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Insomnia


Insomnia is a common sleep disorder. One in three people find it difficult to fall asleep, stay asleep, or both.


Different people need different amounts of sleep. For those who suffer from insomnia however, sleeping poorly or not enough makes it harder to function during the daytime.


Causes

Short-term insomnia, or insomnia that lasts less than three months, is usually associated with stress or situations that disrupt the normal sleep cycle, such as jet lag.


Chronic insomnia, or insomnia that lasts longer than three months and occurs at least three nights per week may have no identifiable cause or can be caused by a medical condition, medicines, and other sleep disorders.


Conditions that are associated with chronic insomnia include:

  • Mental health problems such as depression, anxiety disorders, and posttraumatic stress disorder

  • Medical illnesses such as respiratory disorder, high blood pressure, diabetes, chronic pain

  • Neurological disorders such as Parkinson disease and Alzheimer disease

  • Other sleep disorders such as sleep apnea, restless leg syndrome, circadian rhythm disorders

  • Medications, caffeine, alcohol, or illegal drug use

  • Irregular sleep habits


Symptoms

Symptoms of insomnia include:

  • Lying awake for a long time before falling asleep

  • Sleeping for only short periods

  • Being awake for much of the night

  • Feeling sleep-deprived during daytime

  • Waking up too early


Diagnosis

The diagnosis of insomnia requires a detailed sleep history, along with a medical history, physical exam and laboratory tests to rule out medical causes of the sleep disorder.


A daily sleep diary for one to two weeks can be helpful to record sleep times and identify exacerbating factors.


In some cases, the doctor may recommend a sleep study to determine sleep quality or to identify an underlying sleep disorder.


Treatment

Lifestyle changes can often improve short-term insomnia.


Healthy sleep habits include:

  • Sleep in a cool, quiet place

  • Go to sleep and waking up around the same time each day

  • Avoid caffeine, nicotine, and alcohol close to bedtime

  • Get regular physical activity during the daytime

  • Avoid daytime naps

  • Eat meals on a regular schedule

  • Limit fluid intake close to bedtime

  • Learn new ways to manage stress

  • Avoid certain over-the-counter and prescription medications that can disrupt sleep


In addition to healthy sleep habits, counseling in the form of cognitive behavioral therapy for insomnia (CBT-I) is usually the first treatment for chronic insomnia. Over the course of several weeks, patients work with a CBT-I therapist to correct harmful sleep habits by:

  • Cognitive therapy to feel less nervous about sleep and have more positive thinking.

  • Relaxation or meditation therapy to de-stress and fall asleep faster.

  • Sleep education to learn healthy sleep habits.

  • Sleep restriction therapy to set a specific schedule for when to go to bed and when to get up, even when the patient is unable to sleep the whole time. The fatigue can lead to more restful sleep on following nights. The time in bed can increase when sleep improves over time.

  • Stimulus control therapy to help develop a regular sleep-wake cycle and link being in bed with being asleep.


Medications are sometimes prescribed to treat insomnia. The main categories of medications that are approved for the treatment of insomnia are:

  • Benzodiazepine receptor agonists

  • Dual orexin receptor antagonists

  • Histamine receptor antagonists

  • Melatonin receptor agonists


It’s important to understand that sleeping pills are not a cure for insomnia. Doctors do not generally recommend relying on prescription sleeping pills for more than a few weeks because some of them can be habit-forming and they can have side effects such as dizziness, drowsiness, worsening of depression, and confusion. Patients should always have a discussion with their doctor about the potential benefits and side effects of insomnia medication before starting treatment.




References

https://medlineplus.gov/insomnia.html

Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016;5(4):780-784. doi:10.4103/2249-4863.201153

https://www.uptodate.com/contents/insomnia-beyond-the-basics

https://www.helpguide.org/articles/sleep/insomnia-causes-and-cures.htm

https://www.nhlbi.nih.gov/health-topics/insomnia