Insomnia is one of the most common sleep disorders. It is manifested by challenges falling asleep, staying asleep, or having quality sleep. Insomnia affects even people who have the time and ideal sleeping environments. Short-term insomnia takes place for a few days or weeks but often does not exceed three months. It is usually associated with acute stress, such as grief or a significant illness. Chronic insomnia, on the other hand, takes longer than three months. It is also associated with daytime symptoms such as distress about the inability to fall asleep, resulting in anxiety that may create a vicious cycle.
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Insomnia may result in or worsen health conditions. It affects how well crucial organs such as the heart and brain work. These conditions include asthma, heart problems, mental health conditions, chronic pain, pregnancy complications, reduced immune system functionality, and poor metabolism.
Insomnia can adversely affect people's health and well-being. It may result in mild to severe disruptions in daily life. Given the importance of sleep for optimal mental and physical health, insomnia is a serious condition that requires attention. Understanding the root cause of insomnia often requires exploring other elements of a patient’s life. For instance, insomnia may be a symptom of another health condition or a stand-alone condition.
Symptoms of Insomnia
Some of the common symptoms of insomnia include:
- Difficulty falling asleep despite having the right conditions.
- Sleeping for short periods before waking up and having difficulty getting to sleep again.
- Waking up too early in the morning and failing to go back to sleep.
- Sleep that makes one wake up tired, unrested, and still sleepy.
Prevalence and Causes
About 30% of adults experience some form of insomnia symptoms. However, including the element of daytime distress or impairment reduces this proportion. Further, this proportion lowers under the DSM-IV criteria that outlines the requirements for diagnosis that require symptoms to exist for at least a month and not in the presence of another sleep or mental disorder or direct effects of substance use. Women and older adults have a higher likelihood of having insomnia than other demographics. Family and genetics also play a role. Genetics may affect sleep patterns to raise or lower the risks of insomnia. Further, the work environment or occupation can affect the risk of insomnia. For instance, night or rotating work schedules can result in disrupted sleep schedules, resulting in insomnia. Traveling jobs also affect sleep patterns since timing sleep times becomes difficult.
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Lifestyle habits that raise the risk of insomnia include:
- Too much screen time just as you are about to sleep
- Changing a regular work and sleep routine
- Taking long daytime naps
- Taking caffeine, nicotine, alcohol, or other recreational drugs
- Experiencing sleep interruptions, for instance, when taking care of a newborn
- Extremely sedentary lifestyle – no or little physical activity.
Stress is associated with acute insomnia. You may worry about whether you will get enough sleep, increasing stress levels and risk of insomnia, resulting in a self-perpetuating cycle. Eating a lot too late in the evening may also contribute to insomnia. You may feel uncomfortable lying down, and other conditions, such as heartburn, can make sleeping difficult. Further, mental health disorders such as post-traumatic stress disorder may affect sleep. Certain medications can affect sleep patterns. These include cold and allergy medicines, pain, and weight-loss medicines. Additionally, health conditions such as diabetes, cancer, asthma, pain, gastroesophageal reflux disease, hyperactive thyroid, Alzheimer's, and Parkinson's diseases can reduce the ability to obtain quality sleep.
Diagnosis
Diagnosis often involves self-reports of sleep disruptions that affect daily activities. Insomnia is usually diagnosed when one has difficulty falling or staying asleep for three nights a week. A sleep diary can be a crucial tool to help doctors' diagnostic efforts. Doctors seek to determine the existence of other conditions that may result in insomnia as a symptom. Alternatively, there is increased concern that insomnia is a stand-alone medical condition and not the result of underlying conditions. Primary insomnia is perceived as a disorder of hyperarousal associated with a change in the hypothalamic-pituitary-adrenal axis. It may constitute up to a quarter of all diagnoses. At the same time, the rest is secondary insomnia – a result of medical, psychiatric, circadian, or sleep disorders.
Your doctor may ask questions such as:
- Do you snore loudly and wake up gasping or feeling out of breath?
- How long and how frequently have you had trouble sleeping?
- How long does it take you to fall asleep?
- How often do you wake up at night, and how long does it take to go back to sleep?
- Do you feel refreshed and well-rested when you wake up?
- Do you use electronic devices before going to bed?
- At what time do you go to bed?
- Is your sleep schedule regular?
Further, the doctor will seek to establish whether you have existing health problems and if you are taking any medications. Being pregnant or going through menopause is also crucial in informing the diagnostic decision. The doctor also asks about nicotine, alcohol, caffeine, and illegal drug usage. They can then carry out tests such as sleep studies. The sleep studies may help establish sleep apnea, narcolepsy, and circadian rhythm disorders. Blood tests check for thyroid problems and can help diagnose primary insomnia. An actigraphy examines periods of activity and rest to evaluate how well one sleeps.
Treatment
The doctor may prescribe treatment options such as cognitive behavioral therapy (CBT). This 6-8 week plan helps one learn how to fall asleep and stay asleep longer. It is often recommended as the first treatment option for chronic insomnia. It involves:
- Cognitive therapy – helps reduce anxiety and nervousness about the inability to fall asleep.
- Relaxation therapy – teaches relaxation through meditation or other approaches to help you fall asleep faster.
- Sleep education – instill good sleep habits.
- Sleep restriction therapy – restricts the time one spends in bed. It helps train one to get the most out of the time spent in bed.
- Stimulus control therapy – helps establish a regular sleep-wake cycle. It allows patients to go to bed when sleepy and get out when they are not. It also restricts activities that can take place in bed to sleep.
Prescription medicines can be used in the short term, while others may be appropriate in the long term. Each has its benefits and side effects and should be used wisely. The medications include:
- Melatonin receptor agonists
- Orexin receptor antagonists
- Benzodiazepine receptor agonists
- Benzodiazepines
Over-the-counter options often include medicines containing antihistamines. These are frequently used as sleeping aids. However, they may be unsafe for some people, and you must talk to your doctor before filing a lawsuit. Melatonin supplements contain a version of the melatonin hormone crafted artificially. There is insufficient research-based evidence that melatonin supplements are effective in treating insomnia. Other approaches include dietary supplements.
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Sleep Hygiene – Healthy Sleeping Habits
- Have a regular sleep schedule – go to bed and wake up around the same time every day, even when not working.
- Eat meals on a regular schedule and avoid late-night feasts.
- Be aware of certain OTC and prescription medicines that can disrupt your sleep.
- Make the ideal sleeping environment – The room should be dark, calm, and quiet. Electronic devices should be minimal or non-existent in the bedroom.
- Avoid caffeine, alcohol, and nicotine close to your bedtime.
- Incorporate regular physical activity during the day. It should not be too close to bedtime – 5-6 hours before.
- Finding ways to manage stress – reading, journaling, yoga, meditation, massage therapy, and soothing music- are all approaches to help achieve this.
- Limit the size of drinks close to bedtime to prevent the urge to use the bathroom when asleep.