Insomnia or Sleeplessness
What is Insomnia?
Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be due to poor quality or quantity of sleep.
Insomnia is very common and occurs in 30% to 50% of the general population. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.
Insomnia affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.
Insomnia may be divided into three classes based on the duration of symptoms.
- Insomnia lasting one week or less may be termed transient insomnia
- Short-term insomnia lasts more than one week but resolves in less than three weeks
- Long-term or chronic insomnia lasts more than three weeks.
Insomnia can also be classified based on the underlying reasons for insomnia such as sleep hygiene, medical conditions, sleep disorders, stress factors, and so on.
It is important to make a distinction between insomnia and other similar terminology; short duration sleep and sleep deprivation.
Short duration sleep may be normal in some individuals who may require less time for sleep without feeling daytime impairment, the central symptom in the definition of insomnia.
In insomnia, adequate time and opportunity for sleep is available, whereas in sleep deprivation, lack of sleep is due to lack of opportunity or time to sleep because of voluntary or intentional avoidance of sleep.
What causes Insomnia?
Insomnia may have many causes and, as described earlier, it can be classified based upon the underlying cause.
Situational and stress factors leading to insomnia may include:
- Jet lag
- Physical discomfort (hot, cold, lighting, noise, unfamiliar surroundings)
- Working different shifts
- Stressful life situations (divorce or separation, death of a loved one, losing a job, preparing for an examination)
- illicit drug use,
- cigarette smoking,
- caffeine intake prior to going to bed,
- alcohol intoxication or withdrawal, or
- certain medications.
Most of these factors may be short-term and transient, and therefore insomnia may resolve when the underlying factor is removed or corrected.
Sleep Hygiene
Sleep hygiene can play an important role in insomnia. Poor sleep hygiene includes physical factors such as:
- Using the bedroom for things other than sleeping
- Eating or exercising prior to sleep
- Going to bed hungry
- Sleeping in a room with too much noise or lighting
- Doing work in bed
- Medical and psychiatric conditions
- Medical and psychiatric conditions may also contribute to insomnia
Some of these common medical conditions may include:
- Breathing problems from chronic heart or lung disease (asthma, chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Obstructive sleep apnea)
- Obesity
- Acid reflux
- Hyperthyroidism
- Urinary problems (frequent urination, urinary incontinence)
- Chronic pain,
- Fibromyalgia,
- Parkinson's disease, or
- dementia.
Common psychiatric problems can be responsible for insomnia including:
- Depression
- Psychosis
- Mania
- Anxiety or
- Posttraumatic stress disorder (PTSD)
Some common physiologic conditions can lead to insomnia such as:
- Menopause
- Menstrual cycle
- Pregnancy
- Fever
- Pain
Other causes of insomnia may be related to sleep disorders including:
- Sleep walking
- Sleep apnea
- Restless leg syndrome (creeping sensations in the leg during sleep, relieved by leg movement)
- Periodic limb movement disorder (involuntary repeated leg movement during sleep)
- Circadian sleep disturbance (unusual sleep time due to disturbed biological clock)
What are the risk factors for Insomnia?
There are no specific risk factors for insomnia because of the variety of underlying causes that may lead to insomnia. The medical and psychiatric conditions listed earlier may be considered risk factors for insomnia if untreated or difficult to treat. Some of the emotional and environmental situations that were also mentioned above may act as risk factor for insomnia.
What are the symptoms of Insomnia?
Impairment of daytime functioning is the defining and the most common symptom of insomnia.
Other common symptoms include:
- Daytime fatigue
- Daytime sleepiness
- Mood changes
- poor attention and concentration
- Lack of energy
- Anxiety
- Poor social function
- Headaches
- Oncreased errors and mistakes
When should I call the doctor about Insomnia?
In general, insomnia related to transient situational factors resolves spontaneously when the provoking factor is removed or corrected. However, medical evaluation by a doctor may be necessary if the insomnia persists or it is thought to be related to a medical or a psychiatric condition.
How is Insomnia treated?
The treatment of insomnia depends largely on the cause of the problem. In cases where an obvious situational factor is responsible for the insomnia, correcting or removing the cause generally cures the insomnia.
Generally speaking, the treatment of insomnia can be divided into non-medical or behavioral approaches and medical therapy. Both approaches are necessary to successfully treat insomnia, and combinations of these approaches may be more effective than either approach alone.
What is sleep hygiene?
Sleep hygiene consists of the following strategies:
- Sleep as much as possible to feel rested, then get out of bed (do not over-sleep).
- Maintain a regular sleep schedule.
- Do not force yourself to sleep.
- Do not drink caffeinated beverages in the afternoon or evening.
- Do not drink alcohol prior to going to bed.
- Do not smoke, especially in the evening.
- Adjust the bedroom environment to induce sleep.
- Do not go to bed hungry.
- Resolve stress and anxiety before going to bed.
- Exercise regularly, but not 4-5 hours prior to bed time.
How can stimulus control help with Insomnia?
Stimulus control refers to techniques used to help with initiating sleep. These techniques are used to induce an environment in the bedroom that promotes sleep. Some simple steps include:
Use the bed only for having sex and sleeping, not working, reading, watching TV, eating, or other mentally stimulating activities.
Go to bed only when you feel ready to sleep.
Turn off the lights and all the noise in and around the bedroom.
Get up at the same time every morning to avoid over-sleeping.
If you do not fall asleep longer than 20 minutes after going to bed, get up and try some relaxation techniques until you are ready to sleep again.
Relaxation techniques, which are also a part of non-medical therapy for insomnia, involve sitting or lying comfortably and relaxing muscles of the body in one area at time. This may be combined with deep, relaxed breathing to promote further body relaxation.
What is Sleep Restriction?
Sleep restriction refers another non-medical behavioral therapy for insomnia which involves limiting the time spent in bed for sleeping only. Many people with insomnia may stay in bed for a long time after they wake up in the morning. This over-sleeping may disrupt the circadian rhythm and make sleep initiation more difficult the following night.
Melatonin, a chemical released from the brain which induces sleep, has been tried in supplement form for treatment of insomnia as well. It has been generally ineffective in treating common types of insomnia, except in specific situations in patients with known low levels of melatonin. Melatonin may be purchased over-the-counter (without a prescription).
Insomnia at a Glance
Insomnia is a condition characterized by poor quality or quantity of sleep, despite adequate opportunity to sleep, which could lead to daytime functional impairment.
Many medical and psychiatric conditions may be responsible for causing insomnia.
Insomnia may, at times, be unrelated to any underlying condition.
There are several useful non-medical behavioral techniques available for treating insomnia.
Medications are widely used to treat insomnia in conjunction with non-medical strategies.
Sleep specialists are medical doctors who can play an important role in evaluating and treating long-standing (chronic) insomnia.
