Insomnia – Definition, Causes, Symptoms, Diagnosis, and Treatment

Insomnia is one of the most common sleep disorders, and it is estimated to affect around 30% of the general population. It is defined by the inability to fall (sleep onset), or stay asleep (sleep maintenance insomnia).

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Last Updated: Mon, April 10, 2023
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In an ideal world, everybody would be keeping a balanced diet, exercising regularly, and getting eight hours of sleep every night. Unfortunately, the pressure of everyday life keeps many people from achieving these goals. People often don’t have the time to prepare healthy meals, so they choose fast food instead. Work usually takes up most of our day, and if we have a few other errands, we tell ourselves that there is no time for a gym visit. On top of that, many people decide to sacrifice sleep to get everything done, and that has many negative consequences in the long run.

Lack of sleep has many negative effects. Sleep deprivation leads to numerous health conditions, impaired memory and performance, inability to focus, weaker immune system, and the continual practice of poor sleep hygiene can lead to the development of many sleep disorders.

Insomnia is one of the most common sleep disturbances, and it is estimated to affect around 30% of the general population. It is defined by the inability to fall (sleep onset), or stay asleep (sleep maintenance insomnia). An occasional night of poor sleep can happen to anyone, but if it becomes frequent, you should probably pay a visit to your medical provider to check if there is an underlying condition that’s causing sleep problems.

Continue reading to learn more about insomnia, how it develops, what are the risk factors, what you can do to prevent it from happening, and what the treatment looks like for the affected people.

Insomnia Symptoms

Even though it affects around one-fifth of the population, most people experience transient or short term insomnia. Symptoms usually last from a few days up to three months at most. The cause of these short term sleeping difficulties is generally accounted to periods of high stress, acute illness, a short term medical issue that requires surgery or hospitalization, or a significant life event. Regular sleep patterns usually restore when the situation is resolved. 

An excellent example of transient insomnia is the rebound effects when a person ceases to take sleep aids. These medications are used to help your internal clock adjust to the night and day cycle, and when you stop using them, your brain has to reset your sleep pattern on its own, without any supplements. You can help it by spending some time outdoors in the natural light during the day, as well as by dimming the lights in the evening to boost the production of a sleep-promoting hormone called melatonin. The rebound effects can last up to a few days, depending on a person, and then your sleep rhythm should go back to normal.

Chronic insomnia affects a smaller part of the population, and it troubles people at least three times each week, for a period longer than three months. Besides the environmental factors, it seems that genetics play a significant role in the development of chronic insomnia as well. The most frequent symptoms include:

Health Risks of the Lack of Sleep

Sleep experts recommend 7 to 9 hours of sleep each night, but it appears that one in three Americans is getting less than six hours on average. This trend can have serious health consequences that affect every aspect of your life.

Sleep deprivation can leave you feeling cranky and unmotivated. You feel too tired to work efficiently and participate in your daily activities. On top of that, your performance is affected, and you can’t seem to be able to concentrate and deliver like you used to. To make things even worse, your ability to make rational decisions declines, which leads to more unhealthy choices like smoking, drinking more alcohol, and eating junk food. With a lack of motivation to exercise, unhealthy diet, and increased stress, insomnia can lead to more severe health effects.

Chronic sleep deprivation raises the risk of diabetes, obesity, high blood pressure, stroke, and heart disease. It also appears to be connected with numerous mental health disorders, such as depression and anxiety. Lack of sleep also leads to weakened immune systems, which leaves you more prone to the common cold, inflammations, and infections. Impaired judgment can play a role in the development of alcohol or drug abuse. 

In rare cases, insufficient rest can be even more dangerous. A chronic lack of sleep leads to daytime drowsiness, which can result in the appearance of microsleeps. These events are short bursts of sleep that usually last several seconds. They are involuntary, and anyone who has briefly snoozed during a lecture has experienced them. Although they seem harmless, if they happen when the person is driving or operating heavy machinery, there could be fatal consequences. During microsleep, your brain doesn’t respond to the external stimuli, and you are not aware of what is happening around you for a few moments. People are generally bad at recognizing when these events will occur, or they choose to ignore it, which is even worse. Drowsy driving is responsible for more than 100 thousand car crashes, 1500 fatalities, and 40 thousand injuries each year in the United States. 

What Causes Insomnia?

Insomnia is a condition that affects people of all ages. It is estimated that around 30 percent of adults, and about the same percentage of children and teenagers suffer from it. However, it is a little more prevalent among women and people aged 65 or older. 

Developing this condition is connected to many underlying disorders, and treating it depends on each case. Transient and short term insomnia is often the result of specific circumstances that create a stressful environment and disrupt regular day to day living. Resolving the situation usually leads to the cessation of symptoms.

Development of chronic insomnia is affected by three factors: hereditary, repetitive behaviors, and different triggers. In most cases, the results are a combination of more than one of these factors.

You can’t run from your genetics, and it seems that it has a significant part in the development of sleep disorders. Some people simply have a lower threshold for nocturnal arousals, which means that they are easily woken up by sound or movement. If the arousals are somewhat frequent, they lead to fragmentation of sleep, and it can develop into insomnia. Unfortunately, there is little a person can do to limit this, and people who are easily woken up should aim to eliminate night disturbances from their bedroom so that they can enjoy a sound, restful sleep.

Other people are prone to certain medical conditions that can affect a person’s sleep quality, like:

If another disorder is causing your sleep problems, the first step is to treat that underlying condition. The proper management should eliminate or lessen the symptoms that are interfering with a person’s nightly slumber.

Certain triggers can initiate or make sleep difficulties worse in people, and they include:

While not all of these factors can be controlled and eliminated, the use of cognitive and behavioral therapy can lessen the magnitude of the triggers, and help us understand how to deal with, and overcome them. The removal is easier with the medications as there are usually different alternatives on the market. Some drugs that can increase the risk of insomnia as a side effect are:

The use of stimulants like caffeine, nicotine, and alcohol can additionally disrupt sleep. That is why health professionals are suggesting limited consummation of alcohol and caffeine during the day, and all sleep experts agree that you should restrain from using any stimulants at least six hours before bedtime.

Diagnosis of Insomnia 

Depending on the complexity of the situation, discovering underlying factors can be challenging. First, your physician will review your medical and medication history to see if he or she can spot anything unusual that could be causing sleep problems. Next step is talking about your sleep habits and doing a physical exam to look for any signs of medical conditions that could be the cause of insomnia. They might even order a blood test to determine if everything is alright with your thyroid gland.

Also, a physician can ask you to keep a sleep diary for a week or two. It is a log of your sleep behaviors that should include things like the time you go to sleep and wake up, how long it takes you to fall asleep, if you experience any night disruptions, if you feel well rested in the morning, if you are napping during the day, and more. You should also keep track of other habits that could be affecting sleep like diet and exercise. This detailed information helps them get a more comprehensive view of the situation so that they can prescribe you the best possible treatment, which often includes overall lifestyle and sleep habit changes and in some cases, a short use of medications. 

If the cause of your sleep problems isn’t clear, or your physician suspects that there is some other sleep disorder in question such as restless legs syndrome or sleep apnea, they may refer you to do an overnight sleep study called polysomnography. This procedure is done in specialized facilities called sleep clinics, where the technicians take numerous tests to determine the cause of your sleep disruptions. 

When you first come in, they’ll ask you to fill out several questionnaires like the Pittsburgh Sleep Quality Index, to evaluate your situation. The way these tests work is that there is a certain threshold and if your score passes that, it is an indication that you may have a sleep disorder. After you are done, it is time for the actual sleep study. A sleep technician will hook you up to several machines that measure your brain waves, heart rate, breathing patterns, snoring, eye and body movement, and more. With this detailed data about your sleep, sleep experts can then assert your situation, give a diagnosis, and recommend further treatment.

Different Therapy Options

Based on the individual situation, a doctor can suggest several different approaches to battle with sleep problems.

Behavioral treatment (CBT-I)

These approaches are based on changing behaviors surrounding sleep, which can include internal thoughts and impressions about sleep, creating a pleasant bedroom environment, and doing activities that should improve sleep routines. The goal is to root out all negative and create positive associations that should help with insomnia.

CBT-I is a type of therapy where you are trying to address the recurring thoughts and behavioral patterns that hurt your sleep, with the help of a professional. This method is mostly used for chronic insomnia, as people usually develop frustrations with nighttime rest because they spend so much time trying to fall asleep without success. The goal is to undo this and make healthy, positive associations. This usually takes time, and standard CBT-I involves hour-long weekly sessions over 6 to 12 weeks. The treatment includes the use of sleep restriction, stimulus control, relaxation training, biofeedback, cognitive control, and sleep hygiene training. 

Stimulus control refers to strengthening positive associations between the bed and sleep. Since people with chronic insomnia get frustrated with the inability to fall asleep, a single thought of going to bed can make them anxious. This method requires using your bed only for sleep and intimacy. Everything else like watching TV, reading, scrolling social networks, and answering work emails, should be done somewhere else. If you are using stimulus control should only go to bed when you are feeling sleepy, and if you can’t fall asleep for 20 to 30 minutes, you should get up and do a relaxing activity until you get tired again. Over time, your brain will learn to recognize your bed as the place for nightly slumber, and it will take you a lot less to drop off.

Sleep restriction limits the time you spend in bed each night. The way it works is that you look at your sleeping habits and set a time you spend in bed each night. For instance, if you usually take 8 hours, but only spend 5 of those sleeping, then the limit is set at 5 hours. The goal of this initial restriction is to cut down the time needed to fall asleep so that you don’t spend hours lying awake and getting frustrated. When the falling asleep becomes easier, you gradually expand this time, so that you can get a sufficient amount of sleep.

Relaxation and biofeedback include different methods of meditation and breathing exercises that help calm the mind and body. Biofeedback is achieved through the use of specific devices that let you know your state of relaxation by notifying you about your blood pressure, body temperature, heart rate, or muscle tension. That way, you can use meditation and breathing techniques to get back to the calm state.

Cognitive control refers to the use of psychotherapy to change the negative thoughts and attitudes towards sleep. Therapists use different methods to do that depending on the individual, but you should know that this usually takes some time, so the best you can do is to be open and patient.

Some doctors may prescribe different medications to treat insomnia. Most of them are used for one to four weeks and are not intended to be taken for more extended periods. They are usually used in combination with other treatment methods. The most commonly used ones are benzodiazepines, including Diazepam (Valium), Clonazepam (Klonopin), Alprazolam (Xanax), and Lorazepam (Ativan). Some over the counter sleep aids can include Antihistamines, Benadryl, and Melatonin

Improving Sleep Hygiene

One of the essential things for battling insomnia is to change some of your lifestyle habits and establish good sleep hygiene. That includes:

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Dusan is a biologist, a science enthusiast and a huge nature lover. He loves to keep up to date with all the new research and write accurate science-based articles. When he’s not writing or reading, you can find him in the kitchen, trying out new delicious recipes; out in the wild, enjoying the nature or sleeping in his bed.

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Co-founder of Counting Sheep and Sleepaholic

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