If you’ve ever tossed and turned overnight, you might’ve wondered if you had insomnia. Insomnia is defined as difficulty falling asleep, staying asleep, or sleeping until your desired wake-up time. Though insomnia is not technically the same as one night of sleep trouble, the two are often confused. Insomnia can affect people of all ages, though it’s more prevalent in children, adolescents, and the elderly. In most cases, insomnia is the result of what is happening in your daily life and is treatable.
Insomnia can be a short-term (acute) or a long-term (chronic) problem. To be considered chronic insomnia, sleep disruptions must happen at least three nights per week for at least three months.
Symptoms of insomnia can include tiredness during the day, mood swings, irritability, difficulty concentrating, and poor memory.
What causes insomnia?
Insomnia can have many causes, and it can be triggered by underlying health issues, which need to be addressed before insomnia will improve. Causes of insomnia can include:
- Health problems, both acute and chronic
- Pain
- Stress
- Unhealthy habits
- Poor sleep habits
- Hormone changes
- Medications
- Mental health issues
- Other sleep-related issues
- Environment issues (unsuitable, unfamiliar, or altered)
- Travel
- Shift work
Some people may find they are affected by one or several of these causes. Consequently, their sleep can take a hit. If these causes are not addressed, it can be a challenge to obtain proper sleep.
How is insomnia diagnosed?
On average, most adults need roughly seven to nine hours of sleep each night. This is the range at which most people feel well rested, and it is also the recommendation from the Centers for Disease Control and Prevention, based on research by the American Academy of Sleep Medicine and Sleep Research Society. Though there are people who require less sleep, this is the right range for the majority of people.
If you struggle to feel awake and alert, or you cannot achieve the rest you desire overnight, you may suffer from insomnia. Your healthcare provider will diagnose insomnia by completing a physical exam and asking questions about your sleep. The physical exam is to rule out other possible causes that may be disrupting your sleep cycles and to collect more information about your sleep.
Your provider may suggest you keep a sleep diary in which you write your bedtimes, wake times, naps, and other habits over two weeks. Additional information could include tracking what you eat, as well as your consumption of alcohol and caffeine, and other stimulating habits.
When you meet with a sleep professional or other doctor to determine whether or not you have insomnia, plan to discuss your sleep habits, routines, sleepiness at bedtime, nap habits, anxiety or depression, night waking, sleep environment, possible disruptions, and expectations of sleep, as well as how all of these factors affect you and your well-being during the day.
People who do not take adequate time for sleep should not be diagnosed with insomnia. If work, family, social activities, or fun get in the way of a sufficient amount of sleep, this does not meet the criteria for diagnosis. It is necessary to have good sleep habits and understand how much sleep is needed and when to prevent or overcome sleeplessness.
How is insomnia treated?
Treating insomnia begins by identifying the cause. Since there is such a wide range of causes, the treatments for insomnia can vary dramatically.
In an optimal situation, insomnia treatment begins with managing the cause, not simply prescribing medication. This can come as a surprise to many, especially those who manage sleep issues with over-the-counter sleep medications.
For many, initial treatment begins with improving sleep hygiene. Sleep hygiene is a blanket term referring to proper habits that help promote good sleep. By improving daily routines and bedtime habits, sleep can improve, which can resolve insomnia.
When sleep habits are consistent, and other health problems are managed so as not to cause continued sleep issues, the next step is cognitive behavioral therapy for insomnia (CBT-I). CBT-I is often the first-choice treatment for insomnia. CBT-I helps you recognize and change the negative thoughts or behavior patterns that cause interrupted sleep.
Treating insomnia with CBT begins by creating effective routines, improving your sleep environment, learning relaxation methods for the mind and body, and regulating sleep-wake times.
Improving insomnia takes time, especially when symptoms have been ongoing and severe for a prolonged period. If sleep hygiene improvements and CBT-I are not effective after several months of consistent effort, the next course of treatment is to consider medication for insomnia.
Treating insomnia with medicine
Currently, the approved medications used for treatment of insomnia are short-acting, meaning they begin to both work and leave the body quickly. The purpose of this is to limit or prevent daytime side effects like drowsiness, dozing, fogginess, or moodiness. Benzodiazepines like triazolam and temazepam are commonly used. These medications can be habit forming.
Other medications like zolpidem and zaleplon are less habit forming. Medications are intended for short-term use in the treatment of chronic insomnia, not acute or intermittent sleep disruptions. Doses should be kept low, and you should never take more than is prescribed. If you think the medication is not working, flag it as quickly as possible with your healthcare provider, so they can look into more effective alternatives. Other medications are also available, such as antihistamines, melatonin, and herbal supplements, as well as antidepressants that cause sleepiness. It is also recommended that medications be combined with continued CBT-I methods. Discussing your options with your healthcare provider will help you understand the possibilities available to you.
Other options for insomnia treatment
Avoiding the causes of insomnia can help prevent it. Texas-based rheumatologist Dr. Stella Bard states, “Being more active can help reduce the risk of insomnia; however, do not exercise right before bed.” Exercising too close to bedtime can elevate hormones or endorphins that can prevent sleep.
“Avoiding blue light use, stimulation, caffeine, and nicotine use before bed can help. Also, limit alcohol use before bed. People may use alcohol to make them fall asleep more easily, but it prevents deep sleep and causes awakening in the middle of the night,” states Bard.
Hypnosis therapy is another treatment option that may provide relief from insomnia. “Our mind can get into the habit of following negative thought patterns. Hypnosis can program the mind to stop following negative thoughts,” explains Eli Bliliuos of NYC Hypnosis Center. “Hypnosis can train a fearful mind to relax and stay calm. Throughout the course of a normal 24-hour period, we move through brain waves, or frequencies — the beta, alpha, theta, and delta waves. During hypnosis, the brain can be guided away from negative stressors and into delta waves and a state of dreamless, deep sleep.”
Other natural sleep aids such as chamomile tea, valerian root, white noise, meditation, warm baths, and lavender can be helpful.
To sum it up
Insomnia is a problem that affects many people in both short- and long-term phases. It is often caused by poor sleep routines but may be related to other health conditions or factors. Insomnia is treatable, and treatment should begin with changes in the routine and environment, as well as cognitive-based therapies. If these options do not work, medications can be considered by your doctor.
