What is insomnia?
Insomnia is a sleep disorder that refers to any difficulty sleeping, including problems falling asleep, staying asleep, or returning to sleep after waking even when you have the opportunity to do so. Consequently, people with insomnia often do not get enough sleep, and the sleep they do get is not refreshing.
The word insomnia itself comes from the Latin "in somus" (no sleep), and it is estimated this common disorder affects about 30% of adults.
What are symptoms of insomnia?
The main symptoms of insomnia are difficulty falling asleep and staying asleep, waking during the night, and having problems falling back asleep or waking up earlier in the morning. As a result, people with insomnia often do not sleep much, which can result in the following symptoms:
- Sleep is nonrestorative
- Daytime tiredness
- Lack of energy
- Difficulty concentrating or thinking
- Mood changes
- "Acting out" with impulsiveness or aggression
- Accidents or mistakes
- Problems at work or school
- Difficulty with relationships
- Frustration about sleeping
Women suffer from insomnia more than men.
Women are more likely to suffer from insomnia than men. Hormones seem to be the culprit. Hormonal changes women experience during their menstrual cycle and menopause can impact their sleep. During perimenopause (the years before menopause), women often have hot flashes and night sweats that disturb sleep.
Pregnancy is another sleep disruptor for women. The changes are hormonal, emotional, and physical. Later in pregnancy women may waken during the night to urinate, or because of physical discomfort.
Women are also more likely to develop medical conditions that cause secondary insomnia such as depression, anxiety, fibromyalgia, and sleep disorders such as restless leg syndrome (RLS).
What is secondary insomnia?
Secondary insomnia is insomnia that is a result of another problem such as a medical condition or medication. It is the most common form of insomnia, affecting about 80% of sufferers. Problems that may cause secondary insomnia include:
- Depression, anxiety, post-traumatic stress disorder (PTSD)
- Illness, such as some heart and lung diseases
- Caffeine, tobacco, alcohol
- Another sleep disorder, such as sleep apnea or restless leg syndrome
- Changes in sleep routine or shift work
- Poor sleep environment
_______________ is a type of insomnia that can last for weeks or months.
Chronic insomnia is defined as insomnia that occurs at least three nights per week for three months or longer. It affects 10% of people with insomnia. One possible cause for chronic insomnia is a poor sleep behavioral pattern, such as bedtime routines that do not cue your body to ready itself for sleep, or your sleep schedule does not sync with your biological clock. Another possible cause for chronic insomnia is when it is secondary insomnia, caused by another chronic medical or psychological issue that is not well-managed.
Insomnia that is short-term is called acute insomnia and it usually only lasts for a few days or a few weeks. This type of insomnia is generally the result of life circumstances, usually stressful ones such as divorce, death of a loved one, job loss, or an upcoming major exam. It could also be due to physical pain or discomfort, a bout with a cold, some medications, or jetlag. Acute insomnia may also be caused by the sleep environment being too hot or cold, too noisy, or not dark enough.
What is the medical term for life-long insomnia?
The medical term for lifelong insomnia is idiopathic insomnia. This rare form of insomnia begins in childhood and has no apparent cause. It is not the result of any known stressors, psychological factors, neurological disorders, medications, or other factors that would normally influence sleep. It is believed that idiopathic insomnia is the result of an abnormality in the sleep-wake cycle. The area of the brain that promotes sleep seems to be underactive, and the area that promotes wakefulness is overactive. Most people with idiopathic insomnia adjust to the disorder and do not develop further medical issues.
What is sleep hygiene?
Sleep hygiene is the practice of promoting regular sleep habits. Good sleep hygiene habits benefit everyone by promoting restful sleep and daytime alertness, and preventing sleep disorders. The National Sleep Foundation recommends the following tips to improve sleep:
- Go to bed at the same time each night, and wake up at the same time each morning
- Keep your bedroom quiet, dark, and at a comfortable temperature that is not too hot or too cold
- Use your bed only for sleeping and not for watching TV, reading, or listening to music
- Keep the bedroom a 'gadget-free' zone, and remove the TV, computer, tablet, cell phone, and gaming consoles
- Don't eat large meals close to bedtime.
Some prescription sleep medications may become habit forming.
Prescription sleep medications can help you sleep, but they can be habit-forming. This means they may be addictive, and if you take them for a while you may end up being unable to fall asleep without them. Sleep medications are generally used only for short-term treatment of insomnia, but people who suffer from severe chronic insomnia may be prescribed medication for longer periods. Talk to your doctor about any sleep medicine you are prescribed, and be sure you understand the side effects and risks, which may include:
- You may become addicted
- They may mask underlying medical conditions that cause the insomnia
- There can be drug interactions with other medications you take
- They may cause daytime sleepiness or grogginess
- They can cause rebound insomnia, where your insomnia is worse after stopping the sleep medications than it was before you started taking them
The optimal room temperature for sleeping is about 65 degrees.
The National Sleep Foundation suggests a bedroom temperature of 60 to 67 degrees F (15.5 to 19.5 C) is optimal for sleep. As you are getting ready for your normal bedtime, your body temperature drops slightly to start the sleep cycle. If your room is at an ideal cool temperature this can facilitate you falling asleep.
If the room is much warmer or cooler it may cause restless sleep and interfere with rapid eye movement (REM) sleep, which is the stage of sleep where you dream.
The ideal sleep temperature for babies and toddlers is slightly higher, from 65 to 70 degrees F (18.3 to 21.1 C).
Insomnia can be a serious health problem.
Insomnia may pose serious risks to health. Poor sleep may be a sign of a more serious sleep disorder such as sleep apnea, a condition in which a person may stop breathing for short periods during the night. Sleep apnea can be fatal if untreated.
Daytime sleepiness that results from insomnia can also have significant consequences. People who get insufficient sleep can have more car accidents, even during the day. Lack of sleep also decreases our ability to handle daily stress, which can increase the risk for mental illness or substance abuse, including abuse of sleep medications.
It is important to deal with acute short-term insomnia when it starts, so it does not become a chronic problem. Talk to your doctor to learn about treatments for insomnia.
Prescription medications are the only available treatment options for insomnia.
There are numerous ways to treat insomnia, and prescription medications are just one option. Often, a doctor will recommend non-medical treatments first, such as:
- Relaxation training: including breathing exercises, meditation, guided imagery, and mindfulness
- Stimulus control: limiting activities in the bedroom to only sleep-related ones so you build an association between going to bed and sleeping
- Cognitive behavioral therapy (CBT): behavioral modification including good sleep hygiene practices, and also retraining your thinking surrounding sleep
Medical treatments for insomnia include over-the-counter (OTC) and prescription sleep aids. Consult your doctor to determine the right one for you. Classes of prescription sleep medications include:
- Benzodiazepine hypnotics: estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), triazolam (Halcion), and diazepam (Valium)
- Non-benzodiazepine hypnotics: zolpidem (Ambien, Ambien CR, Intermezzo), pyrazolopyrimidine (Sonata), chloral hydrate (Notec), dexmedetomidine hydrochloride (Precedex), and eszopiclone (Lunesta) - Melatonin receptor agonists: ramelteon (Rozerem)
- Orexin antagonists: suvorexant (Belsomra)
Some people prefer natural remedies for sleep, such as melatonin, valerian root, chamomile, kava kava, passionflower, and hops. Talk to your doctor before using any herbal remedy as many can interact with medications you take.
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