What is insomnia?
Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.
Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.
Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.
Insomnia may be divided into three classes based on the duration of symptoms.
- Insomnia lasting one week or less may be termed transient insomnia;
- short-term insomnia lasts more than one week but resolves in less than three weeks; and
- long-term or chronic insomnia lasts more than three weeks.
Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.
It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation.
- Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia.
- In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.
What causes insomnia?
Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause.
Situational and stress factors leading to insomnia may include:
- jet lag,
- physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings),
- working different shifts,
- stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination),
- illicit drug use,
- cigarette smoking,
- caffeine intake prior to going to bed,
- alcohol intoxication or withdrawal, or
- certain medications.
Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.
Sleep hygiene
Sleep hygiene can play an important role in insomnia. Poor sleep hygiene includes physical factors such as:
- using the bedroom for things other than sleeping,
- eating or exercising prior to sleep,
- going to bed hungry,
- sleeping in a room with too much noise or lighting, or
- doing work in bed.
Medical and psychiatric conditions
Medical and psychiatric conditions may also contribute to insomnia.
Some of these common medical conditions may include:
- breathing problems from chronic heart or lung disease (asthma, chronic obstructive pulmonary disease (COPD),
- congestive heart failure,
- obstructive sleep apnea),
- obesity,
- acid reflux,
- hyperthyroidism,
- urinary problems (frequent urination, urinary incontinence),
- chronic pain,
- fibromyalgia,
- Parkinson's disease, or
- dementia.
Common psychiatric problems can be responsible for insomnia including:
- depression,
- psychosis,
- mania,
- anxiety, or
- posttraumatic stress disorder (PTSD).
Some common physiologic conditions can lead to insomnia such as:
- menopause,
- menstrual cycle,
- pregnancy,
- fever, or
- pain.
Other causes of insomnia may be related to sleep disorders including:
- sleep walking,
- sleep apnea,
- restless leg syndrome (creeping sensations in the leg during sleep, relieved by leg movement),
- periodic limb movement disorder (involuntary repeated leg movement during sleep), or
- circadian sleep disturbance (unusual sleep time due to disturbed biological clock).
What are other causes of insomnia?
Besides the conditions listed previously, there are other types of insomnia that are not necessarily linked to an underlying condition. Some of the common types of insomnia are listed in this section.
Psychophysiological insomnia
Psychophysiological insomnia or primary insomnia is a type of insomnia in which learned behaviors prevent sleep. Individuals with this condition are unable to relax their minds (racing thoughts) and have an increased mental function when they try to fall sleep. This may become a long-term issue, and going to bed becomes associated with an increased level of anxiety and mental arousal, leading to chronic insomnia. This condition may be present in about 15% of people who undergo formal sleep studies for evaluation of chronic insomnia.
Idiopathic insomnia
Idiopathic insomnia (without an obvious cause) (childhood onset insomnia or life-long insomnia) is a less common condition (1% of young adults or adolescents) that starts in childhood and may continue into adulthood. These individuals have difficulty initiating and maintaining sleep and have chronic daytime fatigue. Other more common conditions need to be evaluated and ruled out before this diagnosis is made. This condition may run in families.
Paradoxical insomnia
Paradoxical insomnia is also called subjective insomnia or sleep state misconception. In this condition, individuals may report and complain of insomnia;, however, they would have a normal pattern of sleep if they were to have a formal overnight sleep study done.
What are the risk factors for insomnia?
There are no specific risk factors for insomnia because of the variety of underlying causes that may lead to insomnia. The medical and psychiatric conditions listed earlier may be considered risk factors for insomnia if untreated or difficult to treat. Some of the emotional and environmental situations that were also mentioned above may act as risk factor for insomnia.
What are the symptoms of insomnia?
Impairment of daytime functioning is the defining and the most common symptom of insomnia.
Other common symptoms include:
- daytime fatigue,
- daytime sleepiness,
- mood changes,
- poor attention and concentration,
- lack of energy,
- anxiety,
- poor social function,
- headaches, and
- increased errors and mistakes.
How is insomnia treated?
The treatment of insomnia depends largely on the cause of the problem. In cases where an obvious situational factor is responsible for the insomnia, correcting or removing the cause generally cures the insomnia. For example, if insomnia is related to a transient stressful situation, such as jet lag or an upcoming examination, then insomnia will be cured when the situation resolves.
Generally speaking, the treatment of insomnia can be divided into non-medical or behavioral approaches and medical therapy. Both approaches are necessary to successfully treat insomnia, and combinations of these approaches may be more effective than either approach alone.
When insomnia is related to a known medical or psychiatric condition, then appropriate treatment of that condition is in the forefront of therapy for insomnia in addition to the specific therapy for insomnia itself. Without adequately addressing the underlying cause, insomnia will likely go on despite taking aggressive measures to treat it with both medical and non-medical therapies.
What are non-medical treatments for insomnia?
There are several recommended techniques used in treating people with insomnia. These are non-medical strategies and are generally advised to be practiced at home in combination with other remedies for insomnia, such as medical treatments for insomnia and treatment for any underlying medical or psychiatric disorders.
Some of the most important of these behavioral techniques are sleep hygiene, stimulus control, relaxation techniques, and sleep restriction.
What is sleep hygiene?
Sleep hygiene is one of the components of non-medical treatments for insomnia and includes simple steps that may improve initiation and maintenance of sleep. Sleep hygiene consists of the following strategies:
- Sleep as much as possible to feel rested, then get out of bed (do not over-sleep).
- Maintain a regular sleep schedule.
- Do not force yourself to sleep.
- Do not drink caffeinated beverages in the afternoon or evening.
- Do not drink alcohol prior to going to bed.
- Do not smoke, especially in the evening.
- Adjust the bedroom environment to induce sleep.
- Do not go to bed hungry.
- Resolve stress and anxiety before going to bed.
- Exercise regularly, but not 4-5 hours prior to bed time.
Insomnia At A Glance
- Insomnia is a condition characterized by poor quality or quantity of sleep, despite adequate opportunity to sleep, which could lead to daytime functional impairment.
- Many medical and psychiatric conditions may be responsible for causing insomnia.
- Insomnia may, at times, be unrelated to any underlying condition.
- There are several useful non-medical behavioral techniques available for treating insomnia.
- Medications are widely used to treat insomnia in conjunction with non-medical strategies.
- Sleep specialists are medical doctors who can play an important role in evaluating and treating long-standing (chronic) insomnia.
NATURAL PREVENTION:
