Insomnia - Causes, Risk Factors, Symptoms, and Management

What Is Insomnia?

Insomnia is a sleep disorder affecting numerous people worldwide. People affected with insomnia face difficulty falling asleep and waking up earlier than they go to bed. Insomnia can cause daytime sleepiness, a general feeling of being unwell physically and mentally, mood changes, irritability, and anxiety. Along with these symptoms, insomnia increases the risk of developing chronic diseases like obesity, diabetes, cardiovascular disease, and depression.

What Are the Causes of Insomnia?

Various physical and psychological factors cause insomnia. The common causes are,

1) Getting too little physical exercise.

2) Having bad dreams during sleep.

3) Using recreational drugs.

4) The sleeping room being too hot or cold or the bed being uncomfortable.

5) Stress.

Some health disorders may also disturb sleep. The health disorders that disrupt sleep are,

1. Sleep apnea.

2. Gastrointestinal reflux disease.

3. Chronic obstructive pulmonary disease.

4. Restless leg syndrome.

5. Overactive thyroid.

6. Alzheimer’s disease.

Some medications such as Corticosteroids, Statins, Alpha-blockers, Selective serotonin reuptake inhibitors (SSRI), and Angiotensin-converting enzyme (ACE) inhibitors can cause insomnia in older people. Using devices with screens before bed also causes insomnia in young people.

What Are the Risk Factors of Insomnia?

Insomnia can occur at any age. The common risk factors are,

1. Traveling across time zones.

2. Working in shifts.

3. Being older.

4. Use of caffeine and medications.

5. Having a family history of insomnia.

6. Being pregnant or going through menopause.

7. Having other health conditions.

What Are the Types of Insomnia?

Insomnia is classified based on the duration as transient insomnia, short-term insomnia, and chronic insomnia.

Transient insomnia lasts less than a month and does not recur. Short-term insomnia is otherwise known as acute insomnia or adjustment insomnia. Short-term insomnia is caused by a stressful event such as losing a loved one, a pandemic or rebounding from the cessation of a drug.

Short-term insomnia lasts less than three months, and symptoms may fade on their own as time passes. The affected person copes up with the stressful event that gives rise to sleeping problems.

In some cases, short-term insomnia remains persistent and results in chronic insomnia. Insomnia is considered chronic if people face difficulty sleeping for three nights per week for three months or longer.

Doctors classify insomnia as primary and secondary insomnia or comorbid insomnia based on the cause. Primary insomnia is a condition that occurs without any co-existing disease. Secondary insomnia occurs in conjunction with other medical conditions.

Based on the severity, insomnia is classified as mild, moderate, and severe. Mild insomnia occurs when the lack of sleep results in tiredness. Moderate insomnia and severe insomnia affect a person’s daily functioning.

Insomnia is also classified as sleep-onset insomnia, sleep maintenance insomnia, and early morning awakening insomnia based on the way insomnia is experienced.

Sleep onset insomnia occurs when a person faces difficulty falling asleep at the beginning of the night. Most people with this insomnia can't fall asleep even after spending 20 to 30 minutes in bed. A person with this insomnia has reduced total sleep time and can feel the effects of lack of sleep the next day.

Sleep maintenance insomnia describes the inability to stay asleep through the night. In this insomnia, the affected person wakes up at least once during the night and struggles to get back to sleep for 20 to 30 minutes. Both sleep quantity and quality are affected and create a high chance of developing daytime sleepiness. Early morning awakening insomnia occurs when a person wakes up in the morning before the planned time of waking.

What Are the Symptoms of Insomnia?

Apart from disturbed sleep, insomnia may also cause gastrointestinal problems, low energy, poor concentration, lack of coordination, worry or anxiety about sleep, tension headaches, difficulty in working and studying.

How to Diagnose Insomnia?

The diagnosis of insomnia is made by searching the cause through physical examination, sleep study, and sleep habits review.

1) Physical Examination:

When the cause of insomnia is unknown, the doctor may do a physical examination to look for other medical problems that may cause insomnia.

2) Sleep Habits Review:

The doctor documents a person’s sleep patterns, waking episodes, alcohol and caffeine intake in a sleep diary for one to two weeks before the next appointment to diagnose insomnia.

3) Sleep Study:

If the affected person experiences signs of another sleep disorder, the doctor recommends a sleep study to rule out the cause. Several tests monitor and record various body activities while a person sleeps.

What Are the Effective Methods to Treat Insomnia?

Behavior and lifestyle changes improve a person’s overall sleep quality. These changes do not cause any side effects as medications, and the improvement lasts longer.

1) Cognitive Behavior Therapy:

Cognitive behavior therapy controls negative thoughts and actions that make a person awake, so this therapy is considered the first line of treatment for people affected with insomnia. This therapy often focuses on pinpointing the anxieties of these people about sleep and replacing them with healthier beliefs and attitudes. This therapy also includes one or more of the following components.

2) Sleep Education and Hygiene:

The psychologist educates the patient about healthy sleep patterns and lifestyle habits. It also helps the patient to understand why they experience insomnia symptoms. Specifically, sleep hygiene focuses on improving sleep quality and quantity behaviors and eliminating behaviors that cause sleep problems.

3) Stimulus Control:

This method removes factors that condition the mind to resist sleep. For example, the affected person is trained to set a consistent bedtime and wake time. Using their bed only for rest, leaving the bed when they cannot sleep within 20 minutes and returning to bed when they feel tired.

4) Relaxation Techniques:

Muscle relaxation, biofeedback, meditation, and breathing exercise are some effective relaxation techniques that help in reducing insomnia. Practicing these techniques controls the breathing, heart rate, muscle tension, and mood of a person.

5) Sleep Restriction:

This therapy decreases the time spent in bed and avoids daytime naps, causing partial sleep deprivation. It makes a person feel tired the next night. Once the sleep improves, the time spent on the bed gradually increases.

Medications Prescribed for Insomnia:

Medications serve as the last resort for people affected with insomnia. The medicines prescribed are,

1. Benzodiazepines.

2. Nonbenzodiazepines.

3. Melatonin agonists.

4. Orexin receptor agonists.

5. Antidepressants.

6. Antipsychotics.

7. Over-the-counter antihistamines.

Home Remedies for Insomnia:

Few home remedies help to manage insomnia.

a) Go to bed and wake up at the same time, every day,

b) Avoid using devices with screens before bedtime,

c) Avoid naps,

d) Avoid taking large meals and beverages before bed,

e) Make sure that the room is at a comfortable temperature before bedtime,

f) Find ways to relax,

g) Limit caffeine and alcohol intake at night time.

Conclusion:

Sleep is a state of rest where an individual becomes physically inactive, unaware of the surrounding environment and other body functions. Sleep helps a person to maintain a healthy weight, lowers the risk of developing diabetes and heart disease, reduces stress, improves mood and coordination. People facing insomnia are unable to get these benefits of sleep. Diagnosing and treating insomnia early by consulting a psychologist helps manage insomnia soon to have a good sleep every day.