Insomnia: Causes, Symptoms, and Treatment

What is Insomnia?

Insomnia is a common sleep disorder that makes it difficult to fall asleep, stay asleep, or cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up. Insomnia can sap not only your energy level and mood but also your health, work performance, and quality of life.

How much sleep is enough varies from person to person, but most adults need seven to eight hours a night. At some point, many adults experience short-term (acute) insomnia, which lasts for days or weeks. It's usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications.

Source: Mayo Clinic

Common Causes

Insomnia may be caused by a variety of factors, including:

• Stress: Concerns about work, school, health, finances, or family can keep your mind active at night, making it difficult to sleep.
• Travel or work schedule: Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism, and body temperature. Disrupting your body's circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
• Poor sleep habits: Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating, or watching TV. Computers, TVs, video games, smartphones, or other screens just before bed can interfere with your sleep cycle.
• Eating too much late in the evening: Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
• Mental health disorders: Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
• Medications: Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
• Medical conditions: Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson's disease, and Alzheimer's disease.
• Sleep-related disorders: Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep.
• Caffeine, nicotine, and alcohol: Coffee, tea, cola, and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
• Aging: Insomnia becomes more common with age. As you age, you may experience changes in sleep patterns, such as earlier bedtimes, earlier wake-up times, and less deep sleep. Nighttime urination (nocturia) and pain or discomfort from medical conditions may also interrupt sleep.

Source: Mayo Clinic, NIH

Associated Symptoms

Insomnia itself may be a symptom of an underlying medical condition, but there are several signs and symptoms associated with insomnia:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Not feeling well-rested after a night's sleep
• Daytime tiredness or sleepiness
• Irritability, depression, or anxiety
• Difficulty paying attention, focusing on tasks, or remembering
• Increased errors or accidents
• Ongoing worries about sleep

Source: Mayo Clinic

When to See a Doctor

If insomnia makes it hard for you to function during the day, see your doctor to identify the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

Consider seeing a doctor if:

• Your insomnia lasts for more than a few weeks.
• Your insomnia is affecting your mood, energy, or ability to function during the day.
• You wake up gasping for breath or feel like you're choking.
• You experience other unusual symptoms during sleep, such as restless legs or a crawling sensation in your legs.

Source: Mayo Clinic

Diagnosis

Your doctor will likely perform a physical exam and ask about your medical history and sleep history. They may also recommend:

• Sleep diary: You may be asked to keep a record of your sleep patterns for a week or two, noting when you go to bed, wake up, take naps, and how well you sleep.
• Sleep study (polysomnography): If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record brain waves, breathing, heartbeat, eye movements, and body movements while you sleep.
• Blood tests: Your doctor may want to do a blood test to check for conditions that may be linked to insomnia, such as thyroid problems.

Source: Mayo Clinic

Treatment Options

Treating the underlying cause of your insomnia can help you return to a good night's sleep. In addition, your doctor may recommend cognitive behavioral therapy, medications, or lifestyle changes.

Medical Treatments

• Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps overcome the underlying causes of your sleep problems.
• Prescription sleeping pills: Medications can help you fall asleep, stay asleep, or both. Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use. Examples include eszopiclone (Lunesta), ramelteon (Rozerem), zaleplon (Sonata), and zolpidem (Ambien, Edluar, Intermezzo, Zolpimist).
• Over-the-counter sleep aids: Sleep aids available without a prescription contain antihistamines that can make you drowsy. They aren't intended for regular use, so talk to your doctor before using them. Antihistamines may cause side effects, such as daytime sleepiness, dry mouth, dizziness, and urinary retention.

Home Treatments and Lifestyle Changes

• Stick to a sleep schedule: Keep your bedtime and wake time consistent from day to day, including on weekends.
• Stay active: Regular activity helps promote a good night's sleep. Schedule exercise at least a few hours before bedtime and avoid stimulating activities before bed.
• Check your medications: If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also, check the labels of OTC products to see if they contain caffeine or other stimulants.
• Avoid or limit naps: Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to no more than 30 minutes and don't nap after 3 p.m.
• Avoid or limit caffeine and alcohol: Avoid caffeine late in the day and limit alcohol use, as it can disrupt your sleep cycle.
• Don't put up with pain: If a painful condition troubles you, talk to your doctor about options for pain relief that are effective and won't interfere with your sleep.
• Create a restful environment: Keep your bedroom dark, quiet, and cool. Use it only for sleep and sex.
• Manage worries: Try to resolve your worries or concerns before bedtime. Jot down what's on your mind and then set it aside for tomorrow.

Source: Mayo Clinic, NIH

Prevention Tips

Good sleep habits can help prevent insomnia and promote sound sleep:

• Keep your bedtime and wake time consistent from day to day.
• Stay active — regular activity helps promote a good night's sleep.
• Check your medications to see if they may contribute to insomnia.
• Avoid or limit naps.
• Avoid or limit caffeine and alcohol, and don't use nicotine.
• Avoid large meals and beverages before bedtime.
• Make your bedroom comfortable for sleep and only use it for sleep and sex.
• Create a relaxing bedtime ritual, such as taking a warm bath, reading, or listening to soft music.

Source: Mayo Clinic

Emergency Warning Signs

While insomnia itself is not typically an emergency, certain symptoms associated with insomnia may require immediate medical attention. Seek emergency care if you experience:

• Severe difficulty breathing or shortness of breath during sleep.
• Chest pain or pressure.
• Confusion or disorientation upon waking.
• Severe headache, especially if it's sudden and intense.
• Signs of a stroke, such as sudden numbness or weakness, trouble speaking, or vision problems.
• Seizures or convulsions.
• Suicidal thoughts or severe depression.

If you or someone else is experiencing these symptoms, call 911 or go to the nearest emergency room immediately.

Source: CDC, WHO