Insomnia (in-SOM-ne-ah) is a common sleep disorder. People who have insomnia have trouble falling asleep, staying asleep, or both. As a result, they may get too little sleep or have poor-quality sleep. They may not feel refreshed when they wake up.
Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.
Types of Insomnia
There are two broad categories –
Transient insomnia – occurs when symptoms lasts from a few days to some weeks.
Acute insomnia – also called short-term insomnia. Symptoms persist for several weeks.
Chronic insomnia – this type lasts for at least months, and sometimes years. The majority of chronic insomnia cases are secondary, meaning they are side effects or symptoms of some other problem.
Causes
There are many causes of insomnia.
Extended exposure to environmental toxins and chemicals may prevent people from being able to fall asleep or stay asleep.
Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following –
- Stress
- Environmental noise
- Extreme temperatures
- Change in the surrounding environment
- Sleep/wake schedule problems such as those due to jet lag
- Medication side effects
Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson’s disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.
In addition, the following behaviors have been shown to perpetuate insomnia in some people:
- Expecting to have difficulty sleeping and worrying about it
- Ingesting excessive amounts of caffeine
- Drinking alcohol before bedtime
- Smoking cigarettes before bedtime
- Excessive napping in the afternoon or evening
- Irregular or continually disrupted sleep/wake schedules
These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate the insomnia altogether.
Other –
Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia.
- Difficulty falling asleep at night
- Awakening during the night
- Awakening earlier than desired
- Still feeling tired after a night’s sleep
- Daytime fatigue or sleepiness
- Irritability, depression or anxiety
- Poor concentration and focus
- Being uncoordinated, an increase in errors or accidents
- Tension headaches
- Difficulty socializing
- Gastrointestinal symptoms
- Worrying about sleeping.
- Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day.
Risk Factors
Older people with poor health have a higher risk. Also women have twice the rates compared to men. This may be related to higher rates of anxiety and depression, which can be associated with insomnia. Shift workers have a higher risk too. Some people are more likely to suffer from insomnia than others. These include –
- Travelers
- Shift workers with frequent changes in shifts
- The elderly
- Drug users
- Adolescent or young adult students
- Pregnant women
- Menopausal women
- Those with mental health disorders
Symptoms
Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia.
- Difficulty falling asleep at night
- Awakening during the night
- Awakening earlier than desired
- Still feeling tired after a night’s sleep
- Daytime fatigue or sleepiness
- Irritability, depression or anxiety
- Poor concentration and focus
- Being uncoordinated, an increase in errors or accidents
- Tension headaches
- Difficulty socializing
- Gastrointestinal symptoms
- Worrying about sleeping.
Sleep deprivation can cause other symptoms. The afflicted person may wake up not feeling fully awake and refreshed, and may have a sensation of tiredness and sleepiness throughout the day. Having problems concentrating and focusing on tasks is common for people with insomnia.
Complications
Complications of insomnia may include –
- Lower performance on the job or at school
- Slowed reaction time while driving and higher risk of accidents
- Psychiatric problems, such as depression or an anxiety disorder
- Overweight or obesity
- Irritability
- Increased risk and severity of long-term diseases or conditions, such as high blood pressure, heart disease and diabetes
- Substance abuse
Treatment
Improving “sleep hygiene” – This include – don’t over- or under-sleep, exercise daily, don’t force sleep, try to maintain a regular sleep schedule, avoid caffeine at night, do not smoke, do not go to bed hungry, make sure the environment is comfortable
Using relaxation techniques – such as meditation and muscle relaxation
Cognitive therapy – one-on-one counseling or group therapy
Stimulus control therapy – only go to bed when sleepy, refrain from TV, reading, eating, or worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps
Sleep restriction – decrease the time spent in bed and partially deprive the body of sleep so people are more tired the next night.
Medications – Medical treatments for insomnia include:
- Prescription sleeping pills (often benzodiazepines)
- Antidepressants
- Over-the-counter sleep aids
- Antihistamines
- Melatonin
- Ramelteon
- Valerian officinalis
Alternative Treatment
Melatonin supplements are widely recommended for various sleep conditions. A naturally-occurring hormone that regulates the sleep-wake cycle in the brain, melatonin is produced from serotonin when exposure to light decreases at night. It is used in conditions where sleep is disordered due to low levels of melatonin at night such as aging, affective disorders (e.g. depression), delayed sleep-phase disorder, or jet lag.
Warm baths – Some people find these relaxing. They can help relax the muscles and promote sleep. It is possible that the thermoregulation system, so tied into the sleep cycle, is affected by the warmth and subsequent cooling that happens when the person gets out of the tub. Hypnosis is also a possible therapy for insomnia.
Acupuncture – Some people swear by the ancient practice of acupuncture for a range of maladies, including insomnia. There is no scientific evidence for the effectiveness of acupuncture. A recent meta-study (evaluation of other studies) at Emory University concluded that although most showed some positive effects of acupuncture, the studies were not set up according to scientific standards and their results could not be accepted as scientifically valid.
Passionflower – Passionflower is a vine native to Europe that no grows in the United States also. Herbal supplement companies put extracts into capsules and make it into tea-like preparations. Passionflower is used by enthusiasts for anxiety and insomnia.
Chamomile – Chamomile is an ancient remedy for a range of problems. The flowers are dried and crushed and infused into a tea. Some people are allergic to it. There does not seem to be any scientific evidence it helps with insomnia.
Lavender – Extracts from this shrub are used for aroma enhancement in a range of consumer products. It is also used for aromatherapy for insomnia.
Kava – A drink made from the roots of the kava plant has been used in ceremonies in the Pacific Islands for centuries. Some have used Kava for insomnia and to relieve stress, but the FDA has issued a warning that kava preparations pose a risk of liver damage.
Valerian – Study showed a slight benefit to children treated with a combination of valerian and lemon balm. Valerian is often marketed in combination mixtures with other herbs.
St. John Wort’s – This common yellow-flowered weedy herb from Europe is quickly becoming an important part of modern herbal therapeutics. It has a long history of use dating back to ancient Greek times. Modern scientific studies show that it can help relieve chronic insomnia and mild depression when related to certain brain chemistry imbalances.
Reference –
https://www.nhlbi.nih.gov/health/health-topics/topics/inso
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/
http://www.medicalnewstoday.com/articles/9155.php
https://sleepfoundation.org/insomnia/content/what-is-insomnia
http://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspx
https://www.nlm.nih.gov/medlineplus/insomnia.html
http://www.emedicinehealth.com/insomnia/article_em.htm
http://www.sleepeducation.org/essentials-in-sleep/insomnia
http://www.medicinenet.com/script/main/art.asp?articlekey=47532
http://www.apsfa.org/docs/insomnia.pdf
http://www.theatlantic.com/health/archive/2015/02/insomnia-that-kills/384841/