Insomnia: Symptoms, Causes, and Treatment
Sleep Disorders: Insomnia
Sleep is critical for health and wellbeing. The information presented here can help you understand common sleep disorders such as insomnia and sleep apnea, and provide important tips on how to regain necessary sleep.
Insomnia (from Latin "in" meaning "not", and "somnus" meaning "sleep") is most often defined by an individual's report of sleeping difficulties. Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30%-50% of the general population is affected by insomnia, and 10% have chronic insomnia. Insomnia is a symptom, not a stand-alone diagnosis or a disease. By definition, insomnia is "difficulty initiating or maintaining sleep, or both" or the perception of poor quality sleep. Insomnia may therefore be due to inadequate quality or quantity of sleep.
Insomnia is generally classified based on the duration of the problem, as illustrated below:
- Transient Insomnia: Symptoms lasting less than one week.
- Short-Term Insomnia: Symptoms lasting between one to three weeks.
- Chronic Insomnia: Symptoms lasting longer than three weeks.
- Difficulty falling asleep on most nights.
- Feeling tired during the day or falling asleep during the day.
- Not feeling refreshed when you wake up.
- Waking up several times during sleep.
People who have primary insomnia tend to keep thinking about getting enough sleep. The more they try to sleep, the greater their sense of frustration and distress, and the more difficult sleep becomes.
Understanding insomnia causes can help you to overcome this sleep problem. Insomnia is defined as the difficulty of falling asleep or staying asleep. Insomnia causes are often other medical conditions, psychological difficulties or poor lifestyle choices. There are several common causes.
- Psychological Causes: Insomnia is commonly caused by psychological factors such as stress, anxiety and depression. Stress can lead to insomnia. Anxiety makes an individual more alert and keeps the mind active, leading to insomniac symptoms. Depression can cause some to sleep too much, but some people report the inability to sleep.
- Medications: Some medications can cause insomnia, especially antidepressants. Others include allergy medications, heart medications, blood pressure medications, corticosteroids and other stimulants.
- Medical Conditions: Conditions such as chronic pain, breathing abnormalities, gastro-esophageal reflux disease, congestive heart failure, diabetes and lung disease commonly cause insomnia. Medical conditions such as Parkinson disease, strokes, overactive thyroids, Alzheimer's disease, and arthritis may also trigger insomnia.
- Stimulating Products: Coffee, tea, soda or other kinds of stimulating products make it difficult to fall asleep. Nicotine is also a stimulant. Interestingly, alcohol can lead to insomnia, although it is a natural sedative initially.
- Changing Schedule: Schedule changes or travel can disrupt your body's natural sleep-wake cycle and make it difficult to fall asleep at a decent time of night.
- Poor Sleep Habits: Poor sleep habits such as an irregular sleep schedule, too much activity before bed, eating before bed, or using your bed for reading or watching television, can make it difficult to relax and fall asleep.
Insomnia: Signs and Tests
Your health care provider will do a physical examination and ask you questions about your current medications, drug use, and medical history. Usually, these are the only methods needed to diagnose insomnia. Polysomnography, an overnight sleep study, can help rule out other types of sleep disorders (such as Sleep Apnea).
The following tips can help improve sleep. This is called Sleep Hygiene.
- Avoid caffeine, alcohol, or nicotine before bed.
- Don't take daytime naps.
- Eat at regular times each day (avoid large meals near bedtime).
- Exercise at least 2 hours before going to bed.
- Go to bed at the same time every night.
- Keep comfortable sleeping conditions.
- Remove the anxiety that comes with trying to sleep by reassuring yourself that you will sleep or by distracting yourself.
- Use the bed only for sleep and sex.
Treating insomnia involves making lifestyle changes and treating any underlying medical causes for your sleeping difficulties. When these steps fail, your doctor may prescribe medications to promote relaxation and improve sleep.
1. Behavior Therapy
Behavior therapy focuses on teaching new sleep behaviors and eliminating habits not conducive to restful sleep. In many cases, behavior therapy is more effective than sleep medications for treating insomnia.
Behavior therapy involves:
- Education about good sleep practices and promotion of good Sleep Hygiene. (See right side)
- Teaching relaxation techniques, such as progressive muscle relaxation, breathing exercises, and biofeedback, to reduce anxiety and improve sleep.
- Cognitive Therapy to eliminate negative thoughts and ideas about sleeping and insomnia.
- Implementing a sleep restriction program to reduce the amount of time you spend in bed while awake.
- Using light therapy to readjust your internal clock and allow you to fall asleep and wake up at times that is more appropriate.
Sleep apnea is a sleep disorder where the sleeper stops breathing during sleep, sometimes hundreds of times an hour, often for a minute or longer. This sleep stop is called an "apnea." With obstructive sleep apnea, the most common type, the back of the throat closes down cutting off breath during sleep causing snoring, choking and gasping. Sleep apnea is often undiagnosed because it is frequently confused with traditional snoring; however, if left untreated, these disruptions in the sleep cycle can cause major issues such as:
- Elevated blood pressure
- Heart problems
- Cardiovascular disease
- Memory loss
- Extreme daytime sleepiness
- Falling asleep while working or driving
There are many options for treating sleep apnea including various types of continuous positive airway pressure (CPAP) machines and masks, oral devices and surgery. For details click here.
2. Lifestyle Changes
Lifestyle changes are an effective treatment for many people with insomnia. Even small adjustments in routine can significantly improve sleep. Lifestyle changes for insomnia include:
- Keep bedtime and wake time consistent, even on weekends.
- Use your bed only for sleeping and sex. If you cannot fall asleep after 15 minutes, get out of bed and engage in a relaxing activity.
- Implement a bedtime routine to help you unwind and to prepare your mind and body for sleep. Take a bath, spend a few minutes reading, listen to soft music, or engage in yoga.
- Avoid taking naps during the day, especially after 3:00 p.m.
- Exercise for at least 30 minutes every day, but avoid exercising within six hours of bedtime.
- Limit your consumption of alcohol, caffeine, and nicotine. All three can interfere with sleep.
3. Medications for Insomnia
Prescription Drugs: Medications are typically a last resort for insomnia, as many cause significant side effects or are habit-forming. However, prescription sleeping pills, such as Ambien, Lunesta, and Sonata, are effective treatments for insomnia in most cases. Some doctors prescribe sleeping medications to assist with sleep until lifestyle changes begin to work. Side effects are common and may include impaired thinking, agitation, coordination problems, allergic reactions, excessive drowsiness, and night wandering.
Over-the-Counter Drug Recommendation: Melatonin, a hormone produced naturally by the body, is available in supplement form and may help insomniacs who struggle with falling asleep and waking at appropriate times. Valerian is another supplement that may help reduce anxiety, ease tension, and promote sleep. Consult your doctor before beginning treatment with any over-the-counter medication.