Insomnia is a sleep disorder. People with insomnia have trouble sleeping, in that they have difficulty falling asleep, or staying asleep as long as desired. While the term is sometimes used to describe a disorder as diagnosed by polysomnographic or actigraphic evidence, this is often practically defined as a positive response to either of two questions: “do you experience difficulty sleeping?” or “do you have difficulty falling asleep?
Insomnia is most often thought of as both a medical sign and a symptom that can accompany several sleep, medical, and psychiatric disorders characterized by a long-term difficulty falling asleep and/or staying asleep or sleep of poor quality. Insomnia is typically followed by functional impairment while awake. Insomnia can occur at any age, but it is particularly common in the elderly. Insomnia can be short-term (up to three weeks) or long term (above 3–4 weeks); it can lead to memory problems, depression, irritability and an increased risk of heart disease and automobile related accidents.
Can’t sleep? Understanding insomnia and its symptoms
Insomnia is the inability to get the amount of sleep you need to wake up feeling rested and refreshed. Because different people need different amounts of sleep, insomnia is defined by the quality of your sleep and how you feel after sleeping—not the number of hours you sleep or how quickly you doze off. Even if you’re spending eight hours a night in bed, if you feel drowsy and fatigued during the day, you may be experiencing insomnia.
Insomnia can be grouped into primary and secondary insomnia. Primary insomnia is a sleep disorder not due to a medical, psychiatric, or environmental cause. It is described as a complaint of prolonged sleep onset latency, disturbance of sleep maintenance, or the experience of non-refreshing sleep. Conditions that can result in insomnia include depression, pain, benign prostatic hypertrophy, obstructive sleep apnea, and restless leg syndrome, and substance misuse. A diagnosis will differentiate between primary insomnia, insomnia as secondary to another condition, and primary insomnia co-morbid with one or more conditions.
Insomnia may include:
- Difficulty falling asleep
- Difficulty staying asleep throughout the night
- Waking up too early in the morning
Insomnia involves both a sleep disturbance and daytime symptoms. The effects of insomnia can impact nearly every aspect of your life. Studies show that insomnia negatively affects work performance, impairs decision-making and can damage relationships. In most cases, people with insomnia report a worse overall quality of life.
As many as 30 to 35 percent of adults complain of insomnia. Everyone has the occasional night of poor sleep. In many cases this is due to staying up too late or waking up too early. This does not mean you have insomnia, it means you didn’t get enough sleep.
As many as 30 to 35 percent of adults complain of insomnia. It is more common in groups such as older adults, women, people under stress and people with certain medical and mental health problems such as depression.
Insomnia can be classified as 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 cytokines are more likely than others to have chronic insomnia. Its effects can vary according to its causes. They might include muscular weariness, hallucinations, and/or mental fatigue. Chronic insomnia can cause double vision.
- Difficulty falling asleep, including difficulty finding a comfortable sleeping position
- Waking during the night and being unable to return to sleep
- Feeling un-refreshed upon waking
- Daytime sleepiness, irritability or anxiety
Sleep-onset insomnia is difficulty falling asleep at the beginning of the night, often a symptom of anxiety disorders. Delayed sleep phase disorder can be misdiagnosed as insomnia, as sleep onset is delayed to much later than normal while awakening spills over into daylight hours.
It is common for patients who have difficulty falling asleep to also have nocturnal awakenings with difficulty returning to sleep. Two thirds of these patients wake up in the middle of the night, with more than half having trouble falling back to sleep after a middle of the night awakening.
Early morning awakening is an awakening occurring earlier (more than 30 minutes) than desired with an inability to go back to sleep, and before total sleep time reaches 6.5 hours. Early morning awakening is often a characteristic of depression.
Acute vs. Chronic Insomnia
Insomnia also varies in how long it lasts and how often it occurs. It can be short-term (acute insomnia) or can last a long time (chronic insomnia). It can also come and go, with periods of time when a person has no sleep problems. Acute insomnia can last from one night to a few weeks. Insomnia is called chronic when a person has insomnia at least three nights a week for a month or longer.
Common 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 an upcoming presentation or a painful breakup. Chronic insomnia, however, is usually tied to an underlying psychological or medical issue.
Psychological problems and emotional distress. Anxiety and depression are two of the most common causes of chronic insomnia. Other common emotional and psychological causes include chronic or significant life stress, anger, worry, grief, bipolar disorder, and trauma.
Medical problems or illness. Many medical conditions and diseases can contribute to insomnia, including asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, and cancer. Chronic pain is also a very common cause of insomnia.
Medications. Many prescription drugs can interfere with sleep, including antidepressants, stimulants for ADHD, corticosteroids, thyroid hormone, high blood pressure medications, and some contraceptives. Common over-the-counter culprits include cold and flu medications that contain alcohol, pain relievers that contain caffeine (Midol, Excedrin), diuretics, and slimming pills.
Sleep disorders. Insomnia is itself a sleep disorder, but it can also be a symptom of other sleep disorders, including sleep apnea, restless legs syndrome, and circadian rhythm disturbances tied to jet lag or late-night shift work.
Causes of acute insomnia can include:
- Significant life stress (job loss or change, death of a loved one, divorce, moving)
- Emotional or physical discomfort
- Environmental factors like noise, light, or extreme temperatures (hot or cold) that interfere with sleep
- Some medications (for example those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep
- Interferences in normal sleep schedule (jet lag or switching from a day to night shift, for example)
Causes of chronic insomnia include:
- Depression and/or anxiety
- Chronic stress
- Pain or discomfort at night
If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.
In medicine, insomnia is widely measured using the Athens insomnia scale. It is measured using eight different parameters related to sleep, finally it is represented as an overall scale which assess an individual’s sleep pattern.
A qualified sleep specialist should be consulted in the diagnosis of any sleep disorder so the appropriate measures can be taken. Past medical history and a physical examination need to be done to eliminate other conditions that could be the cause of the insomnia. After all other conditions are ruled out a comprehensive sleep history should be taken. The sleep history should include sleep habits, medications (prescription and non-prescription), alcohol consumption, nicotine and caffeine intake, co-morbid illnesses, and sleep environment. A sleep diary can be used to keep track of the individual’s sleep patterns. The diary should include time to bed, total sleep time, time to sleep onset, number of awakenings, use of medications, and time of awakening and subjective feelings in the morning. The sleep diary can be replaced or validated by the use of out-patient autography for a week or more, using a non-invasive device that measures movement.
Going to sleep and waking up at the same time every day can create a steady pattern which may help to prevent or treat insomnia. Avoidance of vigorous exercise and any caffeinated drinks a few hours before going to sleep is recommended, while exercise earlier in the day is beneficial. The bedroom should be cool and dark, and the bed should only be used for sleep and sex. These are some of the points included in what doctors call “sleep hygiene“.
It is important to identify or rule out medical and psychological causes before deciding on the treatment for insomnia. Cognitive behavioral therapy (CBT) has been found to be as effective as medications for the short-term treatment of chronic insomnia. The beneficial effects, in contrast to those produced by medications, may last well beyond the stopping of therapy. Medications have been used mainly to reduce symptoms in insomnia of short duration; their role in the management of chronic insomnia remains unclear. Several different types of medications are also effective for treating insomnia.