Everyone has nights when they just can’t seem to fall asleep but for some it happens on a daily basis. Insomnia is a type of sleep disorder and a common one at that. About one-third of American adults report symptoms of insomnia, according to the American Psychiatric Association (APA), but 6% to 10% of American adults have symptoms severe enough for them to be diagnosed with insomnia.
Sleep disorders involve various problems with the timing, quality, or amount of sleep which can lead to problems with daytime functioning and distress. Some of the most common sleep disorders are insomnia, narcolepsy, obstructive sleep apnea, and restless leg syndrome. Overall, between 10% and 20% of American adults struggle with sleep problems, the most common which is insomnia.
The key to diagnosing insomnia is learning the difference between occasional difficulty falling or staying asleep and a chronic disorder. In this article, we’ll cover the basics about what insomnia is, the symptoms and causes, diagnosis, and treatment options.
What is Insomnia?
Insomnia is the most common sleep disorder and it is characterized by having trouble falling asleep, staying asleep, or both. Not only do people with insomnia have trouble falling and staying asleep, but they may also wake without feeling refreshed which can lead to daytime fatigue and other symptoms. In fact, the negative effects of sleep problems are part of the diagnostic criteria for this disorder.
There are two primary types of insomnia characterized by their duration. Acute insomnia is brief in duration and is usually associated with a specific life circumstance. For example, receiving bad news or anticipating a stressful event might make it difficult for you to fall asleep for a day or two but acute insomnia typically resolves on its own without treatment. Chronic insomnia is characterized by sleep disturbances that occur at least three nights per week, lasting at least three months.
The potential causes for chronic insomnia are many, ranging from unhealthy sleep habits to certain medications. In many cases, chronic insomnia is comorbid which means that it is linked to another condition, either medical or psychiatric. In both acute and chronic insomnia, patients may exhibit a range of sleep disturbances including difficulty with sleep onset (falling asleep), sleep maintenance (staying asleep), or waking too early. Treatment for this condition may involve medical, behavioral, and/or psychological components.
What Are the Symptoms of Insomnia?
In a 2005 poll taken by the National Sleep Foundation, more than half of those surveyed reported having at least one symptom of insomnia several nights per week over the course of the previous year. Of those surveyed, 33% reported that they had these symptoms every night or almost every night. A total of 63% of women and 54% of men experienced these symptoms at least a few nights each week.
The most common symptoms of insomnia include the following:
- Difficulty falling asleep
- Trouble staying asleep
- Waking often during the night
- Waking too early in the morning
- Not feeling refreshed after sleep
While these are the primary symptoms of insomnia, they can lead to other problems during the day. If you don’t have a restful night of sleep, you’re more likely to develop daytime drowsiness or sleepiness. You might have trouble concentrating or focusing on tasks, and your memory could be impaired. You could experience changes in mood such as depression, anxiety, or irritability, and you might even have a higher risk for making errors or having an accident. Research shows that insomnia can increase the risk of falling and driver sleepiness is responsible for nearly 20% of serious car crash injuries.
If your insomnia makes it difficult for you to function during the day or if it affects your ability to complete tasks at work or in school, it’s time to talk to your doctor. We’ll talk more later about how insomnia is diagnosed and treated but for now let’s take a look at some of the causes.
What Causes Insomnia?
Not only can insomnia be divided into two categories by duration (acute vs. chronic), but also by cause. Primary insomnia is characterized by sleep problems that are not directly associated with another health problem. Secondary insomnia, on the other hand, involves sleep problems triggered or caused by something else – a health condition, medication, pain, or substance use.
The causes of insomnia are many and they can be divided into the following categories:
- Medical causes
- Psychological causes
- Lifestyle causes
- Dietary causes
Let’s take a closer look at each of these categories.
1. Medical Causes for Insomnia
When it comes to medical causes for insomnia, there are two possibilities. In some cases, a medical condition causes insomnia while, in others, the condition causes symptoms or discomfort that makes it difficult to fall asleep. Some examples of medical conditions which can cause insomnia include:
- Sinus allergies and nasal congestion
- Gastrointestinal problems like acid reflux
- Endocrine disorders like hyperthyroidism
- Arthritis and other joint problems
- Asthma or other respiratory problems
- Neurological conditions like Parkinson’s
- Chronic pain, particularly lower back pain
There are also certain medications which can cause insomnia such as drugs for cold and flu, nasal allergies, high blood pressure, heart disease, thyroid disease, asthma, birth control, and depression. Insomnia can also be a symptom of an underlying sleep disorder such as restless legs syndrome or sleep apnea. If insomnia symptoms occur on a regular basis, you should talk to your doctor.
2. Psychological Causes for Insomnia
Not only can insomnia be linked to medical problems, but it can also be a symptom or side effect of psychological disorders such as depression and anxiety. Sleep problems are one of the most common symptoms of depression and the risk of insomnia is particularly high among patients with major depressive disorder – insomnia can also trigger or worsen existing depression.
Anxiety is another common cause of insomnia, even in people who do not have a diagnosed anxiety disorder. Some of the most common symptoms that can lead to insomnia include muscle tension, worrying thoughts, feeling overwhelmed, and feeling overstimulated. Anxiety can lead to problems with all kinds of insomnia symptoms including difficulty falling asleep, staying asleep, and waking too early without being able to fall back asleep.
3. Lifestyle Causes for Insomnia
Outside of medical and psychological causes for insomnia, there are a number of lifestyle factors which may also contribute. Unhealthy sleep habits, as well as other unhealthy lifestyle habits, can cause their own problems, but the two combined makes for an even bigger problem. Here are some examples of lifestyle factors that can contribute to insomnia:
- Working overnight or having irregular work hours. Non-traditional hours and shift work can confuse your body’s biological clock, especially if you have to sleep during the day or if your sleep schedule changes often.
- You take naps in the afternoon. While a short nap may be beneficial in some cases to renew your energy and concentration, frequent and long naps can make it harder for you to fall asleep at night.
- Working at home in the evening. If you tend to take your work home with you, you may have trouble falling asleep later. The light from your computer can keep your brain alert, making it difficult for your body to slow down and unwind in preparation for sleep.
- You sleep late in the morning or on weekends to make up for lost sleep. The effects of sleep deprivation can set in quickly and there is no making up for lost sleep. In fact, sleeping in may just confuse your internal clock and make it harder for you to fall asleep that night.
- Watching television or doing other activities in bed. Your bed should be reserved for sleeping – if you do other activities there, your body may not be able to wind down as well, and you could have trouble falling asleep at night.
In some cases, insomnia is caused by a specific life event such as receiving bad news or anticipating a stressful event. These things tend to resolve on their own but if you find yourself adopting unhealthy sleep habits to compensate for the temporary insomnia, you could end up developing chronic insomnia as a result. Over time, chronic insomnia becomes its own cause – you worry about being able to sleep and, in doing so, make it harder to fall asleep.
4. Dietary Causes for Insomnia
Some of the dietary causes for sleep problems are obvious while others may not be quite so simple. Caffeine, for example, is a well-known cause of insomnia but other dietary factors may include alcohol consumption as well as the size and timing of meals.
Caffeine is a stimulant and, when used in moderation, is perfectly fine for most people. A 2005 study conducted by the National Sleep Foundation found, however, that people do drank 4 or more caffeinated drinks a day were more likely to experience frequent symptoms of insomnia than those who drank 0 to 1 per day. Caffeine can stay in your system for up to 8 hours, so you should avoid food and drinks that contain caffeine near bedtime especially but, ideally, should not consume caffeinated beverages within 4 to 6 hours of bedtime.
Alcohol is another beverage that is problematic for sleep. With its sedative effects, alcohol may help you fall asleep initially, but you may find yourself waking frequently during the night and your sleep may not be restful. The nicotine in cigarettes can have a similar effect, making it difficult for you to sleep well through the night. It can also make it harder for you to fall asleep.
How is Insomnia Diagnosed?
Insomnia can affect everyone, but it is more common in women then men and in older adults than younger people. You may also have a higher risk of insomnia if the following things apply to you:
- High levels of stress
- Depression or anxiety disorders
- Emotional or psychological stressors (such as death of a loved one)
- Lower income levels
- Working at night or frequent changes in work hours
- Traveling long distances with time changes
- Living a sedentary lifestyle
- Being of African American descent
According to the National Heart, Lung, and Blood Institute (NHLBI), there are also certain medical problems or conditions which can increase your risk for insomnia. These include obesity, cardiovascular disease, and menopause.
If you have one or more of the risk factors above, or if you’ve been experiencing symptoms of insomnia, it may be time to talk to your doctor. To diagnose you with insomnia, your doctor will start with a medical history, a review of your symptoms, and a physical exam. From there, he may use other tools to make a diagnosis which may include the following:
- Sleep Log – You may need to keep a diary of details about your sleep such as your bedtime, waking time, length of sleep, and how you feel in the morning and during the day.
- Sleep Inventory – This is an extensive questionnaire about your medical history, personal health, and sleeping habits.
- Blood Tests – These tests may help to rule out medical conditions like thyroid problems.
- Sleep Study – In some cases, an overnight sleep study may be warranted to gather information about your symptoms.
Before you talk to your doctor about your concerns, think carefully about the details of your symptoms so you can convey them accurately. You’ll want to be able to answer questions about the frequency of symptoms and their duration as well as the onset of symptoms and your current sleep habits.
What Are the Treatment Options for Insomnia?
The ideal treatment for insomnia is dependent on its cause and severity. If you experience symptoms of insomnia several times a week or most nights and if those symptoms have an impact on your daily life, you could very well benefit from treatment. Treatment options for insomnia can be broken into the following categories:
- Cognitive Behavioral Therapy – Also known as CBT, cognitive behavioral therapy is a type of counseling that can help you become more cognizant of your thoughts and behaviors so you can adjust them to resolve your symptoms.
- Relaxation Training – If you have trouble falling asleep at night, relaxation training techniques such as progressive muscle relaxation, breathing exercises, mindfulness, meditation, and guided imagery may help you relax enough to fall asleep.
- Medical Treatments – Over-the-counter sleep aids and prescription medications may help resolve symptoms of insomnia, just be aware that some of them come with a high risk for dependence. You can also try natural treatments like melatonin and other sleep supplements, aromatherapy with essential oils, chamomile tea and other natural sleep aid solutions.
- Lifestyle Changes – Perhaps the most effective long-term treatment for insomnia is lifestyle changes such as losing weight, quitting smoking, reducing alcohol and caffeine consumption, and making changes to your sleep habits. To encourage a healthy night’s sleep, start winding down 30 minutes before sleep by turning off your TV and mobile devices. You should also keep your bedroom cool, quiet, and dark to encourage healthy sleep.
Every case of insomnia is different, so the treatment that works for you may not work for someone else. You should share your concerns with your doctor and provide as much information as you can about your symptoms, so he can make an accurate diagnosis and develop an effective treatment plan. With that diagnosis, and with proper treatment, you’ll be sleeping like a baby in no time.