What Is Insomnia?
Insomnia disorder is a short-term or chronic condition whereby individuals have difficulty sleeping.
Other common symptoms include fatigue, difficulty with concentration, social dysfunction, reduced motivation, and behavioral changes. The short-term form of the condition is usually the result of an identifiable stressor whereas the chronic form of the condition may occur without a known cause.
The main treatment option is cognitive behavioral therapy (CBT) to learn how to better deal with any stressors leading to insomnia, as well as preventative measures via improved sleep hygiene and habits.
Sleep is of critical importance to physical and mental wellbeing. You should speak with your primary care physician about your inability to sleep well. Things you can do to improve your sleep are: regular exercise, keeping a regular bedtime and routine, avoiding caffeine several hours before going to bed and putting away your electronic devices before bedtime. In addition, try to do something relaxing like reading, listening to music or breathing exercises.
Insomnia can be the result of difficulty falling asleep, poor sleep quality, or waking up too early. The following are the most common symptoms associated with the condition [1,2]:
- Distress about falling asleep
- Distress about staying asleep
- Difficulty with concentration
- Social dysfunction
- Reduced energy or motivation
- Behavioral changes
Insomnia is a very common condition with more than five million doctors office visits related to the condition . Insomnia is particularly common in women and elderly individuals .
As mentioned above, insomnia can be subcategorized as acute (short-term) or chronic. Short-term insomnia oftentimes has an identifiable associated stressor (e.g. work-related stress, family pressure, traumatic event) . Insomnia is considered chronic if it occurs at least three times per week for at least three months. Insomnia is often present alongside other medical or psychiatric conditions. Everyone should be evaluated for comorbidities (underlying conditions) that may be causing this sleeplessness. Conditions that can predispose you to insomnia can be categorized as follows:
- Psychiatric conditions: Such as depression, anxiety, substance use disorders, and PTSD
- Medical conditions: Such as COPD, asthma, arthritis, fibromyalgia, chronic pain, heart failure, angina, high blood pressure, hyperthyroidism, excessive nighttime urination, reflux, diabetes, pregnancy, cancer, Lyme disease, menopause, and HIV
- Neurologic conditions: Such as dementia, stroke, brain tumor, concussion, and headache
- Medications: Such as stimulants, depressants, antidepressants, beta blockers, bronchodilators (e.g. albuterol), diuretics, steroids, caffeine, and alcohol
Other sleep disorders
Chronic insomnia has been linked in research to a number of adverse health outcomes including:
- Reduced quality of life
- Suicide risk: Studies have shown a relationship between insomnia and suicide, even when controlling for the possibility of co-occurring depression .
- Cardiovascular risk: Insomnia is associated with increased activation of the sympathetic nervous system (also known as the “fight or flight response”). This overactivation puts stress on the heart and can lead to increased risk of high blood pressure and heart attack .
Insomnia Symptom Checker
Take a quiz to find out if you have Insomnia
Treatment Options and Prevention for Insomnia Disorder
One of the most important aspects of managing insomnia is an in-depth patient history and physical exam to determine if you are experiencing primary insomnia due to another condition. Management of acute insomnia is focused on identifying acute stressors and adapting behavior accordingly. If the acute insomnia is severe and causing you significant distress, medication may be recommended. The most commonly recommended therapy, in this case, is a short course of a sedative. The recommended sedative is often a benzodiazepine receptor agonist, usually taken for two to four weeks .
The first-line therapy for chronic insomnia is cognitive behavioral therapy. There is a specific form of cognitive behavioral therapy that has been developed for people with insomnia called CBT-I. CBT-I focuses on the following components:
- Establishment of a stable bedtime and wake time seven days per week
- Sleep restriction: This is reducing the time in bed to approximate the total hours of estimated sleep.
- Encouragement to use the bed only for sleep and sex
- Sleep hygiene: This includes avoidance of substances that interfere with sleep, avoidance of naps to maximize sleep drive, and optimization of the comfort of the sleep environment.
- Addressing anxious and catastrophic thoughts that are associated with sleeplessness
- Addressing inappropriate expectations about hours of sleep
- Addressing misattributions regarding the effects of sleeplessness
- Relaxation: This is achieved through progressive muscle relaxation, mindfulness, and meditation. People with insomnia that is refractory to cognitive behavioral therapy are often trialed on medications. The most commonly used medications for insomnia include benzodiazepines, antidepressants, melatonin agonists, and antipsychotics .
Prevention of insomnia is aimed at management of day-to-day stressors and improving sleep hygiene. Improvements in sleep hygiene include :
- Routine: Your sleep routine should involve going to sleep and waking up at the same time every night/day.
- Limit daytime napping
- Spend 15 to 20 minutes outside each day
- Avoid bright light before bedtime
- Avoid mind-engaging activities when physically in bed
- Keep the bedroom dark and cool
- Avoid caffeine and nicotine for at least five hours before bedtime
- Avoid heavy meals and excessive liquids before bedtime
- Do not remain in bed for too long: If you still cannot sleep after about 15 minutes of getting into bed and turning out the light, get out of bed and do something relaxing until you feel sleepy.
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When to Seek Further Consultation for Insomnia Disorder
Acute insomnia may be self-resolving over a span of days or weeks. If insomnia is causing distress or persists, an individual should consult his or her healthcare provider.
Questions Your Doctor May Ask to Determine Insomnia Disorder
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Have you experienced any nausea?
- How long has your current headache been going on?
- How severe is your headache?
- Are you sick enough to consider going to the emergency room right now?
If you've answered yes to one or more of these questions
Insomnia Symptom Checker
Take a quiz to find out if you have Insomnia
- Insomnia Symptoms. National Sleep Foundation. National Sleep Foundation Link
- Insomnia. National Heart, Lung, and Blood Institute. NHLBI Link
- Ford ES, Wheaton AG, Cunningham TJ, Giles WH, Chapman DP, Croft JB. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: Findings from the National Ambulatory Medical Care survey 1999-2010. Sleep. 2014;37(8):1283-1293. PubMed Link
- Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97-111. PubMed Link
- Insomnia. U.S. National Library of Medicine: MedlinePlus. Updated November 30, 2018. MedlinePlus Link
- Woznica AA, Carney CE, Kuo JR, Moss TG. The insomnia and suicide link: Toward an enhanced understanding of this relationship. Sleep Med Rev. 2015;22:37-46. PubMed Link
- Nagai M, Hoshide S, Kario K. Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature. Curr Cardiol Rev. 2010;6(1):54-61. NCBI Link
- Overview of the treatment of insomnia in adults. UpToDate. UpToDate Link
- Insomnia. Office on Women’s Health. OWH Link
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