9

Insomnia

Last Updated: September 5, 2023

Featured Image

Table of Contents

Experiencing insomnia or sleep deprivation can be incredibly challenging and result in difficulties with concentration, changes in memory, and increased daytime tiredness. Lack of sleep and chronic insomnia can cause serious health problems like heart disease and obesity.

Insomnia Explained

what is insomnia

Insomnia is a prevalent sleep disorder that disrupts the quality and quantity of an individual's sleep. The symptoms include difficulties falling asleep, staying asleep, or experiencing non-restorative sleep.

Approximately 10% of the world’s population experiences insomnia that meets the medical diagnostic standard, and many are left undiagnosed but suffer its symptoms.

Research shows that poor sleep hygiene negatively affects work performance, impairs decision-making, and can damage relationships as it can affect one’s ability to carry out daily tasks.

Classifications of Insomnia

There are two main classifications of an insomnia disorder diagnosis:

  • Short-term also called primary insomnia
  • Chronic

Short-term or primary insomnia, or transient acute insomnia, can be caused by stress or changes in a person’s schedule or environment that leads to a trouble falling asleep. This would last for a few days or as long as a few weeks and is experienced largely by older adults.

Chronic insomnia lasts over three months, occurs three or more nights a week, and cannot be explained by other medical conditions.

Mental health issues, environmental considerations, and lifestyle choices affect the likelihood of developing chronic insomnia or other sleep deprivation difficulties.

How is Insomnia Diagnosed

Medical professionals diagnose insomnia by conducting both physiological and behavioral tests. A doctor usually investigates an individual’s sleep habits by recommending a sleep diary to track sleeping patterns. This process is known as a sleep habit review.

The Epworth Sleepiness Scale is a well-known quiz that determines if a patient’s sleep patterns are considered unhealthy and what the patterns may signify.  

A sleep study is another approach taken if the cause of insomnia is unclear or if there is a possibility that another sleep disorder is present.

An Electroencephalogram (EEG) is often one of the primary machines used in these studies. It is a procedure that utilizes specialized equipment to observe brain activity during the sleep/wake cycle.  

Causes of Insomnia

factors that could cause insomnia

Various risk factors, including age, can contribute to difficulty falling asleep or staying asleep.

Beginning in middle age, the average person loses around twenty-seven minutes of sleep per night for each subsequent decade. Thus, sleep latency and the time it takes to fall asleep increase with age. 

Family history and genetics can also contribute to insomnia. Specific genes may increase the risk of insomnia, as it can run within families.

Environment and Health

A person’s environment is an essential factor when looking at their overall health and their ability to stay asleep. Environment and occupation are also significant factors that affect the body’s sleep-wake cycles.

  • Excess noise or light at night and uncomfortably high or low temperatures are environmental factors that can significantly impact sleep quality.

  • Jet lag is a common sleep problem people experience after traveling over two time zones. Jet lag can also lead to insomnia, as jet lag generally influences the body’s clock and circadian sleep rhythm.  

Lifestyle

Significant changes in routine, inconsistent sleep schedules, interruptions, and taking long daytime naps can all harm sleep quality.

  • A lack of physical activity, substances such as caffeine, and watching tv close to bedtime are common behaviors listed in the literature as potential influences on sleep.

Exercise can be helpful for sleep. Yoga, swimming, pilates, and moderate aerobic exercises can be relaxing before bed, as slower and less rigorous forms of exercise are better at reducing tension or anxiety.

  • Stress can be related to lifestyle factors, such as stress about school, work, relationships, or money. Although some stress levels are normal, extreme stress can raise the risk of insomnia symptoms.

Treating Insomnia

Most treatments for insomnia focus on examining sleeping habits and addressing outside factors influencing sleep habits, as well as medical history.

For some cases of insomnia, a doctor or health care provider may recommend cognitive behavioral therapy or medication management.

Cognitive Behavioral Therapy

Research has shown that Cognitive Behavioral Therapy (CBT) helps people control or eliminate negative thoughts or actions that interfere with sleep, making it a first-line treatment for insomnia. The philosophy behind this approach is that individuals can learn to recognize and change the beliefs that affect their ability to sleep.

Stimulus control therapy is a part of CBT as a strategy. People learn to remove factors that condition their minds to resist sleep. An example is avoiding taking naps and setting a consistent bedtime.

Other strategies are relaxation techniques involving breathing exercises, sleep restriction, and light therapy. Remaining passively awake, also known as paradoxical intention, is a controversial strategy.

This insomnia treatment targets anxious feelings about falling asleep by physically getting in bed and attempting to stay awake rather than expecting to fall asleep.

Sleep Medication

Some sleep medicine is available to t insomnia, although typically, people only stay on them for a maximum of a few weeks. Several long-term use medications are available, including Eszopiclone (Lunesta) and Ramelteon (Rozerem).

Both examples are classified as sedative-hypnotics and can have side effects. Common side effects include daytime grogginess and an increased risk of falling. The highest side effect for concern is habit-forming, as drug dependence can be very dangerous for the body.

Conditions Related to Insomnia

Insomnia can occur independently, but more often than not, it often results from other physical or mental health conditions. Approximately 50% of insomnia cases are related to mental health disorders such as depression or anxiety. 

Therefore, it is beneficial to look at an individual's mental disorders if such occur and how that may contribute to their sleep habits.

For instance, early morning wakefulness can be a sign of depression, low energy, inability to concentrate, sadness, and a change in appetite and weight. Some symptoms of mental illnesses and insomnia go hand in hand.

In addition, sleeping difficulties can worsen the symptoms of mental health issues significantly and decrease the effectiveness of mental health treatments.

Regarding physical health, some conditions linked to insomnia include; chronic pain, cancer, overactive thyroid, and heart disease. When the body experiences imbalances in the thyroid, it can throw off the body's metabolism, leading to reduced quality of sleep.

The thyroid releases hormones, and too much product can lead to anxiety, rapid heart rate, and insomnia. Thyroid problems can also cause people to be more prone to other conditions, such as restless leg syndrome, which can make people uncomfortable and lead to sleep quality issues.

Sleep Apnea

Sleep disorders are a broad category encompassing a range of sleep problems related to quality, timing, and amount of sleep, as previously discussed. They often result in daytime distress and impaired functioning.

Sleep Apnea is a sleep disorder that involves breathing interruptions during sleep. There are two types of sleep apnea; obstructive airway and central sleep apnea.

Obstructive airway sleep apnea is typically characterized by repeated airway obstruction during sleep, causing symptoms such as snoring, gasping for air, and even breathing pauses. It affects approximately two to fifteen percent of middle-aged adults and more than twenty percent of older adults.

With central sleep apnea, the brain does not correctly control breathing during sleep. Therefore, breathing will start and stop. A person may use a continuous positive airway pressure (CPAP) machine during sleep to treat both types of sleep apnea.

Narcolepsy

Narcolepsy is a rare neurological sleep disorder characterized by uncontrollable periods of sleep. As a result, people with narcolepsy can lapse into sleep multiple times a day.

For a diagnosis of narcolepsy, sleepiness has to occur daily but at least three times a week for a minimum of three months. Cataplexy is a common symptom of narcolepsy characterized by a sudden loss of muscle tone.

This disorder almost always results from a loss of cells called orexin neurons. These neurons control sleep-wake states, energy, and arousal. A doctor can test for this deficiency by performing a spinal tap, where a needle is inserted into the spine to collect fluid for testing.

Restless Leg Syndrome

Restless leg syndrome is an uncomfortable urge to move the lower limbs. Usually, it’s characterized by the legs described as tingling, burning, or itching.

The start of sensations can begin or worsen during periods of rest or inactivity and be partially or completely relieved by movement.

Typically, these sensations are worse in the evening or at night and, in some cases, can only occur at night.

Like many other sleep disorders, the diagnosis is that symptoms occur at least three times a week for at least three months and cause problems with daily functioning. The age of onset is in the teenage years or twenties and affects 2-7.2% of the population.

Circadian Rhythms and Insomnia

Circadian rhythms are the body’s internal clock. Physical, mental, and behavioral factors typically follow a 24-hour cycle. Disorders involving circadian rhythms involve a persistent or recurrent pattern of sleep disturbance.

These are due to modifications of the circadian timekeeping necessary or the lack of alignment with the body’s internal clock and the external environment.

Insomnia is a symptom of a circadian rhythm disorder. Establishing a constant routine will reset the circadian rhythm naturally and allow the body to adapt to the new rhythm being trained to follow. 

Insomnia in Children and Youth

Though most people get diagnosed with insomnia later in life, insomnia can also affect youth. Due to the effects on youth, parents should observe their child’s sleeping behavior and track any significant changes.

Bedtime and night-time signs of insomnia in children can include children making excuses to avoid going to bed, taking a long time to get to sleep, and getting out of bed often to ask for things. Children with insomnia may wake up frequently during the night and have difficulties returning to sleep.

Adolescent Insomnia is common because, in this period, melatonin begins releasing later on into the night. Melatonin is a compound that the brain produces in response to darkness. Melatonin is essential for regulating the circadian rhythm and biological timing of sleep.

There are other predicted causes of insomnia in youth. For example, sleep associations can play a role. A child may also require specific environmental conditions or reliance on particular objects.

Bedtime behavior is another critical factor to consider. For example, excessive screen time or a lack of quiet activities before bedtime could affect a child’s ability to fall asleep.

Insomnia and Aging

Many older adults experience insomnia and other sleep problems due to the natural changes to their circadian rhythm and sleep-wake cycle. Notably, as people age, their sleep architecture also changes.

A typical sleep cycle has four stages, two stages of light non-rapid eye movement, one of heavy or slow-wave sleep, and a final stage of rapid eye movement. All four stages occur before the cycle repeats throughout the entire sleep duration.

Collected data from many sleep studies conducted on older adults have shown that aging lowers the percentage of slow wave and rapid eye movement (REM) stages of sleep. As a result, older adults are more likely to wake up during the night, negatively impacting sleep quality.

Pregnancy and Insomnia

Women experience more insomnia, especially during pregnancy, due to hormonal changes. Around 75% of women report experiencing insomnia within the third trimester of pregnancy which can affect a woman’s mental and physical health.

Pregnant women may require frequent bathroom trips throughout the night; they may experience aches and pains, difficulty getting comfortable with a growing belly, kicking from the active baby, and pre-birth anxiety and worries.

Pillows are recommended between the bent knees or under the belly area to create a comfortable sleeping position for pregnant women.

Insomnia can also occur during early pregnancy within the first trimester or the first three months. Hormones such as progesterone are increasing, and the body’s metabolism is running high.

Insomnia and Alternative Medicine

Alternative medicine and treatments can be beneficial for some when it comes to alleviating symptoms of insomnia or other sleep disorders. It is always helpful to consult one’s healthcare provider or doctor when considering starting treatment for insomnia.

Acupuncture

Utilized primarily in traditional Chinese medicine, acupuncture uses fine needles, electrical stimuli, or heat inserted into the skin at specific areas or regions.

It is believed that acupuncture helps promote feelings of relaxation, therefore allowing people to fall asleep faster.

Acupuncture can also help with pressure relief and pain management to help promote sleep.

Melatonin

Melatonin can be considered an alternative medicine and an over-the-counter medication. As previously mentioned, melatonin is an important hormone involved in circadian rhythms.

There is no general opinion on whether taking too much melatonin poses any dangers. Generally, it is regarded as safe for short-term use.

Sleep Hypnosis

Sleep hypnosis is a hypnotherapy technique that guides individuals into a trance-like state to address sleep-related changes, such as sleep hygiene and reducing anxiety to falling asleep faster.

But, sleep hypnosis can have adverse effects, including creating false memories and physical symptoms such as headaches.

Meditation for Insomnia

In a study published in JAMA Internal Medicine, half of the participants had trouble sleeping and completed a mindfulness awareness program, while the other half completed a sleep education class.

The program taught them meditation and exercises designed to focus on moment-by-moment experiences, thoughts, and emotions. When compared, the mindfulness group experienced less insomnia, fatigue, and depression at the end of just six sessions.

Mindfulness's relaxation response is a profound physiological shift that reduces stress-related ailments. Mindfulness meditation can bring the mind back to the present by focusing on breathing.

Dr. Herbert Benson, director of the Benson-Henry Institute for Mind-Body Medicine at Harvard University, endorses this technique and recommends practicing mindfulness for at least twenty minutes daily. Practicing mindfulness can promote a relaxation response that can help with sleep.

References

How to Deal With Insomnia and Work - Somnus Therapy

Insomnia: What It Is, Causes, Symptoms & Treatment

What Is Insomnia? | NHLBI, NIH

The Role of EEG for Sleep Disorders in Adults

Insomnia - Diagnosis and treatment - Mayo Clinic

Insomnia - Causes and Risk Factors | NHLBI, NIH

Sleep Disorders | NAMI: National Alliance on Mental Illness

Circadian Rhythm Sleep Disorders - PMC

Insomnia in children and teenagers

Psychiatry.org - What are Sleep Disorders?

Mindfulness meditation helps fight insomnia, improves sleep - Harvard Health.

Alternative Treatments for Insomnia and Sleep Disorders

Disclaimer

The contents of this article are provided for informational purposes only and are not intended to substitute for professional medical advice, diagnosis, or treatment. It is always recommended to consult with a qualified healthcare provider before making any health-related changes or if you have any questions or concerns about your health. Anahana is not liable for any errors, omissions, or consequences that may occur from using the information provided.

Sleep Deprivation

11 min read

Sleep Deprivation

Sleep deprivation occurs when an individual does not get enough sleep necessary for the human body to function properly. Without enough sleep, an...

Chronic Pain

17 min read

Chronic Pain

Pain is a subjective experience in which actual or potential physiological damage occurs. This feeling is different for everyone and can be...

Sleep Disorders

15 min read

Sleep Disorders

Sleep disorder is an umbrella term that constitutes various health conditions that change a person’s sleeping patterns. There are many types of sleep...

Migraine

12 min read

Migraine

According to the American Migraine Foundation, a migraine is the seventh most disabling disorder among all diseases. An estimated 10% of...

Immune System

16 min read

Immune System

The immune system defends against infections by recognizing and eliminating foreign substances. Some disorders can cause overactive or underactive...

Respiratory System

12 min read

Respiratory System

The respiratory system is one of the most vital systems in the human body, responsible for providing the body with oxygen and getting rid of carbon...