“O sleep, O gentle sleep,
Nature's soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids down
And steep my senses in forgetfulness?”
William Shakespeare, Henry IV
Insomnia is an experience that is surely familiar to all humans. At one time or another, we’ve all been there: it’s 3:00 AM, you’re staring at the pale green numbers on your digital clock, sleep won’t come no matter what you do. It may be that your mind is distracted by some problems at work. Or maybe a new relationship has you giddy and excited. The only thing to do is to wait it out and hope sleep arrives before you have to get up and face your day.
Some studies have shown that as much as 30%-35% of the adult population experiences bouts of insomnia at some point in their lives. It is further estimated that a full 10% have had significant enough trouble with sleeping that it has started to affect their daytime lives. Even besides the potential negative effects on one’s health, regular sleeplessness can also begin to affect productivity and attention to detail at work; it can even be potentially dangerous, especially in fields where accidents can have catastrophic effects.
What is insomnia?
Insomnia is characterized as a sleep disorder, and it even appears in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an important reference book published by the American Psychiatric Association. Doctors thus diagnose insomnia when a patient has one or more of the following symptoms:
- Difficulty initiating sleep
- Difficulty staying asleep (frequently waking up or difficulty going back to sleep after waking)
- Waking up too early and being unable to go back to sleep
- The problem sleeping causes distress or impairment in day-to-day life activities and interactions
- Problem sleeping happens 3 nights a week
- Problem sleeping happens for 3 months consistently
- Problem sleeping happens even if there is sufficient opportunity for sleep
- The insomnia isn’t related to another sleep disorder like narcolepsy or a breathing-related disorder
- The insomnia isn’t related to the effects of a substance like a drug or medication
Transient vs. Acute vs. Chronic Insomnia
Insomnia is typically classified into a few simple categories. Transient insomnia refers to difficulty sleeping that lasts less than a week. It is the type that many people experience in short bursts at different times in life. Transient insomnia is often caused by some other medical problem, disorder, or just temporary stress or depression.
The parameters of acute insomnia are typically limited to a month or less. It is generally defined by difficulty initiating sleep, staying asleep, or going back to sleep after waking in the middle of the night. Acute insomnia can also include getting sleep but it being poor quality or otherwise not refreshing. It can also be referred to as short term insomnia or sometimes stress-related insomnia.
By contrast, chronic insomnia lasts longer than a month, and it similarly involves difficulty initiating sleep or staying asleep. However, the long term nature of chronic insomnia can result in much more serious consequences that can have a major impact on a person’s ability to live their life. Chronic insomnia can be a primary disorder or can be caused by a separate medical condition.
Causes of Insomnia
The truth is that insomnia can be caused by a whole range of factors that can be different for different people. This fact can make it truly difficult for some people to conquer their insomnia: because they don’t know where to start. Fortunately, doctors have been able to determine some common categories of causes that can help sufferers of insomnia begin to understand why they might be having so much trouble sleeping:
Medical: There are numerous medical conditions that can lead to insomnia; some of them are a factor of the condition itself, and some of them are an indirect result of the symptoms of the condition.
- Chronic pain in any part of the body
- Gastrointestinal problems like acid reflux
- Nasal or sinus allergies
- Parkinson’s disease
- Medications for various conditions may affect sleep patterns
- Restless legs syndrome
- Sleep apnea
Depression: Psychological problems like depression are well known to be a factor in insomnia. In addition to feelings of depression potentially leading to insomnia, insomnia itself can, in turn, bring about changes in mood, hormones, or physiological changes; so, depression can lead to insomnia, which can lead to depression, which can lead to insomnia...and on the cycle goes.
Anxiety: Similar to depression, anxiety can have a major impact on our ability to sleep soundly. It is a fairly common experience to feel anxious in life about something — such as a problem at work or tension in an important relationship — and then have trouble going to sleep or staying asleep. It is normal for worries about past or future events, or feelings of being overwhelmed by the circumstances of life, to get in your brain and make it seemingly impossible to sleep. It can be further compounded in chronic insomnia; the feelings of anxiety about not being able to sleep are added to the original feelings of anxiety that started it all.
Lifestyle: Sometimes the cause of insomnia isn’t related to specific psychological or medical circumstances; instead, lifestyle factors can lead to insomnia. For example, if you regularly take a nap late in the afternoon, that may very well affect your ability to sleep through the night. Another example is working late on a computer screen; the glow of the screen may signal your brain to stay more alert. It’s even possible for temporary lifestyle factors to push a case of transient or acute insomnia into chronic insomnia by initiating new, unhealthy sleep habits that become difficult to break.
Food and Drink: The foods we eat and beverages we drink can also play a role in whether or not we develop insomnia. A heavy meal right before bedtime, for example, can disrupt sleep; similarly, spicy foods eaten before bed can cause heartburn that keeps you awake. Perhaps the most obvious example is caffeine; so many people rely on caffeine to keep them awake for important reasons, but they don’t always realize that caffeine can have an impact long after it is initially ingested. Also, the nicotine in cigarettes and other tobacco products is a stimulant that can lead to insomnia.
Neurological: There are many potential causes we can control, but there are some we can’t. Scientists have begun to identify some neurotransmitters and chemical interactions in the brain that are associated with insomnia. This may make some people genetically predisposed to having regular bouts with insomnia.
Treatments and Home Remedies
Seeing the list of possible causes of insomnia can be intimidating for someone who has truly been struggling to overcome the disorder. So what can be done? Treatment options are naturally somewhat dependent on the cause of insomnia. For people with transient or acute insomnia, the problem may resolve itself over time; however, there are also some basic tips for how to get your sleep habits back in order:
- Keep a regular bedtime, including on the weekends
- Make your bedroom a comfortable place that is dedicated to sleep
- Develop a nighttime ritual that is relaxing (reading, listening to music, etc.)
- Limit daytime napping
- Stay active during waking hours (exercise is a great choice!)
- Avoid caffeine, alcohol, and nicotine
- Don’t eat a large meal right before bedtime
For people with chronic insomnia, making tweaks to a nighttime ritual or modifying sleep habits may not be enough. It may require talking with a sleep specialist or considering more involved treatment routes:
- Therapy: Cognitive behavioral therapy is one type of psychological therapy that is focused on controlling or replacing thoughts. This, or other types of therapy, can potentially help deal with underlying emotions and remove the driving force of insomnia. Therapy can involve a variety of techniques, including relaxation and meditation.
- Medication: There are numerous prescription and over-the-counter medications available to treat insomnia. These can include antidepressants and anti-anxiety drugs as well as antihistamines and sedatives. Doctors generally don’t recommend medications for long term use, though.
When should I see a doctor?
For most people, insomnia will typically resolve itself over time or as a result of available techniques and remedies. If you’ve tried a lot of those and still have trouble sleeping, or if your insomnia has started to impact your daily life, it might be time to see a doctor. Another fact about insomnia is that it typically affects women more than men; this is in large part because of hormonal changes that accompany menstruation, pregnancy, and menopause. For this reason, women may have even more reason to speak with a doctor about insomnia.
If you have the symptoms of chronic insomnia and would like to speak with a doctor, contact the Woman’s Clinic to make an appointment.