Insomnia affects one in three adults worldwide, causing significant interference in daily activities. Approximately 10% of adults each year are diagnosed with meeting the criteria for some form of insomnia disorder. That same percentage may also have insomnia severe enough to cause associated daytime consequences.
Insomnia is also linked to significant health issues and declining quality of life. Diagnosing insomnia and determining its cause can help you sleep better at night and feel more energized and productive during the day.
What Is Insomnia?
Insomnia is a condition where a person does not get enough sleep. It can take multiple forms, and you might experience one or more issues over time.
- Initial insomnia (sleep onset): difficulty falling asleep
- Middle insomnia (maintenance): waking up during the night and then falling back asleep
- Late insomnia (early waking): waking up too early and unable to return to sleep
For some people, sleep is of poor quality or nonrestorative. These individuals may get the recommended 7 to 9 hours of sleep each night yet still be tired.
Sleep duration decreases with age, often due to changing hormone levels. Menopause and andropause (low testosterone) can also bring night sweats that cause nocturnal waking.
Insomnia is not the same thing as sleep deprivation, which occurs when a person cannot get a full night’s sleep due to extenuating circumstances, such as having an event to attend late at night yet still needing to arise early the next morning.
Is it Dangerous?
While insomnia is not dangerous, it can lead to dangerous occurrences and situations if not controlled and treated. One of the most dangerous aspects of insomnia and insufficient sleep occurs when people operate heavy machinery or drive. Feeling fatigued can lead to potentially deadly accidents at work or on the road.
Lack of sleep can also increase certain health risks, including:
- Heart attack
- High blood pressure
- Hormonal imbalance
- Obstructive sleep apnea
- Type 2 diabetes
These conditions can also lead to other health concerns and risk factors. Untreated insomnia can worsen into significant problems.
Symptoms of Insomnia
The effects of insomnia can be felt in many areas of your life, both day and night. While it is natural to assume that the most prevalent issue is not getting a good night’s sleep, the symptoms and effects of lack of sleep can be more severe than that.
Here are some of the leading daytime effects associated with insomnia:
- Lack of energy
- Slow reflexes
- Falling asleep at work or behind the wheel of a car
- Mood changes
- Feeling unwell
- Reduced work productivity
- Poor judgment
- Mistakes at work
- Slow thinking
- Upset stomach
- Memory issues
- Decreased motivation
- Trouble concentrating
- Decline in social activities
- Missed deadlines
- Increased stress
- Reduced immunity
At night, insomnia can cause other issues, such as:
- Tossing and turning
- Keeping your partner awake
- Interrupted sleep
- Lack of sexual interest
Methods of Diagnosis
The first step in diagnosing insomnia is a consultation to discuss your sleep duration, issues, symptoms, and concerns. Depending on what you report, the doctor may want to run some medical tests to determine if there is a cause of your sleep problems. A physical examination is recommended to rule out underlying issues.
Testing may include the following:
- Actigraphy: wearing a watch-type device to track your sleep patterns and circadian rhythm disorders
- Blood analysis: to check for medical issues and hormonal imbalance
- Electroencephalogram (EEG): checks brain waves for unusual activity that could cause sleep disturbances
- Multiple sleep latency test (MSLT): used to diagnose narcolepsy, this test checks for daytime sleeping
- Sleep apnea testing: overnight in a sleep lab or with an at-home screening device for sleep apnea
Types of Insomnia
Insomnia is often categorized in the following ways:
Cause: there is a reason why insomnia occurs:
Primary insomnia: it happens by itself with no underlying reason and has 3 subtypes:
- Idiopathic: no identifiable contributory factor
- Stress-related: mild stress influence
- Sleep state misperception (SSM): also known as paradoxical insomnia, this is when a person gets enough sleep, is not tired, yet feels they are dealing with insomnia
Secondary insomnia: an underlying condition or situation causes the problem, such as the following:
- Medical issues or medication interference
- Environmental causes, including alcohol, caffeine, substance abuse
- Psychiatric issue/mental disorder
Time: the duration of insomnia
Acute insomnia: this is a short-term occurrence that is also called adjustment insomnia, typically lasting from a few days to a few weeks, and is more common in women than men, and older adults than younger people
Short-term insomnia is often due to some type of stressful situation, including death, divorce, job loss, arguments, and external situations.
Chronic insomnia: long-lasting issue referred to as insomnia disorder with various characteristics:
- Circumstances: no underlying issues interfering with the ability to sleep
- Duration: lasting three or more months
- Explanation: no mental or medical health, substance, medication, or other issue
- Frequency: occurring at least three times each week
Mild insomnia may result in tiredness during the day. Moderate insomnia may start to affect daily functions. Severe insomnia can significantly influence daily life, increasing the risk of accidents and health problems.
Causes of Insomnia
Insomnia can occur for many reasons. Having a deadline at work or a stressful personal situation can make it difficult for the brain to relax at night as you attempt to find solutions. Stress increases the production of cortisol, which tends to keep people awake.
Changes in routine or work schedules can interfere with sleep. Shift workers who are up all night and sleep during the day often have trouble getting enough sleep. Daytime noises can make it hard to get proper rest.
Some people are light sleepers; any sound can wake them up. Mothers tend to sleep more lightly once they have a child, as they are listening for every little sound. Individuals in the military (especially combat) may become light sleepers due to their awareness of what is happening around them.
Other causes of insomnia include:
- Brain chemistry: increased brain activity or chemistry differences interfering with sleep
- Genetics: some sleep traits run in families
- Fear or anxiety: unsafe situations, such as domestic violence or abuse, nocturnal panic attacks, nightmare disorder
- Life changes or circumstances: new job, divorce, moving, vacation (unfamiliar bed), jet lag, death of a loved one
- Lifestyle factors: daytime naps, caffeine or alcohol consumption, drug usage, late nights, eating huge meals within two hours of bedtime, uncomfortable temperature, bed, or bedroom environment
- Medical conditions: some health issues, infections, injuries, and chronic conditions can interfere with the body’s circadian rhythm
- Medications: some medications can interfere with sleep
- Mental health conditions: anxiety, depression, stress, or other mental health issues
- Pain: this can come from chronic pain, such as arthritis, injuries, overexertion, medical conditions associated with pain, or sunburn
- Pregnancy: women who are pregnant experience hormonal, physical, and psychological changes that can interfere with sleep
Prevention of Insomnia
Insomnia is often preventable, especially when in conjunction with poor lifestyle habits. Changing bad habits like turning off electronics two hours before bed can help. Avoiding caffeine, nicotine, and alcohol at night and not overeating before bed can reduce sleeplessness.
Other ways of preventing insomnia include following a set sleep schedule, allowing yourself time to relax and wind down before bed, maintaining a comfortable temperature environment, using white noise, being active during the day, and turning to meditation at night can help. Blackout curtains, a mattress topper, a warm bath, eating a banana, yogurt, nuts, cottage or string cheese, and drinking tart cherry juice can help promote better sleep.
If underlying conditions are present, such as medical or mental health issues, contact the appropriate doctor for help.
Treatment of Insomnia
The treatment for insomnia depends on the type and cause. A sleep professional can help you determine the best actions to take. If medication is necessary, taking it for as short a time as possible is recommended, as they do not treat the cause and may become less effective over time.
- Antihistamines: these over-the-counter medications often help with sleep but might make you drowsy during the day
- Herbal supplements: very little evidence to support their benefits (speak with a healthcare provider first)
- Benzodiazepine: prescription hypnotics for short-term use only
- Nonbenzodiazepine: prescription sleeping pills with fewer risks and longer use
- Antidepressants: not FDA-authorized for insomnia but may help some people
- Antipsychotics, nonhypnotic benzodiazepines, barbiturates, and anticonvulsants: not FDA-approved for insomnia and may have significant risks
- Antiseizure medications: may help people with restless leg syndrome, which can interfere with sleep
- Melatonin: available over-the-counter and by prescription, melatonin tells the brain it is time for sleep (speak with a healthcare provider before using)
- Human growth hormone (HGH) deficiency occurs when the body does not produce enough HGH for its needs. As HGH levels decline, cortisol often increases, causing higher levels of stress that interfere with sleep. HGH also works on neuroreceptors that help you relax. Balanced HGH levels are vital for stable mental health. HGH therapy is not available over the counter and requires a legal prescription. You can get an HGH prescription online with comprehensive testing and diagnosis from a hormone therapy clinic. Only those with a legitimate HGH deficiency should use HGH therapy.
Cognitive-behavioral therapy (CBT)
A grouping of various therapies used alone or in combination to improve sleep includes lifestyle modification:
- Relaxation training: guidance in relaxing the body and mind
- Cognitive therapy: changing beliefs and attitudes that hinder sleep
- Sleep restriction: significantly limiting sleep and then slowly increasing time spent in bed
- Stimulus control: only going to bed when feeling sleepy and waking at the same time each day; avoiding naps; getting up from bed when unable to sleep; only using the bed for sex and sleep
- Breathing support: sleep apnea equipment, mouthpieces, and different pillows can help improve sleep quality
- Sleep hygiene training: correcting any bad habits that might contribute to insomnia
Other treatment recommendations include the following:
- Manage alcohol and caffeine intake: these products can influence sleep ability.
- Consistent sleep schedule: going to bed at the same time each night helps get your brain used to a pattern. Wake up at the same time each morning, even on weekends.
- Avoid electronics and other stimulation before bed: the light from electronic devices can trick the brain into thinking it is daytime, releasing chemicals that inhibit sleep.
Getting a good night’s sleep is crucial to your physical and mental health and well-being. Contacting the appropriate healthcare provider can provide valuable assistance to help you get back to sleeping well at night.
If insomnia is frequent or long-lasting, seek medical guidance to help you wake up feeling refreshed and restored.