Insomnia is not a disease, but is often the symptom of something else. Simply put, insomnia involves difficulty in falling asleep or staying asleep. It is associated with the feeling of not having had enough sleep and the feeling that this has a negative impact during waking hours. Insomnia can appear in different ways. For example, one may find that it takes more than 30 minutes to fall asleep, one may experience problems staying asleep during the night, one may wake up very early (for example, three to four hours earlier than usual), or one may wake up after a night of sleep and not feel refreshed.
Restful sleep is important for our emotional and physical well being. While the exact amount of sleep each person needs is different, it needs to occur continuously to be effective (for example, 7–8 hours in a row rather than frequent, short naps). There are two stages of sleep: rapid eye movement (REM) and non-rapid eye movement (NREM). Throughout the night, sleep cycles between these two stages. NREM sleep is associated with a slowing in brain activity and body functions, and REM sleep is associated with dreaming and acceleration in body functions.
Most people occasionally experience a restless night; however when this lasts for several nights, it is called "transient insomnia." This usually happens because of situational stress (for example, an upcoming test) or a change in sleep schedule (for example, jet lag). If difficulty sleeping lasts from several days up to three weeks, it is called "short-term insomnia." This is often caused by prolonged stress (for example, a short-term illness). Difficulty sleeping that lasts longer than three weeks (lasting anywhere from months to years) is called "chronic insomnia." This is often associated with an underlying psychological or medical condition.
What Causes Insomnia?
Insomnia is often the symptom of another problem. Understanding the cause is important in managing insomnia. There are numerous factors that can cause insomnia. They can be broken down into four major categories: precipitating factors, perpetuating factors, psychological factors, and medical or biological conditions.
Precipitating factors include:
Traumatic or stressful events
Travel through different time zones (jet lag)
Certain working conditions (night shifts or swing shifts)
Medication (some antidepressants, agents to lower blood pressure, some cold medications)
Perpetuating factors include the following:
Anxiety — a person with insomnia may become anxious, which in turn perpetuates the insomnia
Ingestion of caffeine, alcohol or other substances (such as stimulants)
Bright lights in the sleeping environment (this disrupts the "circadian cycle," the body’s internal clock)
Psychological factors include:
Stress or worry
Medical or biological factors include:
Aging — as people age, sleep becomes lighter and less restful
Underlying medical conditions (some examples are allergies, arthritis, heart disease, high blood pressure, asthma)
Genetics or family history
Fluctuation in female hormones (especially during menstruation, pregnancy or menopause)
Who Gets Insomnia?
Sleep disturbances are a common health concern. Estimates of people affected with insomnia vary, but approximately 20–30 million Americans experience short-term insomnia, while more than 35 million suffer from chronic insomnia. Even though millions of people are affected, only a few (about 5%) seek professional help, and the majority do not mention it to their health care providers.
Insomnia can affect people of all ages and gender, but it tends to be more common in the elderly, especially in women who are going through menopause.
Risk factors that may be associated with insomnia include:
People who travel frequently or work night or swing shifts
People who smoke or consume alcohol, caffeine or other stimulants
Signs and Symptoms
The symptoms associated with insomnia are related to difficulty falling asleep or staying asleep. Insomnia may have negative effects during the day such as fatigue (excessive tiredness), impaired ability to function or disturbed mood.
The classic symptom of insomnia is difficulty in sleeping.
This difficulty sleeping can include many variations in symptoms:
Taking at least 30–45 minutes to fall asleep
Waking up many times during the night
Waking up very early in the morning and being unable to fall back asleep
Not feeling refreshed despite sleep
The Diagnosis of Insomnia
Transient or short-term insomnia may not need to be diagnosed by a health care provider. If insomnia is chronic and lasts more than a couple of weeks, one should seek professional help. In order to diagnose insomnia, the physician will ask questions about the difficulties associated with sleeping, sleep habits, or medications, and will obtain a complete medical history. The physician may request that one complete a sleep diary. If the insomnia appears to be due to an underlying medical condition, the physician may perform a more thorough examination including a physical exam and blood tests.
How Serious is Insomnia?
Complications of Insomnia
Losing sleep occasionally is common and does not cause any long-term problems. However, if insomnia lingers, it can result in daytime impairments, affect mood and increase the risk of accidents. Insomnia is an expensive problem; it costs the United States billions of dollars each year in medical costs and decreased productivity. It can affect mental functioning by impairing concentration and memory; and it can increase stress and contribute to depression. Insomnia and resulting daytime sleepiness may also increase the risk of injury due to motor vehicle or machinery-related accidents. One report showed that 30% of fatal trucking accidents were caused by fatigue. Some people with chronic insomnia may turn to alcohol or other substances, which may result in abusive or addictive behaviors.
Insomnia generally goes away when its cause is addressed or when people adopt healthy sleep habits. By itself, insomnia is not life threatening. However, chronic or recurrent insomnia is most likely the symptom of an underlying medical or psychological illness that needs to be treated.
What are the Complementary and Alternative Treatments for Insomnia?
What are the Conventional Treatments for Insomnia?
Identifying the cause of insomnia is important in treating it successfully. Often, once the underlying cause is treated, the insomnia goes away. The specific treatment will differ depending upon the type of insomnia. Treatment options include lifestyle changes, behavioral therapies (such as relaxation techniques or changing thoughts or attitudes about sleep) and medication. Usually medications are tried only after non-drug approaches have not been successful.
Transient and short-term insomnia may go away without treatment or with changes in sleep habits. If changes in sleep habits do not produce relief, then a few weeks of a sleeping medication, called a "hypnotic," may help. Sleeping medications should not be used for longer than three weeks.
The treatment of chronic insomnia is directed at treating the underlying medical or psychological cause. Note that sleeping medications are not useful for chronic insomnia, as overuse may cause dependency or addiction.
Examples of sleeping aids (hypnotics) are:
Over-the-counter (OTC) medications: diphenhydramine alone (Benadryl, Nytol, Sleep-Eez, Sominex), diphenhydramine in combination with a pain reliever (Anacin PM, Excedrin PM, Tylenol PM), doxylamine (Unisom), and melatonin (a dietary supplement).
Benzodiazepines: examples are flurazepam (Dalmane), estazolam (ProSom), quazepam (Dural), temazepam (Restoril), and triazolam (Halcion).
Non-benzodiazepines: zolpidem (Ambien).
The goals of treatment are to:
Minimize effects during waking hours
Establish healthy sleep habits
Treat or address underlying causes of chronic insomnia
How Can Insomnia Be Prevented?
There are many things that one can do to prevent insomnia:
Avoid caffeine, alcohol and smoking 4-6 hours before bedtime (while alcohol may help one fall asleep, it interferes with sleep after a few hours).
Put all worries out of mind before bedtime.
Do not exercise 4–6 hours before bedtime (however, exercising earlier in the day can improve sleep).
Perform relaxing rituals before bedtime, such as having a warm bath, reading, listening to relaxing music, or eating a light snack.
Reserve the bed for sleeping and sexual activities (do not eat, read, work or watch TV in bed).
Go to bed only when tired; if sleep does not occur within 15–20 minutes, get out of bed and relax for a while.
Avoid watching the clock.
Make sure the bed and the environment are comfortable and conducive to sleeping (for example, the room should be quiet, dark and at a comfortable temperature).
Go to bed and wake up at the same time every day, even on weekends.
Avoid taking naps, especially in the late afternoon.