Insomnia Guide: Facts, Causes, Symptoms and Treatments

What do Bill Clinton, Marilyn Monroe, Charles Dickens, Madonna and Ben Franklin have in common? Other than being well-known, they all suffered from insomnia!

What is Insomnia?

Simply stated, insomnia is defined as sleeplessness. Insomnia is the most common form of sleep disorder and involves an inability to go to sleep or stay asleep. Insomnia may also be defined as waking up too early in the morning or experiencing sleep that is not refreshing. If you have insomnia, sooner or later it will begin to affect your waking hours and you will begin to notice that you are less productive during the day.

The American Academy of Sleep Medicine in collaboration with other international sleep groups developed “The International Classification of Sleep Disorders (ICSD)” which classifies sleep disorders as either dyssomnias (disorders that produce insomnia or excessive sleepiness) or parasomnias (disorders that occur during sleep but do not produce insomnia or sleepiness). Insomnia is one of the dyssomnias.

How many hours of sleep is enough? Insomnia is not defined by the number of hours you sleep each night since the amount of sleep a person needs varies. Most adults need between seven and eight hours of sleep each night, but that number varies from person to person — and from night to night. Sleep requirements will also be influenced by your general health. Children will typically need ten to twelve hours of sleep each night.

It is estimated that 60 million Americans suffer from insomnia each year. The condition tends to increase with age and affects 40 percent of women and 30 percent of men. Insomnia is particularly common in females (especially during and after menopause) and in the elderly. Children may be affected by insomnia, but insomnia in children is typically a result of some other sleep disorder or disease and is NOT a primary insomnia.


Types of Insomnia

Insomnia can be classified by the cause of insomnia or by how long it lasts.

Insomnia classified by cause

Insomnia classified by cause is either of the following:

  • Primary Insomnia
  • Secondary Insomnia

Primary insomnia occurs when there is not another health problem that causes the sleeplessness. About twenty percent of insomnia can be classified as primary insomnia.

Secondary insomnia is sleeplessness that is caused by medication, pain, drugs or alcohol, or another health problem such as asthma, heartburn, depression, or many others.

Insomnia classified by length

Insomnia classified by how long it lasts I either of the following:

  • Acute Insomnia
  • Transient Insomnia
  • Chronic Insomnia

Acute insomnia is typically very short term lasting from one night to a couple of weeks. It is typically caused by a specific event, acute illness, or environmental conditions such as excessive noise, light or temperature.

Transient insomnia is insomnia that comes and goes. The periods of insomznia are usually broken up by periods where you sleep well.

Chronic insomnia is usually defined as sleeplessness at least several nights each week for one month or longer. Acute insomnia may become chronic if the primary cause is not fixed. Chronic insomnia is typically caused by pain, chronic stress, chronic depression, and learned insomnia.


Insomnia Causes and Risk Factors

How likely are you to develop insomnia? That depends. Common risk factors for insomnia include: Being a woman; Being over 60 years of age; Having a mental disorder especially depression or anxiety; Working inconsistent shifts or shifts that don’t coincide with your own circadian rhythm.

Even if you don’t fit into any of these at-risk populations, there are other causes of insomnia that may increase your chances of developing insomnia.

Stress and anxiety may be the leading cause of insomnia. Poor sleep hygiene are those activities you do that make restful sleep hard. Poor sleep habits include having an uncomfortable sleep environment, keeping an irregular sleep/wake schedule, or being extremely active before bed. Prescription and over the counter medications (especially allergy medicines decongestants, stimulants, and weight loss products) may cause insomnia for the period of time you are taking the medications. Caffeine and alcohol, especially if taken in the late afternoon or evening, may cause insomnia. Eating too much before going to bed can make you uncomfortable and produce heartburn when you lay down.

There are many health conditions that can cause insomnia. Any condition that causes pain may lead to insomnia. As you age, you may find that you need to get up during the night to urinate.

Other sleep disorders such as sleep apnea, night terrors in children, and restless leg syndrome (particularly in young women) may lead to insomnia. Many medical conditions such as hypertension, vitamin and mineral deficiencies (especially magnesium and serotonin), constipation, and prostate enlargement may result in insomnia.

Hormonal imbalances can also cause insomnia. For example, a woman going through menopause will have decreased estrogen which may cause hot flashes that increase the chances of insomnia. Likewise, in addition to being uncomfortable due to the pregnancy, the pregnant or postpartum woman’s hormone fluctuations may also cause insomnia.

Genetics may play a part in insomnia although there is no conclusive proof for this. What looks like a genetic cause of insomnia may simply be that a family may teach their children their own poor sleep hygiene. However, there is one well documented inherited disease of the brain, fatal familial insomnia (FFI), that results in progressive insomnia in young children that ultimately results in hallucinations and death.

Learned insomnia is a condition that occurs when you try too hard to get to sleep or worry about not being able to sleep. You can “learn” sleeplessness — but, the good news is that you can also learn how to sleep better!


Signs and Symptoms of Insomnia

Everyone has an occasional sleepless night — what should you watch for to determine if your sleeplessness is insomnia or just a sleepless night?

One of the primary symptoms of insomnia is taking more than 30 minutes to fall asleep and getting only a few hours of sleep for three or more nights a week. Many insomniacs report waking up during the night or waking up too early in the morning or not feeling well rested after sleeping.

Because of the sleep deprivation that may result from insomnia, you might feel depressed or anxious after not sleeping well or you might have extreme daytime sleepiness. This daytime sleepiness may result in difficulty paying attention or focusing on tasks during the day and increased errors or accidents at work or at home.

Physical signs and symptoms may include headaches, nausea, heartburn or other physical symptoms not associated with a known health problem. And most insomniacs have ongoing worries about sleep that only tend to make the problem worse.


Diagnosis of Insomnia

Your doctor may diagnose insomnia by asking a couple of key questions: “Do you have trouble going to sleep?” and “Do you have trouble staying asleep?”. Your healthcare provider will also do a physical examination, including lab tests, to be sure you don’t have a disease or physical condition causing your sleeplessness.

You may be asked to keep a sleep diary in which you record what you were doing before going to bed and how you slept each night. You may also complete a questionnaire like the Epworth Sleepiness Scale (ESS) which measures your daytime sleepiness by asking about your likelihood of dozing off while doing common daytime activities like reading, watching TV, sitting in a public place, talking to someone, sitting after eating driving, and lying down.

Insomnia can be formally diagnosed in a sleep lab using a polysomnograph that monitors your brain waves, vital signs, and eye and body movements while you are sleeping. This testing is usually not done unless other sleep disorders are also suspected.


Severity and Effects of Insomnia

The Insomnia Severity Index is a simple seven question index that ranks severity of insomnia based on seven questions including:

  1. Difficulty falling to sleep
  2. Difficulty staying asleep
  3. Waking up too early
  4. Satisfaction with current sleep pattern
  5. How noticeable your sleep problem is to others
  6. Worry or distress with sleep problem
  7. Extent to which the insomnia interferes with daily functioning

When the index is scored, your insomnia will be classified as Severe Clinical Insomnia, Moderate Clinical Insomnia, Subthreshold Insomnia, or No Clinically Significant Insomnia.

If insomnia is untreated, many complications and adverse effects can occur. Many psychiatric conditions may develop including depression, stress and anxiety.

Your immune system may be affected leading to the development of other diseases. Your reaction time may be slowed leading to increased risk for accidents. Your brain may work slower causing decreased performance at school or your job. You may become overweight leading to an increased risk for high blood pressure, heart disease and diabetes.

If you already have one or more of these conditions, insomnia may make it worse. Insomnia may eventually lead to poorer relationships and decreased overall quality of life.


Insomnia Treatment Options

Lifestyle changes

When you can’t sleep, your first step should be to look at what you can do for yourself to break the insomnia cycle without any other treatment.

Be sure to get enough exercise, but don’t exercise right before sleep. If you are used to taking naps, stop. Get on a regular sleep schedule… even when you don’t have to get up in the morning, do it.

Prepare your bedroom for sleep by keeping the room cool, dark and quiet. Use your bedroom for sex or sleeping only; read or watch television in another room.

Take a warm bath before bedtime and try yoga or massage before bedtime. If you find that you still can’t sleep, get out of bed and do something relaxing; go back to bed when you are tired.

Natural remedies

Many alternative therapies for beating insomnia, such as hypnosis and aromatherapy are controversial, but they do seem to help many people. They can usually be safely and inexpensively tried. When it comes to herbs, however, there can be side effects if they are taken regularly. Therefore, you should research any herb and ask your doctor’s advice before self-medicating with herbs.

Food Diet

Avoid or limit caffeine, alcohol and nicotine before bedtime; although alcohol may put you to sleep quickly, your sleep will not be the sound sleep you need. Caffeine and nicotine are known to increase insomnia. Likewise, large meals and beverages before bed can cause heartburn that may increase insomnia.

Sleep medications

Prescription medication or over-the-counter medications is usually considered a last resort when it comes to treating insomnia. While many drugs, including antidepressants such as Trazodone and Zoloft and sedatives such as Ambien and Lunesta can be helpful, they often come with unwanted side effects, especially drowsiness.

Therapy Treatments

If you find that the above treatments don’t work for your insomnia, there are other therapy treatments you can try. Some of these require taking a class and some require spending some money; however, all of them have been shown to decrease insomnia for some people. These therapies include: biofeedback, control of breathing, Cognitive Behavioral Therapy (CBT), voluntary sleep restriction, light therapy, and acupuncture or acupressure.

When is Insomnia Dangerous?

According to the Harvard Women’s Health Watch, everyone experiences occasional sleep problems. The dangers happen when you experience chronic sleep loss. At that point, other problems can develop including weight gain, immune system disorders, and high blood pressure.

Consult your doctor if your insomnia happens consistently — or if you feel that your safety or health is at risk.

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