Sleep is a vital part of life and if disrupted can lead to many health problems including heart disease and diabetes. Unfortunately, the quality and quantity of sleep can be disrupted by a number of sleep disorders including insomnia. Sufferers of insomnia have poor quality, disrupted sleep that leads to daytime sleepiness and reduced cognitive function.
What is Insomnia?
Insomnia is a common sleep disorder where the person has a hard time falling and staying asleep. The sufferer will wake up multiple times during the night and feel too alert to fall back asleep. The overall quality of such disruptive sleep is poor The sufferer will not feel refreshed when they wake up and will feel drowsy during the day as well.
Insomnia is different from sleep deprivation since sleep deprivation occurs when the person does not have the ability to fall asleep. Sufferers of insomnia do have the whole night to sleep but are unable to fall and/or stay asleep.
Types of Insomnia
Insomnia does require a clinical diagnosis. A person is considered to be suffering from insomnia if the lack of sleep is causing significant stress and anxiety, and if it impairs daily functioning.
Insomnia is divided into two broad categories: acute or short-term insomnia, and chronic insomnia. Chronic insomnia has several subtypes.
Acute or short-term insomnia lasts a few days or weeks. It is usually triggered by a stressful event like divorce or the loss of a loved one. It occurs in 10-15% of people If short-term insomnia persists it can develop into chronic insomnia. Women and older adults are more prone to suffer from short-term insomnia.
A person suffers from chronic insomnia if they have trouble falling and staying asleep three times a week for over three months. Chronic insomnia can occur if the person suffers from other health problems as well like restless leg syndrome, chronic pain, respiratory issues, gastroesophageal reflux disease (GERD), and immobility issues.
Below are the subtypes of chronic insomnia.
- Paradoxical insomnia: A sufferer will feel as if they are not getting enough sleep even though there is no evidence to support such a claim. This type is most prevalent among young and middle-aged adults.
- Idiopathic insomnia: There is no known cause for this type of insomnia. Unfortunately, it is a lifelong condition starting in childhood and continuing on to adulthood. 0.7% of young adolescents and 1% of young adults suffer from idiopathic insomnia.
- Psychophysiological insomnia: A sufferer will worry so much about not being to sleep that their anxiety will actually prevent them from falling asleep.
- Inadequate sleep hygiene: Good sleeping habits and rituals lead to good quality sleep. Not having proper sleep hygiene can lead to chronic insomnia. Sufferers will have habits that keep them awake or will have disruptions during their sleep.
Symptoms of insomnia vary but include the following:
- Fatigue and daytime sleepiness
- Moodiness and irritability
- Problems with focus, attention, and memory
- Difficulty with keeping up with school or work
- Making too many errors or getting into accidents
- Concerns about sleep
- Headaches or tension
Causes of Insomnia
Insomnia is usually the result of another psychological or physiological factor that is causing the sufferer to not sleep well throughout the night.
The factors that can lead to insomnia include:
- Stress: A tragic life event like divorce, loss of a loved one, loss of a job can hinder sleep.
- Other sleep disorders: Conditions like sleep apnea and restless leg syndrome can increase the chances of a person having insomnia.
- Medical conditions: Insomnia due to medical conditions occurs mostly in the elderly as they suffer from aches, pains, and reduced mobility due to aging. However, younger women can suffer from it too during the third trimester of pregnancy when movement is difficult.
- Mental disorders: A mental disorder is often diagnosed when a person presents with insomnia as one of the symptoms of a mental disorder is insomnia. Disorders like depression, bipolar, and anxiety disorder can increase the risk of insomnia for sufferers.
- Medications: Several medications including those that treat blood pressure, ADHD, and Parkinson's disease cause insomnia as a side effect. Medicines for common cold and allergy contain pseudoephedrine that evokes alertness.
- Substance or stimulant abuse: Drugs, alcohol, and stimulants like coffee can interfere with falling asleep and staying asleep. If addiction to drugs or alcohol has developed and the person is trying to quit then one of the withdrawal symptoms will be insomnia.
- Poor sleep hygiene: Watching TV or using the phone before bed, or sleeping in a well-lit, loud room can make it difficult to fall asleep. Sleeping next to a snoring partner can cause sleep disturbances as well.
- Lifestyle: Workers who usually work the night shift will have a hard time falling asleep on their nights off. Similarly, people who stay up too late at night may have a hard time eventually falling asleep. Excess daytime napping can make it hard to fall asleep at a decent hour.
Risk Factors for Insomnia
- Middle-aged and older people suffer from insomnia more than younger ones.
- Women suffer from insomnia more than men.
- People with medical conditions like restless leg syndrome, or psychological conditions like depression can suffer from insomnia.
- If a person is taking medication that lists insomnia as a side effect then they are at risk as well.
- People dealing with stressful situations like divorce, loss of a loved one, or a job.
- Shift workers or people who travel long distances.
- African Americans have a higher rate of insomnia than other races.
There are two ways that insomnia symptoms are treated: cognitive behavioral therapy (CBT), and medication.
Cognitive Behavioral Therapy
CBT is a very good tool to deal with insomnia as it not only relieves immediate symptoms but it helps the person manage symptoms later on in life as well. CBT has five components
- Cognitive therapy: This involves changing the person’s mindset and how they approach to sleep. Often sufferers will worry that they will not fall asleep which in turn keeps them up. Changing the way they approach sleep helps alleviate insomnia.
- Relaxation training: A therapist will teach the sufferer different ways to relax their mind and body so they can fall asleep.
- Sleep hygiene training: The person will learn how to instill good sleep habits and a daily sleep routine to ensure good quality and quantity of sleep.
- Sleep restriction: The number of hours a person sleeps is initially reduced during sleep restriction therapy and then gradually increased.
- Stimulus control: The person will learn to only go to bed when sleepy, to avoid taking daytime naps, and to leave the bed if they are not falling asleep. And to use the bed only for sleep and sex.
There are several medication options for insomnia sufferers: prescription medication, over-the-counter medication, as well as supplements and herbs.
Antihistamines are often used as a sleep aid, however, they can contribute to daytime sleepiness as well. Some prescription medications work well for short-term alleviation of symptoms and some, like nonbenzodiazepines, are suitable for long-term use.
Melatonin is a sleep supplement that can help sufferers with falling asleep as it
reduces the time it takes to fall asleep by 7-12 minutes.
Tips for Preventing Insomnia
Lifestyle changes can help alleviate insomnia symptoms and the person may not even need medication.
- Good sleep hygiene: Maintaining a regular sleep routine and a bedroom environment that promotes relaxation at the end of the day helps a person get drowsy and fall asleep easily. An ideal bedroom environment is dark, quiet, free of electronic devices at nighttime, and includes a comfortable bed. A regular sleep routine means that the person wakes up and goes to sleep at the same time every day.
- Reducing stimulants: Reducing the intake of caffeinated drinks that include coffee, tea, and energy drinks allows the onset of sleep at nighttime. If the person has a hard time staying away from caffeine then it is best to stop consuming caffeinated drinks in the evening.
- Avoiding daytime naps: Although daytime naps are good for normal sleepers a person with insomnia is better off saving all their sleep for nighttime.
- Avoiding drugs, alcohol, and smoking: All of those are factors that interfere with normal sleep.
When to Talk to Your Doctor
It is best to see a doctor if the person is suffering from daytime sleepiness, has impaired functioning during the day, and is concerned about not getting enough sleep at night . Insomnia symptoms overlap with other sleep disorder symptoms so it is important to see a doctor to rule out any other causes. A doctor will likely take a detailed history of the patient and order a sleep test. Once clinically diagnosed, the patient can begin the appropriate treatment for insomnia that will resolve the symptoms.