Insomnia

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What Is Insomnia?

Insomnia (1) refers to problems falling asleep, staying asleep, or sleeping soundly despite having a reasonable opportunity to do so, coupled with daytime symptoms as a result of poor sleep. Insomnia affects an estimated 35% to 50% of adults (2), making it the most common sleep disorder (3). It may appear more frequently in women, older adults, and people with a lower socioeconomic status.

Types of Insomnia

The American Academy of Sleep Medicine divides insomnia into short-term and chronic forms:

  • Short-Term Insomnia: Often triggered by a stressful event or an injury that causes pain at night, short-term insomnia lasts for less than three months. In any given year, approximately 15% to 20% of adults experience short-term insomnia. The insomnia may persist and develop into chronic insomnia.
  • Chronic Insomnia: People with chronic insomnia experience symptoms at least three times a week for at least three months. An estimated 10% of the population experiences chronic insomnia, and a further 30% to 35% of people experience some symptoms of insomnia. Symptoms may fluctuate over time.
  • Other Insomnia: Sleep problems that do not meet the criteria for short-term or chronic insomnia may be diagnosed as other insomnia.

Many people experience sleep problems along with another condition, such as chronic pain. They may be diagnosed with insomnia as well if the sleep problems require their own treatment.

What Are the Symptoms of Insomnia?

For many people, insomnia symptoms manifest as either trouble falling asleep or trouble staying asleep, though it is not uncommon to have both issues:

  • Sleep Onset Insomnia: A person with sleep onset insomnia takes upwards of 20 or 30 minutes to fall asleep, even in perfect conditions.
  • Sleep Maintenance Insomnia: Sleep maintenance insomnia refers to fragmented sleep with multiple nighttime awakenings, or waking up too early and not being able to fall back asleep.

Children with insomnia may refuse to go to bed, or they may have trouble sleeping without their parent or caregiver. This may be partly due to separation anxiety or fear of the dark.

To be diagnosed with insomnia, a person must also experience daytime symptoms as a result of poor sleep. Examples of daytime symptoms include:

  • Trouble concentrating
  • Memory problems
  • Decreased performance at work, school, or at social or family obligations
  • Irritability and mood problems
  • Daytime sleepiness or fatigue
  • Hyperactivity, impulsivity, or aggression
  • Loss of motivation
  • Clumsiness or making more mistakes than usual
  • Worrying about sleep

As a result of not sleeping well, people with insomnia may have a higher chance of experiencing car or workplace accidents.

What Causes Insomnia?

Insomnia may stem from problems in wake-promoting and sleep-promoting hormones and brain regions.

Scientists have observed that many people with insomnia seem to have a faster metabolism, a faster heart rate, a higher body temperature, and higher levels of certain stress-related hormones. These differences are especially noticeable at bedtime. People with insomnia may also have more high-frequency brain waves during deep sleep, a phase that is usually associated with slow brain waves (4).

Taken together, these signs point to a heightened state of arousal. In support of this theory, people with insomnia tend to report that they slept less than they actually did, suggesting feelings of being alert at night.

Insomnia can occur by itself, but it often occurs along with another condition such as depression or chronic pain. When this happens, the two conditions may exacerbate each other.

What Are Risk Factors for Insomnia?

Certain risk factors can make you more likely to develop insomnia. Potential triggers for insomnia include:

  • Drugs, medications, or alcohol dependence
  • Persistent daily stress or major stressors, such as the death of a loved one
  • Irregular sleep schedule
  • Mood and anxiety disorders
  • Sleep disorders such as restless legs syndrome or sleep apnea
  • Chronic pain or immobility
  • Health issues, such as gastroesophageal reflux disease
  • Too much caffeine
  • Sharing a room
  • Not having a safe, dark, quiet, and comfortable place to sleep
  • Genetics

People who have already had insomnia in the past or who are generally light sleepers, especially when stressed, seem more likely to develop insomnia.

How Is Insomnia Treated?

Because insomnia presents differently from person to person, treatment depends on the specific symptoms and the underlying causes. If insomnia stems from chronic pain, a mental health disorder, substance use, or another physical condition, this underlying issue needs to be treated separately.

When you seek insomnia treatment, your doctor may ask you questions about your sleep problems and daytime symptoms. They may also ask you to keep a sleep diary, or ask your bed partner for additional information. If they suspect you might have a sleep disorder, they may have you take an overnight sleep test where they measure your movements or brain waves.

The standard treatment for insomnia (5) is cognitive behavioral therapy for insomnia (CBT-I), which aims to teach you practices and behaviors to improve your sleep. CBT-I generally incorporates multiple components:

  • Stimulus Control: Stimulus control reinforces the association between bed and sleep. This involves avoiding naps and only going to bed when you feel sleepy.
  • Sleep Restriction Therapy: Sleep restriction therapy asks sleepers to adjust their time in bed based on how much sleep they are getting on a daily basis, with the aim of gradually increasing sleep.
  • Relaxation Therapy: Techniques such as deep breathing, progressive muscle relaxation, guided imagery, or meditation may help you relax at bedtime.

CBT-I takes place over multiple weeks, during which you keep a sleep diary and have periodic visits with your doctor so they can monitor your progress and make adjustments as necessary. Therapy may be preferable to medication, because it has fewer side effects and the improvements seem to last longer. However, if necessary, your doctor may also prescribe sleep aids.

What Are Tips for Preventing Insomnia?

To supplement insomnia therapies, your doctor will likely recommend sleep hygiene tips that help lay the groundwork for better sleep, including:

  • Reducing naps
  • Avoiding alcohol, caffeine, and nicotine in the evening
  • Eating a healthy diet and avoiding heavy meals before bed
  • Exercising regularly
  • Going to sleep and waking up at the same time every day
  • Setting clear sleep-related limits for children during both day and night
  • Avoiding screen time close to bedtime
  • Keeping the bedroom cool, dark, and quiet

When to Talk to Your Doctor

You should talk to your doctor if you have sleep problems that affect your daily life. Treating short-term insomnia (6) can prevent it from becoming chronic insomnia, which is known to raise the risk of developing diabetes, obesity, cardiovascular disease, chronic pain syndrome, anxiety, and depression. Your doctor can also help you rule out other conditions, which may need treatment of their own.

References

+ 6 Sources
  1. 1. Accessed on August 20, 2021. https://aasm.org/
  2. 2. Accessed on August 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33164741/
  3. 3. Accessed on August 20, 2021. https://pubmed.ncbi.nlm.nih.gov/30252392/
  4. 4. Accessed on August 20, 2021. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
  5. 5. Accessed on August 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33164742/
  6. 6. Accessed on August 20, 2021. https://pubmed.ncbi.nlm.nih.gov/32119403/

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