Insomnia: Symptoms, Causes, and Treatments

Insomnia means having trouble sleeping. It can make you struggle to fall asleep, wake up too early, or feel tired even after sleeping. It can mess up your mood, energy, work, and health.

Most adults need 7 to 9 hours of sleep each night. Short-term insomnia might happen because of stress or tough times. But long-term insomnia, lasting three months or more, can be more serious and might be connected to health issues or medicines.

You can fix sleep problems with small changes in your daily routine.

What is Insomnia?

Insomnia is a condition where you have trouble sleeping, either falling asleep, staying asleep throughout the night, or waking up too early and being unable to go back to sleep.

It can be acute (short-term, lasting a few days or weeks) or chronic (lasting for 3 months or more).

There are different types of insomnia:

• Sleep-onset insomnia: Difficulty falling asleep at the beginning of the night.
• Sleep-maintenance insomnia: Waking up frequently during the night and having trouble going back to sleep.
• Mixed insomnia: A combination of both difficulty falling asleep and staying asleep.

Symptoms and Complications

The main symptoms of insomnia include:

• Difficulty falling asleep at night
• Waking up frequently during the night
• Waking up too early and being unable to go back to sleep
• Feeling tired or sleepy during the day
• Irritability, anxiety, or depression
• Difficulty concentrating or remembering things
• Increased errors or accidents

Chronic insomnia and the resulting sleep deprivation can lead to several complications and increased health risks, including:

• Increased risk of high blood pressure, heart disease, and stroke
• Increased risk of obesity and diabetes
• Impaired immune function
• Depression and anxiety
• Decreased productivity and performance
• Increased likelihood of accidents or injuries due to impaired functioning

Insomnia is also associated with a higher risk of developing other mental health disorders like substance abuse.
Lack of sleep can significantly impact daily life, work performance, and overall quality of life.

Causes of Insomnia

Insomnia can be caused by various factors, including:

• Stress, anxiety, or depression
• Medications (e.g., certain antidepressants, asthma medications, caffeine)
• Medical conditions (e.g., chronic pain, cancer, asthma, heartburn)
• Hormonal changes (e.g., menstrual cycle, menopause, pregnancy)
• Poor sleep habits (e.g., irregular sleep schedule, using electronic devices before bed)
• Disruptions to the body’s circadian rhythms (e.g., jet lag, shift work)
• Stimulants (e.g., caffeine, nicotine)
• Environmental factors (e.g., noise, light, uncomfortable temperature)

Insomnia can also be classified as primary (not linked to any other health condition) or secondary (caused by another medical or mental health condition).

Risk Factors

The risk factors for insomnia are varied and can be influenced by biological, psychological, and environmental factors.

• Age: Older adults are more likely to experience insomnia. Changes in sleep patterns and health with age can increase the likelihood of insomnia.
• Gender: Women are more prone to insomnia than men. Hormonal changes during the menstrual cycle, menopause, and pregnancy can disrupt sleep.
• Medical Conditions: Various medical conditions are linked with insomnia, including chronic pain, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease, and Alzheimer’s disease. Mental health disorders such as depression and anxiety also frequently co-occur with insomnia.
• Medications: Certain medications can interfere with sleep, including some antidepressants, asthma medications, and over-the-counter drugs containing stimulants like caffeine.
• Lifestyle Factors: Stress, irregular sleep schedules, and poor sleep habits (such as using electronic devices before bed or inconsistent sleep times) can significantly contribute to insomnia. Lifestyle choices like consuming caffeine and nicotine can also disrupt sleep patterns.
• Environmental Factors: Noise, light, and uncomfortable sleep environments can prevent restful sleep.
• Socioeconomic Status: Lower socioeconomic status has been identified as a risk factor, potentially due to increased stress levels and access to healthcare resources.
• Family History and Genetics: A family history of insomnia can increase one’s risk, suggesting a genetic component to the disorder.

Diagnosis and Tests

Insomnia is diagnosed through a combination of patient-reported symptoms, medical history, physical examinations, and sometimes specific tests.

• Patient-Reported Symptoms: The primary basis for diagnosing insomnia involves the patient reporting difficulty in falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. These issues must occur at least three nights per week and persist for at least three months to be classified as chronic insomnia.
• Medical and Sleep History: The diagnosis process starts with a detailed discussion about the patient’s medical history, sleep patterns, and any symptoms they are experiencing. This may include questions about stress, lifestyle, and habits that could affect sleep.
• Physical Examination: A physical exam may be conducted to look for physical signs that could be contributing to insomnia, such as respiratory issues or neurological problems.
• Sleep Diary: Patients may be asked to keep a sleep diary for one to two weeks. This diary should document details such as the times they go to bed and wake up, how long it takes to fall asleep, the number of awakenings during the night, and daytime sleepiness.
• Questionnaires: Questionnaires can be used to assess sleep quality, the impact of sleep problems on daytime functioning, and other related issues. These help in understanding the severity and impact of insomnia on the patient’s life.
• Sleep Studies: In some cases, further tests such as polysomnography (a sleep study that records brain waves, oxygen levels, heart rate, and breathing during sleep) or actigraphy (using a sensor worn on the wrist to monitor movement during sleep) might be recommended. These tests help rule out other sleep disorders like sleep apnea or restless legs syndrome.
• Blood Tests: Occasionally, blood tests may be conducted to check for underlying conditions such as thyroid issues or other medical problems that could be causing sleep disturbances. 

Treatments

Insomnia can be treated through a variety of approaches, ranging from lifestyle changes and cognitive behavioral therapy to medications.

Lifestyle Changes

• Improve sleep habits (maintain a regular sleep schedule, create a relaxing bedtime routine, avoid caffeine/alcohol before bed)
• Optimize the sleep environment (keeping the bedroom dark, quiet, and cool)
• Increase physical activity and exercise (but not too close to bedtime)
• Manage stress through relaxation techniques like meditation, yoga, or deep breathing exercises

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is considered the first-line treatment for chronic insomnia. It involves:

• Identify and changing negative thoughts/behaviors that interfere with sleep
• Learn relaxation techniques and sleep restriction therapy
• Establish a consistent sleep schedule

This treatment is typically as effective or more effective than sleep medications.

Prescription Medications

• Benzodiazepines (e.g., temazepam, triazolam) – sedative-hypnotic drugs that help with sleep onset
• Non-benzodiazepine hypnotics (e.g., zolpidem, eszopiclone) – promote sleep onset and maintenance
• Antidepressants (e.g., doxepin, trazodone) – can help with sleep in low doses
• Melatonin receptor agonists (e.g., ramelteon) – mimic the sleep-promoting effects of melatonin

Prescription sleep medications are generally recommended for short-term use (a few weeks) due to potential side effects and risk of dependence. Long-term use is evaluated on a case-by-case basis.

Over-the-Counter (OTC) Options

• Antihistamines (e.g., diphenhydramine) – can cause drowsiness but have potential side effects
• Melatonin supplements – may help with sleep onset, but long-term safety is unclear

Complementary and Alternative Therapies

While evidence is limited, some people find relief with therapies like:

• Herbal supplements (e.g., valerian root)
• Acupuncture
• Yoga/tai chi
• Meditation

It’s important to discuss any supplements or alternative therapies with a doctor, as they can interact with medications or have side effects.

The most effective treatment approach often combines cognitive behavioral therapy with lifestyle adjustments. Medications may be used short-term if non-drug therapies are ineffective.

Dr. John Williams

Dr. John Williams is a sleep specialist. He offers Sleep Telemedicine to help people deal with various sleep disorders, particularly sleep apnea.

Graduating from the University of Zagreb’s School of Medicine, he investigates the cellular mechanisms of vascular endothelial dysfunction in obstructive sleep apnea. He also addresses cardiovascular complications of sleep deprivation and COPD. So if you have any sleep problems, let Dr. John Williams help you out.