machine, or even use a small fan to help drown out the noise that keeps your brain awake.
Cognitive Behavioral Therapy for Insomnia (CBTI or CBT-I)
The goal of CBT is to change patterns of thinking or behavior and there are several CBT methods that can help insomnia sufferers sleep better. Working with a CBT therapist may take 2-3 months, but has been found to be more effective long-term than using medications alone (though CBT can be used with medication).
This method trains your brain to sleep well by limiting the amount of sleep you get for a period of time, then slowly adding back time allowed for sleep until you're back to sleep for a normal amount of time. When you're only allowed to sleep a limited number of hours per night, it trains your brain to fall asleep quickly, and get the highest amount of high-quality sleep possible. Then you would progressively add 15 minutes per night back to the time you're allowed to sleep until you are sleeping 7-9 hours per night.
Relaxation training may include meditation, deep breathing, and progressive muscular relaxation (tensing and relaxing different muscles to relax the body and mind).
The goal of stimulus control therapy is to break the conditioned anxiety or arousal associated with going to sleep. According to the Ohio Sleep Medicine Institute, there are several different techniques commonly used:
- Patients are instructed not to watch the clock and even to remove the clock from the bedroom.
- Not to lay in bed awake for more than 20-30 minutes. The bed shouldn't be associated with frustration and anxiety.
- Learn to see a bad night of sleep as not a big deal. Insomniacs tend to get really frustrated about not sleeping well which creates more anxiety about sleeping, which prevents good sleep.
- Use the bed only for sleep and sex. Some people work on their laptops in bed which can develop an association of stress and arousal with sleeping.
The goal of cognitive restructuring is to change the way you think about different aspects of your life that cause you stress to no longer cause you stress. Regarding insomnia, it usually means getting rid of sleep anxiety. Sleep anxiety are the thoughts and feelings that prevent restful sleep. Insomniacs usually worry about how bad they'll sleep, which prevents them from sleeping. Breaking this cycle is necessary for many insomniacs.
These are the basic rules for sleep. Many sleep experts explain that the most important rule is to fall asleep and wake up at the same time every day. Other guidelines include:
- Limiting screen time an hour or more before bed
- Get sun exposure in the morning if possible
- Exercise regularly, but not within 3 hours of going to sleep
- Have a nightly sleep routine that relaxes you
- Don't eat too much at night, and avoid alcohol, marijuana, and caffeine in the later part of the day
CBT may also involve individual or group therapy to work through your thoughts and feelings about sleep to help reduce that anxiety and frustration.
Your doctor may prescribe medication for your insomnia, though usually only for the short-term, as some drugs can be addictive, and there are sometimes negative side effects. Side effects can include:
- Poor concentration
- Muscle aches
- Balance issues
- Dry mouth
- Rebound insomnia (if you don't take the medication, insomnia can be even worse than before)
Drugs for insomnia are either sedatives, tranquilizers, or anti-anxiety drugs. Some of the most common insomnia drugs are:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Ramelteon (Rozerem)
- Zaleplon (Sonata)
Over-the-Counter Sleep Aids (OTC)
Many OTC products include diphenhydramine or doxylamine, which are antihistamines that are used to relieve a runny nose, watery eyes, itching, and other cold and allergy symptoms. They are also used for motion sickness and for symptoms of Parkinson's disease and can be used to induce sleep. Doctors generally only recommend for these to be used as sleep aids for short periods of time.