Insomnia: Types, Causes, Symptoms & Treatment

Picture of insomnia

Insomnia Overview

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep. People with insomnia have one or more of the following symptoms:

  • Difficulty falling asleep
  • Waking up often during the night and having trouble going back to sleep
  • Waking up too early in the morning
  • Feeling tired upon waking

What Causes Insomnia?

Insomnia can be caused by psychiatric and medical conditions, unhealthy sleep habits, specific substances, and/or certain biological factors. Recently, researchers have begun to think about insomnia as a problem of your brain being unable to stop being awake (your brain has a sleep cycle and a wake cycle when one is turned on the other is turned off insomnia can be a problem with either part of this cycle: too much wake drive or too little sleep drive). It’s important to first understand what could be causing your sleep difficulties.

Medical Causes of Insomnia

There are many medical conditions (some mild and others more serious) that can lead to insomnia. In some cases, a medical condition itself causes insomnia, while in other cases, symptoms of the condition cause discomfort that can make it difficult for a person to sleep.

Examples of medical conditions that can cause insomnia are:

  • Nasal/sinus allergies
  • Gastrointestinal problems such as reflux
  • Endocrine problems such as hyperthyroidism
  • Arthritis
  • Asthma
  • Neurological conditions such as Parkinson’s disease
  • Chronic pain
  • Low back pain

Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, and depression can also cause insomnia.

Insomnia & Depression

Insomnia can be caused by psychiatric conditions such as depression. Psychological struggles can make it hard to sleep, insomnia itself can bring on changes in mood, and shifts in hormones and physiology can lead to both psychiatric issues and insomnia at the same time.

Sleep problems may represent a symptom of depression, and the risk of severe insomnia is much higher in patients with major depressive disorders. Studies show that insomnia can also trigger or worsen depression.

Insomnia & Anxiety

Most adults have had some trouble sleeping because they feel worried or nervous, but for some it’s a pattern that interferes with sleep on a regular basis. Anxiety symptoms that can lead to insomnia include:

  • Tension
  • Getting caught up in thoughts about past events
  • Excessive worrying about future events
  • Feeling overwhelmed by responsibilities
  • A general feeling of being revved up or overstimulated

It’s not hard to see why these symptoms of general anxiety can make it difficult to sleep. Anxiety may be associated with onset insomnia (trouble falling asleep), or maintenance insomnia (waking up during the night and not being able to return to sleep). In either case, the quiet and inactivity of night often brings on stressful thoughts or even fears that keep a person awake.

Insomnia & Lifestyle

Insomnia can be triggered or perpetuated by your behaviors and sleep patterns. Unhealthy lifestyles and sleep habits can create insomnia on their own (without any underlying psychiatric or medical problem), or they can make insomnia caused by another problem worse.

Examples of how specific lifestyles and sleep habits can lead to insomnia are:

  • You work at home in the evenings. This can make it hard to unwind, and it can also make you feel preoccupied when it comes time to sleep. The light from your computer could also make your brain more alert.
  • You take naps (even if they are short) in the afternoon. Short naps can be helpful for some people, but for others they make it difficult to fall asleep at night.
  • You sometimes sleep in later to make up for lost sleep. This can confuse your body’s clock and make it difficult to fall asleep again the following night.
  • You are a shift worker (meaning that you work irregular hours). Non-traditional hours can confuse your body’s clock, especially if you are trying to sleep during the day, or if your schedule changes periodically.

Some cases of insomnia start out with an acute episode but turn into a longer-term problem. For example, let’s say a person can’t sleep for a night or two after receiving bad news. In this case, if the person starts to adopt unhealthy sleep habits such as getting up in the middle of the night to work, or drinking alcohol before bed to compensate, the insomnia can continue and potentially turn into a more serious problem. Instead of passing, it can become chronic.

Insomnia & Food

Certain substances and activities, including eating patterns, can contribute to insomnia. If you can’t sleep, review the following lifestyle factors to see if one or more could be affecting you:

Alcohol is a sedative. It can make you fall asleep initially, but may disrupt your sleep later in the night.

Caffeine is a stimulant. Most people understand the alerting power of caffeine and use it in the morning to help them start the day and feel productive. Caffeine in moderation is fine for most people, but excessive caffeine can cause insomnia. A 2005 National Sleep Foundation poll found that people who drank four or more cups/cans of caffeinated drinks a day were more likely than those who drank zero to one cups/cans daily to experience at least one symptom of insomnia at least a few nights each week.

Caffeine can stay in your system for as long as eight hours, so the effects are long lasting. If you have insomnia, do not consume food or drinks with caffeine too close to bedtime.

Nicotine is also a stimulant and can cause insomnia. Smoking cigarettes or tobacco products close to bedtime can make it hard to fall asleep and to sleep well through the night. Smoking is damaging to your health. If you smoke, you should stop.

Heavy meals close to bedtime can disrupt your sleep. The best practice is to eat lightly before bedtime. When you eat too much in the evening, it can cause discomfort and make it hard for your body to settle and relax. Spicy foods can also cause heartburn and interfere with your sleep.

Insomnia & The Brain

In some cases, insomnia may be caused by certain neurotransmitters in the brain that are known to be involved with sleep and wakefulness.

There are many possible chemical interactions in the brain that could interfere with sleep and may explain why some people are biologically prone to insomnia and seem to struggle with sleep for many years without any identifiable cause even when they follow healthy sleep advice.

Symptoms of insomnia

Insomnia symptoms may include:

  • Difficulty falling asleep at night
  • Awakening during the night
  • Awakening too early
  • Not feeling well rested after a night’s sleep
  • Daytime tiredness or sleepiness
  • Irritability, depression or anxiety
  • Difficulty paying attention, focusing on tasks or remembering
  • Increased errors or accidents
  • Tension headaches
  • Distress in the stomach and intestines (gastrointestinal tract)
  • Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week over a month or more.

Treatment for insomnia

Some types of insomnia resolve themselves when the underlying cause is removed or wears off. In general, treating insomnia focuses on determining the cause of the sleeping problems. Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be employed as adjuvant therapies.

Non-pharmacological approaches to treating insomnia include:

  • Improving “sleep hygiene” – don’t over- or under-sleep, exercise daily, don’t force sleep, try to maintain a regular sleep schedule, avoid caffeine at night, do not smoke, do not go to bed hungry, make sure the environment is comfortable
  • Using relaxation techniques – such as meditation and muscle relaxation
  • Cognitive therapy – one-on-one counseling or group therapy
  • Stimulus control therapy – only go to bed when sleepy, refrain from TV, reading, eating, or worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps
  • Sleep restriction – decrease the time spent in bed and partially deprive your body of sleep so you are more tired the next night.

Medical treatments for insomnia include:

  • Prescription sleeping pills (often benzodiazepines)
  • Antidepressants
  • Over-the-counter sleep aids
  • Antihistamines
  • Melatonin
  • Ramelteon
  • Valerian officinalis.

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