Sleep is an essential but often neglected body function that's vital for overall health and general well-being. Without it, your body would suffer burnouts faster, and your health would deteriorate. Unfortunately, too many people don't sleep enough.
Even if you're not the type of person who needs to clock in at least 8 hours each night, it's still an essential part of your health and well-being. Without a good night's rest every now and then, you'll suffer from sleep deprivation which can cause physical, emotional, and mental impairments.
But what exactly is insomnia?
What is Insomnia?
Insomnia is a common sleep disorder that makes it hard to fall asleep or stay asleep. People with insomnia have difficulty initiating, maintaining, consolidating, or having adequate quality sleep even though they have the time and opportunity to sleep.
If you consistently have insomnia, you'll experience a sluggish feel all day long or even start getting sick more often. It's also possible to suffer from other impairments such as irritability, depression, or anxiety, among others.
According to research, about 50% of adults experience insomnia occasionally(1). However, only 10% of Americans experience persistent insomnia. While anyone can have difficulty falling asleep, women and older adults are more likely to suffer this type of insomnia.
The disorder can interfere with sleep for a few days, weeks, and sometimes longer.
What Are The Types of Insomnia?
There are several types of insomnia. The difference between them is how long each lasts, its effect on the quality of sleep, and the causes of a specific type of insomnia.
Acute Insomnia
Acute insomnia causes a lack of sleep for timelines ranging from a couple of days to a few weeks. Of the three types, acute insomnia is the most common.
Often, patients experience acute insomnia after suffering a stressful or traumatic event such as the loss of a loved one or anxiety starting a new career. As a result, acute insomnia is also known as adjustment insomnia. The causes of acute insomnia include:
- Stress.
- External factors such as light or noise disruptions.
- Sleeping in new surroundings.
- Discomfort from pain or inability to adopt a comfortable sleeping position.
- Specific medications.
- Illness.
Chronic Insomnia
Doctors diagnose you as having chronic insomnia if you lack sleep for at least three days a week for more than a month. This type of insomnia is more complex and is further categorized into two types - primary and secondary:
Primary Chronic Insomnia
This type of persistent insomnia is also known as idiopathic insomnia. Unlike other types of sleeping disorders, this one has no known definite cause. It's also not connected to any underlying medical conditions.
Secondary Chronic Insomnia
Also known as comorbid insomnia, secondary chronic insomnia is the most common long-term insomnia. This type occurs with an underlying medical condition. The common causes of secondary chronic insomnia include:
- Long-term medical conditions like central sleep apnea, obstructive sleep apnea, hyperthyroidism, Parkinson's disease
- Mental health conditions that include ADHD (attention deficit hyperactivity disorder), anxiety, and depression
- Medication - antidepressants, chemotherapy drugs, and beta-blockers
- Stimulants - caffeine, nicotine, alcohol, and other drugs
- Lifestyle - napping, jet lag, rotating shifts at work that interfere with sleep habits
Onset Insomnia
If you have trouble initiating sleep, you might be suffering from onset insomnia. Onset insomnia can be short-term or chronic. It can be caused by any of the factors that cause acute or chronic insomnia. Other causes of onset insomnia include depression, stress, and anxiety.
According to a publication in the journal of sleep medicine (2), chronic onset insomnia is often accompanied by other conditions such as periodic limb movement disorder or restless leg syndrome.
While the three above are the most common disorders that interfere with sleep, other types include:
Altitude Insomnia
Altitude Insomnia occurs in approximately 25% of people who go two miles above sea level. This rare type of insomnia is also called Alpine Sickness, Hypobaropathy, Acosta’s Disease or Acute Mountain Sickness. It often occurs with pilots, skydivers, military personnel and mountain climbers as an effect of high altitude.
Repeated exposure to high altitudes can lead to this type of insomnia and it might not occur until a week after the event. Symptoms include a loss of appetite, headache and fatigue along with insomnia. That is, sleep that is constantly interrupted by an inability to catch their breath. It gives people the feeling that they are choking or suffocating and cannot catch their breath.
Maintenance Insomnia
This type of insomnia makes it hard to stay asleep or causes you to wake up too early and have trouble sleeping again. It triggers worry that you won't fall back asleep, and therefore won't sleep enough. Some of the causes of maintenance insomnia include:
- Depression
- Restless leg syndrome
- Respiratory conditions like asthma
- Sleep apnea
- Periodic limb movement
- Dry mouth syndrome
- Gastroesophageal reflux disease
BIC (Behavioral Insomnia of Childhood)
BIC is a type of insomnia that affects children, with about 25% of kids suffering from this sleep disorder. There are three sub-types of BIC:
Sleep-onset BIC
When kids have negative sleep associations, they develop BIC sleep-onset. Some of the negative sleep associations that cause irregular sleep in children are:
- Presence of a child or watching TV while they fall asleep
- Learning to fall asleep while being rocked
- Sleeping while being nursed
Limit-setting BIC
When a child has this type of childhood insomnia, they make repeated attempts to avoid going to bed. They take up behaviours such as asking to go to the bathroom, take a drink, or be read a bedtime story before they sleep.
Combined BIC
A combination of the two children's sleep disorders above, this form of BIC occurs when the child's association with sleep is negative, specifically when the parent or caretaker fails to set limits for sleeping time. Fortunately, you can resolve BIC by changing a few behaviours like:
- Relaxation techniques
- Creating a healthy sleeping routine
- Teaching the child how to self-soothe
What are the Signs and Symptoms of Insomnia?
Insomnia's signs and symptoms vary depending on the person and whether their insomnia is short-term or chronic.
Chronic Insomnia Symptoms
If you've been sleeping poorly for months and your bad sleep habits are causing problems during the day, you may have chronic insomnia. However, to be diagnosed with this type of insomnia, the following symptoms must happen more than three times per week over three consecutive months or longer.
Fatigue and illness
- Memory lapses and difficulty concentrating or paying attention
- Poor academic, social, and professional performance
- Short temperateness and mood swings
- Excessive sleepiness during the day
- Behavioral issues including aggression and hyperactivity
What Are The Common Causes of Insomnia?
Insomnia comes in different ways and can either be primary or secondary insomnia. Primary insomnia is caused by factors not related to the state of your health. On the other hand, secondary insomnia occurs as a result of underlying health conditions.
The National Sleep Foundation states that the most common causes of insomnia are stress, physical illness, pain, interrupted sleep schedules, neurological problems, and poor sleep habits. It can also be caused by certain medications, mental disorders like depression and anxiety, and specific sleep disorders.
When several of these factors are combined, they can initiate or aggravate insomnia. While some find it hard to fall asleep, others find staying asleep difficult. As such, the effects of insomnia vary from person to person –depending on the state of their health, the causes of insomnia, and how serious it is.
How Does Insomnia Affect Sleep?
Depending on the state of your mind and body, insomnia affects sleep as follows:
Stress
People with insomnia experience hyperarousal of the mind or body. Often, such hyperarousal is a result of post-traumatic stress disorder, where the body suffers the effects of mental or physical trauma despite the absence of immediate danger. The body copes by kicking into high alert, making it difficult to relax and sleep.
Irregular sleep schedule
Interrupted sleep patterns can be caused by a shift in your daily schedule or life events. A good example is shift work, jet lag, environment, and hormonal changes. These affect your sleep cycle by interrupting your body's internal clock, known as the circadian rhythm.
Lifestyle habits
Unhealthy lifestyle habits and routines also put you at greater risk of insomnia. If you actually do sleep, you'll likely have a snoring issue and other sleep disorders. Eating heavy meals and spicy food or taking excessive caffeine and alcohol can cause severe bloating and reflux. These make you wake up in the middle of the night and get out of bed to find relief. It is important to keep a healthy lifestyle and follow a clean diet while paying attention to your mind and body needs.
Mental health
Insomnia is a common symptom of mental health conditions like bipolar disorder, anxiety, and depression. These cause hyperarousal of the mind, where insomnia experienced starts a chain of cause and effect. As a result, mental health issues are aggravated when falling asleep, and staying asleep becomes difficult. Those affected become highly irritable and suicidal.
Pain, physical illness, and medication
Pain and different types of physical illnesses like heart disease can affect sleep. Chronic pain makes it hard to lie comfortably in bed, making sleep impossible. Illnesses that affect the nervous and respiratory system also cause insomnia. According to the National Sleep Foundation, the medication used to treat diseases like Parkinson's, high blood pressure, and asthma has side effects such as daytime sleepiness which disrupt your sleep schedule.
Neurodegenerative and neurodevelopmental disorder
People with neurodegenerative and neurodevelopmental disorders like dementia, attention deficit or hyperactivity disorder (ADHD) have a higher risk of getting insomnia due to nighttime confusion. These disorders alter the circadian rhythm making it hard for people that suffer from these diseases to get quality sleep.
Specific sleep disorders
If you suffer from a sleep disorder, your sleep schedule is more likely to be interrupted. The Sleep Foundation identifies various sleep disorders. They include parasomnias like sleep paralysis, sleepwalking, and nightmares. Others like obstructive sleep apnea cause breathing lapses, while Restless Leg Syndrome (RSL) causes a powerful urge to move your legs. As such, you experience temporary sleep interruptions. Such frequent interruptions significantly affect the quality of your sleep.
How can Insomnia be Diagnosed?
The diagnosis of insomnia is a process involving the following steps:
Physical exam
During a physical exam, your doctor looks for signs of health problems that may cause your lack of a good night's sleep. A blood test is also conducted to help rule out conditions that may be associated with inadequate rest.
Sleep habits review
Here, your doctor asks questions to learn more about your sleep problems and their symptoms. You may also be required to fill out a questionnaire to help determine the level of your daytime sleepiness and your sleep-wake pattern. You may also be asked to keep a sleep diary where you record your hours of sleep and any disrupting incidences that occur when you go to bed.
Sleep study
If your causes of insomnia remain unclear after the first two steps, your doctor may subject you to a sleep study. Special tests are conducted at a sleep center to monitor a variety of body activities while you sleep. This helps assess your heartbeat, brain waves, breathing, body, and eye movement.
Management & Treatment of Insomnia
The management and treatment of insomnia are possible. Short-term insomnia such as that caused by health problems like illnesses, chronic pain, and medication can be treated using over-the-counter sleep aids. These contain antihistamines that make you feel drowsy. However, their effectiveness decreases over time.
If your insomnia lasts more than a few days and affects your daily routine, it may be time for your doctor to provide medical advice diagnosis. Make sure to get a thorough check-up to determine the root cause and get the proper treatment.
Addressing insomnia symptoms and adjusting your sleep patterns can help you sleep better. If this doesn't work, you can opt for a more proactive approach like prescription pills and Cognitive Behavioral Therapy for Insomnia (CBT-I). Prescription pills should not be relied on for more than a few weeks as they have undesirable side effects.
What is CBT-I?
Cognitive-behavioral therapy for insomnia is an approach used by sleep medicine doctors to help you control or overcome negative thoughts and actions that play a role in your sleepless nights. It enables you to recognize and change or eliminate ideas that prevent you from having a good night's sleep.
Following such advice, diagnosis, or treatment, you can develop habits that promote your sleep cycle so you can sleep better.
Strategies Used in Cognitive-behavioral Therapy
Relaxation techniques
High blood pressure and anxiety affect your sleep-wake cycle. Relaxation techniques are aimed at helping you control your mood, muscle tension, breathing, heart rate, and blood pressure to promote calm.
Stimulus control therapy
Through this strategy, you can eliminate factors that condition your mind to resist sleep. This is done through coaching to set a consistent sleep routine to avoid naps during the day.
Sleep restriction
Frequent daytime naps contribute to insomnia. Sleep restriction helps address this by reducing the time you spend in bed and the total amount of time you sleep. This makes you more tired the next night and improves the quality of your sleep. A gradual increase in the time you spend in bed is then effected to bring you back to a set routine.
Light therapy
Sleeping too early and waking up early can cause insomnia. Light therapy is used to manipulate your circadian rhythm to restore regular sleep patterns. This is especially useful when your internal clock is disrupted by shift work or a change in time zone.
Paradoxical intention
The expectation of sleep may bring insomnia once you go to bed. The best therapy for that is the paradoxical intention, where you stay up passively and reduce the anxiety around getting enough rest because your mind doesn't worry as much about it when it's not at the forefront of your thoughts.
Is Insomnia Preventable?
Following good sleep hygiene and keeping your mental health and emotions in check goes a long way in helping you avoid and overcome insomnia. Other essential measures recommended by the American Academy of sleep medicine are:
Regular exercise
Regular exercise helps keep your physical health in check and encourages the production of happy hormones in your body. These hormones help improve your general well-being and help fight against poor sleep by bringing positive feelings of pleasure, love, and happiness.
To avoid overstimulation, you should exercise at least three hours before bedtime. This will give you enough time for the good emotions to wear off so you can easily relax into deep slumberland!
Maintain a clean, balanced diet.
Insomnia may be caused by excessive intake of stimulants like nicotine and caffeine. When taken in large quantities, spicy food and alcohol may also cause discomfort. To avoid health issues, it's always advisable to eat a clean, balanced diet. Rather than eat a large serving in one sitting, doctors recommend eating in small, frequent portions.
Following a routine before bed
It is vital to have a relaxation routine before going to bed. This helps condition your brain in preparation for sleep. Such a routine can include calming activities like bathing, listening to music, or reading until you feel sleepy.
Avoid anxiety
Anxiety causes insomnia. If your anxiety kicks in at night as you try to figure out if you've accomplished your tasks for the day, having a to-do list at hand eases the burden. As you go about your daily routine, mark the things you achieve and keep the list to go through later. The sense of accomplishment brought by knowing you've done what you were supposed to do brings comfort and helps you relax.
Have a regular sleep pattern
Changing your sleep pattern throws off your internal clock and causes insomnia. To avoid this, ensure you sleep at the same time and wake up on cue every morning. Further, avoid daytime naps as they make you feel less sleep at night.
Also see our article on the relationship between insomnia and sleep apnea.
References
Bhaskar, S., Hemavathy, D., & Prasad, S. (2016). Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. Journal of family medicine and primary care, 5(4), 780–784. https://doi.org/10.4103/2249-4863.201153
J Korean Sleep Res Soc. 2009;6(2): 74:74-85. Publication Date (Web): 2009 December 31 (Review article) doi:https://doi.org/10.13078/jksrs09015
Roth, T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine, 3(5 suppl), S7-S10.
Morin, C. M., & Benca, R. (2012). Chronic insomnia. The Lancet, 379(9821), 1129-1141.
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307-349.
