Insomnia is a highly prevalent sleep disorder that regularly affects millions of people worldwide. In short, individuals with insomnia find it difficult to fall asleep and/or stay asleep.
Insomnia commonly leads to daytime sleepiness, lethargy, and a general feeling of being unwell both mentally and physically.
In this article, we will discuss what insomnia is, its causes, symptoms, diagnosis, and possible treatments.
Contents of this article:
Fast facts on insomnia
Here are some key points about insomnia. More detail and supporting information is in the main article.
- There are many possible causes of insomnia
- An estimated 30-40 percent of Americans report experiencing insomnia each year
- Often, insomnia is due to a secondary cause, such as illness or lifestyle
- Causes of insomnia include psychological factors, medications, and hormone levels
- Treatments for insomnia can be medical or behavioral
What is insomnia?
An estimated 22 percent of Americans say they experience insomnia every or almost every night.
Insomnia includes a wide range of sleeping disorders, from lack of sleep quality to lack of sleep quantity.
Insomnia is commonly separated into three types:
- Transient insomnia - occurs when symptoms last from a few days to a few weeks.
- Acute insomnia - also called short-term insomnia. Symptoms persist for several weeks.
- Chronic insomnia - this type lasts for months, and sometimes years. According to the National Institutes of Health, the majority of chronic insomnia cases are secondary, meaning they are side effects or symptoms resulting from another primary problem.
Although insomnia can affect people of any age, it is more common in adult females than adult males. The sleeping disorder can undermine school and work performance, as well as contributing to obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, and reduced reaction time.
Insomnia has also been associated with a higher risk of developing chronic diseases.
According to the National Sleep Foundation, 30-40 percent of American adults report that they have had symptoms of insomnia within the last 12 months, and 10-15 percent of adults claim to have chronic insomnia.
What causes insomnia?
Insomnia can be caused by physical factors as well as psychological factors. There is often an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Insomnia is commonly caused by:
- Disruptions in circadian rhythm - jet lag, job shift changes, high altitudes, environmental noise, heat, or cold.
- Psychological issues - people with mood disorders such as bipolar disorder, depression, anxiety disorders, or psychotic disorders are more likely to have insomnia.
- Medical conditions - brain lesions and tumors, stroke, chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases, hyperthyroidism, arthritis.
- Hormones - estrogen, hormone shifts during menstruation.
- Other factors - sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, pregnancy.
- Media technology in the bedroom - researchers from the University of Helsinki, Finland, reported in the journal BMC Public Health that media technology in the bedroom disrupts sleep patterns in children. They found that children with TVs, computers, video games, DVD players, and mobile phones in their bedrooms slept considerably less than kids without these devices in their bedrooms. In addition, a study conducted by Rensselaer Polytechnic Institute found that back-lit tablet computers can affect sleep patterns.
Medications - according to the American Association of Retired Persons (AARP), the following medications can cause insomnia in some patients:
- Corticosteroids - used for treating patients with allergic reactions, gout, Sjögren's syndrome, lupus, rheumatoid arthritis, and inflammation of the muscles and blood vessels. Examples include prednisone, triamcinolone, methylprednisolone, and cortisone.
- Statins - medications used for treating high cholesterol levels. Examples include simvastatin, rosuvastatin, lovastatin, and atorvastatin.
- Alpha blockers - used for treating hypertension (high blood pressure), Raynaud's disease and BPH (benign prostatic hyperplasia). Examples include terazosin, silodosin, alfuzosin, prazosin, doxazosin, and tamsulosin.
- Beta blockers - used for treating hypertension and irregular heartbeat (arrhythmias). Examples include carvedilol, propranolol, atenolol, metoprolol, and sotalol.
- SSRI antidepressants - used for treating depression. Examples include fluoxetine, citalopram, paroxetine, escitalopram, and sertraline.
- ACE inhibitors - used for the treatment of hypertension and other heart conditions. Examples include ramipril, fosinopril, benazepril, enalapril, lisinopril, and captopril.
- ARBs (Angiotensin II-receptor blockers) - used for treatment of hypertension (generally when patient cannot tolerate ACE inhibitors). Examples include candesartan, valsartan, and losartan.
- Cholinesterase inhibitors - used for treating memory loss and other symptoms in patients with dementia, including Alzheimer's disease. Examples include rivastigmine, donepezil, and galantamine.
- Second generation (non-sedating) H1 agonists - used for treating allergic reactions. Examples include loratadine, levocetirizine, desloratadine, and cetirizine.
- Glucosamine/chondroitin - dietary supplements used for relieving the symptoms of joint pain and to reduce inflammation.
Who gets insomnia?
Shift workers commonly suffer from insomnia because of inconsistent sleep routines.
Some people are more likely to suffer from insomnia than others; these include:
- Shift workers with frequent changes in shifts (day vs. night)
- The elderly
- Drug users
- Adolescent or young adult students
- Pregnant women
- Menopausal women
- Those with mental health disorders
Signs and symptoms of insomnia
Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia:
- Difficulty falling asleep at night
- Waking during the night
- Waking earlier than desired
- Still feeling tired after a night's sleep
- Daytime fatigue or sleepiness
- Irritability, depression, or anxiety
- Poor concentration and focus
- Being uncoordinated, an increase in errors or accidents
- Tension headaches (feels like a tight band around head)
- Difficulty socializing
- Gastrointestinal symptoms
- Worrying about sleeping
Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day.
Having problems concentrating and focusing on tasks is common for people with insomnia.
According to the National Heart, Lung, and Blood Institute, 20 percent of non-alcohol related car crash injuries are caused by driver sleepiness.
Tests and diagnosis
A sleep specialist will usually begin a diagnostic session by asking a battery of questions about the individual's medical history and sleep patterns. A physical exam may be conducted to look for conditions that could be causing insomnia. Similarly, doctors might screen for psychiatric disorders and drug and alcohol use.
The Stanford Center for Sleep Sciences and Medicine explains that the term "insomnia" is often used colloquially in reference to "disturbed sleep."
For somebody to be diagnosed with an insomnia disorder, their disturbed sleep should have persisted for more than 1 month. It should also negatively impact the patient's wellbeing, either through the distress that results or the disturbance in mood or performance.
A sleep specialist is trained to determine whether the symptoms are being caused by an underlying condition. The patient may be asked to keep a sleep diary to help understand their sleeping patterns.
More sophisticated tests may be employed, such as a polysomnograph, which is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted, which uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.
Treatment options for insomnia
Studies have suggested that electronic devices with self-luminous "backlit" displays can affect evening melatonin, which might result in delayed sleep.
Some types of insomnia resolve when the underlying cause is treated or wears off. In general, insomnia treatment focuses on determining the cause.
Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be used as therapies.
Non-pharmacological approaches and home remedies for insomnia include:
- Improving "sleep hygiene" - not sleeping too much or too little, exercising daily, not forcing sleep, maintaining a regular sleep schedule, avoiding caffeine at night, avoiding smoking, avoiding going to bed hungry, and ensuring a comfortable sleeping environment
- Using relaxation techniques - such as meditation and muscle relaxation
- Cognitive therapy - one-on-one counseling or group therapy
- Stimulus control therapy - only go to bed when sleepy, avoid watching TV/ reading/ eating/ worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps
- Sleep restriction - decrease the time spent in bed and partially deprive the body of sleep, this increases tiredness ready for the next night
Medical treatments for insomnia include:
- Prescription sleeping pills
- Over-the-counter sleep aids