Do you struggle to get to sleep no matter how tired you are? Or do you wake up in the middle of the night and lie awake for hours, anxiously watching the clock? Insomnia is a common problem that takes a toll on your energy, mood, health, and ability to function during the day. Chronic insomnia can even contribute to serious health problems.
Insomnia, the Latin word for “no sleep” is characterized by difficulty falling and/or staying asleep. People with insomnia have difficulty falling asleep, wake up often during the night and having trouble going back to sleep, and often feel tired upon waking.
Although insomnia is the most common sleep complaint, it is not a single sleep disorder. It’s more accurate to think of insomnia as a symptom of another problem, which differs from person to person. It could be something as simple as drinking too much caffeine during the day or a more complex issue like an underlying medical condition or feeling overloaded with responsibilities.
Half of all those who have experienced insomnia blame the problem on stress and worry. In the case of stress-induced insomnia, the degree to which sleep is disturbed depends on the severity and duration of the stressful situation. Sometimes this may be a disturbing occurrence like loss of a loved one, loss of a job, marital or relationship discord or a tragic occurrence. Anticipation of such things as weddings, vacations, or holidays can also disturb sleep and make it difficult to fall asleep or remain asleep. Insomnia can also occur with jet lag, shift work and other major schedule changes.
The prevalence of insomnia is higher among older people and women. Women suffer loss of sleep in connection with menstruation, pregnancy, and menopause. Rates of insomnia increase as a function of age but most often the sleep disturbance is attributable to some other medical condition.
Types of Insomnia
There are different types of insomnia: transient, acute or chronic
- Transient insomnia lasts for less than a week. It can be caused by another disorder, by changes in the sleep environment, by the timing of sleep, severe depression, or by stress. Its consequences – sleepiness and impaired psychomotor performance – are similar to those of sleep deprivation.
- Acute insomnia is the inability to consistently sleep well for a period of less than a month. Insomnia is present when there is difficulty initiating or maintaining sleep or when the sleep that is obtained is non-refreshing or of poor quality. These problems occur despite adequate opportunity and circumstances for sleep and they must result in problems with daytime function. Acute insomnia is also known as short term insomnia or stress related insomnia.
- Chronic insomnia lasts for longer than a month. It can be caused by another disorder, or it can be a primary disorder. People with high levels of stress hormones or shifts in the levels of hormone regulators are more likely to have chronic insomnia. Its effects can vary according to its causes. They might include muscular fatigue, hallucinations, and/or mental fatigue. Some people that live with this disorder see things as if they are happening in slow motion, wherein moving objects seem to blend together. Chronic insomnia can be dangerous to anyone driving or needing to stay alert because it has been known to cause double vision.
Causes of Insomnia
Sometimes, insomnia only lasts a few days and goes away on its own, especially when the insomnia is tied to an obvious temporary cause, such as stress over a work or family situation, a painful breakup, or even jet lag. Other times, insomnia is stubbornly persistent. But chronic insomnia is usually tied to another underlying mental or physical issue.
- Psychological problems that can cause insomnia: depression, anxiety, bipolar disorder, chronic stress, post-traumatic stress disorder.
- Medications that can cause insomnia: antidepressants; pain relievers that contain caffeine (Midol, Excedrin); diuretics, cold and flu medications that contain alcohol, corticosteroids, thyroid hormone, high blood pressure medications.
- Medical problems that can cause insomnia: asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain.
- Sleep disorders that can cause insomnia: sleep apnea, narcolepsy, restless legs syndrome.
Lifestyle and daily habits can also lead to insomnia. A changing in your environment or work schedule can disrupt your body’s natural circadian rhythms, throwing your internal clock out of whack. When the rhythms get disrupted, other things suffer like your metabolism and core body temperature.
Sleep habits, or sleep hygiene, can be a big factor in regular bouts of insomnia. Poor sleep hygiene includes an irregular sleep schedule, stimulating activities before bed, an uncomfortable sleep environment and use of your bed for activities other than sleep or sex.
“Learned” insomnia is a common complaint among people who suffer from the inability to sleep well. This occurs when you worry excessively about not being able to sleep well and try too hard to fall asleep. Most people with this condition sleep better when they’re away from their usual sleep environment or when they don’t try to sleep, such as when they’re watching TV or reading.
Eating late in the evening can make it uncomfortable to lie down, which makes it difficult to fall asleep. Your body needs to burn fuel to digest, which can hinder its ability to slow down and relax before bedtime. Light snacking isn’t usually an issue, but eating a whole meal within an hour or two of bedtime can easily disrupt your sleep.
Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression. [Source: http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep]
Since the majority of causes of insomnia are related to behavior, the treatment would generally include sleep behavior modification. Bedtime routines or the bedroom itself may become linked with anxiety for a person who is experiencing insomnia because they dread the thought of another sleepless night. A combination of several behavioral treatments is typically the most effective approach. Some examples of behavioral treatments are:
- Stimulus Control Therapy: creating a sleep environment that promotes sleep
- Cognitive Therapy: learning to develop positive thoughts and beliefs about sleep
- Sleep Restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night
If behavioral therapies are not enough, treating insomnia with medication is usually the next step. Patients who combine behavioral approaches with medication have seen success.
Creating and maintaining good sleep hygiene is important for avoiding the pitfalls of insomnia and decreasing the occurrence of it. Speaking to a doctor or sleep therapist about your habits and outside stressors can help narrow down the cause of insomnia.
The National Sleep Foundation has a series of helpful videos about insomnia and helping people find the rest they need. NBC’s Today Show produced an eye-opening study about why we don’t get enough sleep: http://www.sleepfoundation.org/video/nbcs-today-show-why-we-dont-get-enough-sleep
Please read about Dr. Castelli’s approach to helping patients suffering from Insomnia.