Insomnia: Everything you need to know
Insomnia is a sleep disorder that regularly affects millions of people worldwide. In short, individuals with insomnia find it difficult to fall asleep or stay asleep. The effects can be devastating.
Insomnia commonly leads to daytime sleepiness, lethargy, and a general feeling of being unwell, both mentally and physically. Mood swings, irritability, and anxiety are common associated symptoms.
Insomnia has also been associated with a higher risk of developing chronic diseases. According to the National Sleep Foundation, 30-40 percent of American adults report that they have had symptoms of insomnia within the last 12 months, and 10-15 percent of adults claim to have chronic insomnia.
Here, we will discuss what insomnia is, its causes, symptoms, diagnosis, and possible treatments.
Fast facts on insomnia:
- There are many possible causes of insomnia.
- An estimated 30-40 percent of Americans report experiencing insomnia each year.
- Often, insomnia is due to a secondary cause, such as illness or lifestyle.
- Causes of insomnia include psychological factors, medications, and hormone levels.
- Treatments for insomnia can be medical or behavioral.
Causes
Insomnia can be caused by physical and psychological factors. There is sometimes an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Insomnia is commonly caused by:
- Disruptions in circadian rhythm – jet lag, job shift changes, high altitudes, environmental noise, extreme heat or cold.
- Psychological issues – bipolar disorder, depression, anxiety disorders, or psychotic disorders.
- Medical conditions – chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson’s and Alzheimer’s diseases, hyperthyroidism, arthritis, brain lesions, tumors, stroke.
- Hormones – oestrogen, hormone shifts during menstruation.
- Other factors – sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, pregnancy.
Media technology in the bedroom
Several small studies in adults and children have suggested that an exposure to light from televisions and smartphones prior to going to sleep can affect natural melatonin levels and lead to increased time to sleep.
In addition, a study conducted by Rensselaer Polytechnic Institute found that backlit tablet computers can affect sleep patterns. These studies suggest that technology in the bedroom can worsen insomnia, leading to more complications.
Medications
According to the American Association of Retired Persons (AARP), the following medications can cause insomnia in some patients:
- corticosteroids
- statins
- alpha blockers
- beta blockers
- SSRI antidepressants
- ACE inhibitors
- ARBs (angiotensin II-receptor blockers)
- cholinesterase inhibitors
- second generation (non-sedating) H1 agonists
- glucosamine/chondroitin
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 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 non-alcohol related car crash injuries are caused by driver sleepiness.
Types
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 Health, the majority of chronic insomnia cases are side effects resulting from another primary problem.
Treatment
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 behaviorlal therapy (CBT) in one-on-one counseling sessions or group therapy:
Medical treatments for insomnia include:
- prescription sleeping pills
- antidepressants
- antihistamines
- ramelteon
Home remedies
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
A sleep 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, the 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
Insomnia can affect people of any age; it is more common in adult females 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