Insomnia: Causes, symptoms and treatments

What is insomnia?

Insomnia is a common sleep problem which causes trouble falling asleep or staying asleep for long enough that you don’t feel refreshed the next morning. Adults need at least 7–9 hours of sleep in every 24-hour period.

What Are the Different Types of Insomnia?

Sleep problems may come and go, or they may be ongoing. There are two main types of insomnia on the basis of duration.

Short-term insomnia can last for days to weeks. It often gets better in less than a month. Short-term insomnia is often caused by a stressful life event, such as the loss of a loved one, a disconcerting medical diagnosis, a pandemic, rebounding from cessation of a drug or marijuana, or a major job or relationship change. Symptoms may fade on their own as time passes and a person copes with the stressful incident that gave rise to their sleeping problems. However, short-term insomnia can be persistent and become chronic insomnia.

Chronic insomnia is characterized by symptoms that occur at least three times per week for at least three months. It is often a symptom of another health problem, such as depression or chronic pain. Chronic insomnia is less common than short-term sleep problems.

insomnia can significantly impact daily life.

Insomnia can manifest in different ways.

Sleep-onset insomnia refers to difficulty falling asleep. This type of insomnia may occur with people who have a hard time relaxing in bed, as well as people whose circadian rhythm is not in sync due to factors like jet lag or irregular work schedules.

Sleep maintenance insomnia refers to difficulty staying asleep after initially nodding off. This type of insomnia is common in elderly sleepers, as well as people who consume alcohol, caffeine, or tobacco before bed. Certain disorders like sleep apnea and periodic limb movement disorder can also cause sleep maintenance insomnia.

Some people may have mixed insomnia that involves both sleep-onset and sleep maintenance difficulties, and people with chronic insomnia may find that these symptoms shift over time.

Insomnia can also be classified as:

Primary insomnia: Insomnia that is present with no other co-existing disease.

Co-morbid insomnia: When insomnia exists in conjunction with another medical or psychiatric condition. Co-morbid insomnia does not have to be caused by or change with the co-existing disorder. Most cases of insomnia belong to this category. Sometimes, having insomnia can make the medical or psychiatric condition worse and hinder its treatment. For example, people with depression and insomnia do not respond as well to depression treatment as depressed people without insomnia.

What causes insomnia?

Insomnia is believed to originate due to a state of hyperarousal that can impact sleep-onset and sleep maintenance. Hyperarousal can be mental, physical, or a combination of both. Environmental, physiological, and psychological factors can all play a role in insomnia.

These include:

  • Stress
  • Irregular sleep schedule
  • Poor sleeping habits
  • Anxiety
  • Depression
  • Heart problems
  • Physical illnesses
  • Chronic pain
  • Restless legs syndrome
  • Medications
  • Neurological problems
  • Specific sleep disorders

How is insomnia diagnosed?

Insomnia is not a disease, so no specific test can diagnose it. “Normal sleep” differs for each person, so checking your health and sleep history is an important first step to finding a cause for poor-quality sleep. The requirements for an insomnia diagnosis are continually evolving as researchers learn more about this sleep disorder. According to current criteria, patients must report at least one of the following problems in order to receive an insomnia diagnosis.

  • Difficulty falling asleep
  • Difficulty remaining asleep during the night
  • Repeated instances of waking up earlier than desired
  • Feelings of resistance about going to sleep at a reasonable hour
  • Difficulty sleeping without help from a parent or caregiver

Additionally, patients must experience one or more of the following daytime impairments after a night of insomnia-affected sleep:

  • Feelings of fatigue or malaise
  • Difficulty concentrating, paying attention, recalling, or remembering
  • Impaired performance in social, family, academic, or occupational settings
  • Excessive daytime sleepiness
  • Hyperactivity, impulsivity, aggression, and other behavioral problems
  • Decreased energy, motivation, or initiative
  • Higher risk of errors or accidents
  • Concerns or dissatisfaction regarding sleep

Additional Diagnostic Tests
In some cases, the doctor won’t be able to make a firm insomnia diagnosis without further testing. They may refer you for one of the following procedures

Sleep study: The doctor may prescribe an overnight sleep study, also known as a polysomnogram test. This study may require you to spend the night at a dedicated sleep center with sensors on your scalp, face, eyelids, chest, limbs, and one finger. The sensors monitor brain wave activity, heart and breathing rates, oxygen levels, and muscle movements that occur prior to, during, and after sleep.

Actigraphy tests are somewhat similar to overnight sleep studies, but in most cases you’ll conduct the tests at home. For this test, you’ll wear a sensor on your wrist or ankle that monitors sleep and wakefulness patterns. The recommended duration for wearing the sensors is three to 14 consecutive days.

Treatments


The best approach can depend on the underlying cause and the type of insomnia. Treatment for insomnia may involve nonmedical therapy, such as developing better sleep habits or psychotherapy, and sometimes medications. Making behavior and lifestyle changes can improve your overall sleep quality and help you fall asleep faster. These changes don’t have the side effects that sleep medicines can cause. And the improvements last longer over time.

Cognitive behavioral therapy (CBT) is recommended as a first-line treatment for chronic insomnia in adults. It can help improve your sleep patterns until you’re able to get more quality sleep. One part of CBT-I is learning to have good sleep hygiene, which includes getting rid of distractions in your room and keeping a consistent sleep schedule. You also focus on goals such as:

  • Changing thoughts and behaviors that interfere with good sleep.
  • Creating a sleep schedule that gradually helps you sleep more over time.

Lifestyle changes: Making simple lifestyle changes may help you sleep better. These may include:

  • Changing your sleep area or schedule. Keep regular bedtimes and wake times every day, and try not to nap during the day.
  • Avoiding big meals or too much fluid later in the evening.
  • Minimizing time spent on your bed when you’re not specifically intending to sleep, such as watching TV or surfing the web on your phone
  • Avoiding caffeinated beverages near bedtime
  • Doing relaxation exercises. For example, you can try progressive muscle relaxation. This may help if you lie in bed with your mind racing.
  • Avoiding exercise near bedtime
  • Avoiding alcohol before bed. Drinking alcohol may make you sleepy. But when you drink alcohol, you are more likely to wake up later in the night and have a hard time falling back asleep.

Medicines: In some cases, taking sleeping pills for a short time can help you sleep. Doctors recommend taking sleep medicines only now and then or only for a short time. They are not the first choice for treating ongoing (chronic) insomnia. Your doctor may recommend prescription or nonprescription sleep medicines. Or you may take other medicines that can help you relax and fall asleep, such as benzodiazepines or antidepressants.


Complementary medicines: are sometimes used to treat insomnia. They include dietary supplements, such as melatonin or valerian.

Meditation is a natural, easy, drug-free method for treating insomnia. Meditation can help improve the quality of your sleep, as well as make it easier to fall asleep and stay asleep.

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