Understanding Insomnia Medications (cont.)

What Causes Insomnia?

Almost everyone experiences occasional or short-term insomnia (less than three weeks). Causes of short-term insomnia are typically related to environmental factors such as too much noise or light, temperature extremes, or an uncomfortable bed. Other possible causes include stress (for example, new job or school, deadlines, or examinations) or relationship concerns or losses (for example, death of a family member or friend).

Causes of chronic insomnia (greater than three weeks) are more variable and include the following:

• Medical disorders
  
  
  • Chronic pain
    
    
  • Severe emphysema
    
    
  • Menopause
    
    
  • Chronic kidney disease (especially if undergoing dialysis)
    
    
  • Chronic fatigue syndrome
    
    
  • Fibromyalgia
  
  
• Neurologic disorders
  
  
  • Parkinson disease
    
    
  • Other movement disorders
    
    
  • Cluster headaches
    
    
• Psychiatric disorders
  
  
  • Depression
    
    
  • Schizophrenia
    
    
  • Anxiety disorders
    
    
• Drug-related insomnia
  
  
  • Stimulants (for example, caffeine)
    
    
  • Alcohol
    
    
  • Addictive substance abuse or withdrawal (for example, attempting to quit smoking)
    
    
  • Overuse of sedative-hypnotic drugs
    
    

Sleep disorders causing insomnia:

• Restless leg syndrome (RLS) is characterized by the urge to move the legs usually accompanied by an uncomfortable sensation in the legs such a crawling, burning, aching or cramping sensations. RLS often occurs at night while sitting and relaxing, and the sensation and the urge to move is often relieved by movement.  
  
  
• Periodic limb movement disorder (PLMD) occurs during sleep and involves periodic movements of the lower legs, causing brief mini-awakenings (arousals from sleep). Severe cases can cause significant sleep interruption and insomnia.
  
  
• Sleep apnea is a less common cause of insomnia. This condition is associated with loud snoring and frequent brief awakenings during the night. Many factors, including abnormal structures in the nose or throat, may cause this condition. 
  
  
• Circadian rhythm disorders (disruption of an individual’s “biological clock”) may occur when a person stays up later and sleeps later, then has difficulty returning to a more normal sleep schedule. People who work during the night (“graveyard shift”) frequently have problems with insomnia.
  
  

Primary insomnia may be diagnosed when all other disorders have been excluded. Primary insomnia is often referred to as psychophysiologic insomnia. This disorder often results from a period of stress in a person’s life. Normally, this condition resolves over time, but for some, insomnia results in ongoing tension and an inability to sleep. Bad sleep habits develop, and the person begins to worry about his or her sleep. The bad habits must be “unlearned,” and the person educated regarding good sleep hygiene practices.

Next: What Are the Risks of Insomnia? »

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