A lot of us have had to deal with insomnia or sleeplessness at one point or the other in our lives and there are people that have had to battle chronic insomnia.
Generally, there is no specific number of hours of good sleep that defines insomnia and this is because as humans, our body demands different things in different measures, e.g., sleep and IQ needs and practices. Some of us can describe insomnia and how it affects our daily routine, we all know how we feel after one or two nights of sleeplessness. However, not everybody does the right thing, which is to seek medical advice. There are so many medical and behavioral options for correcting insomnia but so many people are oblivious of these.
The classification of insomnia is based on how long the problem has existed. However, it can be classified as explained below:
- Transient insomnia is when the symptoms have lasted less than seven days.
- Short-term insomnia is when the symptoms have lasted between one to three weeks.
- Chronic insomnia is when the symptoms have lasted more than three weeks.
Insomnia affects people of all ages. It affects both young and old but it is more prevalent among adult women than men. It is known to increase with age. Research has also shown that insomnia is prevalent among people in lower socioeconomic groups and people that are addicted to alcohol. It is also common among post-traumatic stress disorder and mental health patients.
Acute or short-term insomnia is triggered by stress and if this isn’t corrected promptly, it may become chronic insomnia. Studies have also shown that there is a connection between anxiety, depression, and insomnia albeit the basis of this connection is yet to be established.
What is insomnia?
Insomnia is not a stand-alone disease or diagnosis. It is a symptom that can be defined as difficulty catching a good sleep or maintaining one or both. Therefore, insomnia can be as a result of inadequate sleep quantity or quality.
What are the signs and symptoms of insomnia, and what is its effect on health?
Medics have associated so many signs and symptoms with insomnia. These are symptoms that can lead to complications in other mental and medical health conditions.
People with insomnia find it difficult to fall asleep. They also have the tendency to wake up frequently at night. This may be caused by stress and if it persists, it may become chronic. Insomnia can lead to daytime problems such as
- Poor concentration and focus
- Difficulty with memory
- Impaired social interaction and irritability
- Impaired motor coordination
- Vehicular accidents caused by fatigue and drivers that are sleep-deprived.
What is the cause of insomnia?
There are so many factors that may lead to insomnia. Causes of insomnia may be classified as medicinal or psychiatric, situational, or primary sleep problems.
Popular causes of transient and short-term insomnia are:
- Jet lag
- Unpleasant or excessive noise
- Changes in shift work
- Uncomfortable room temperature (excess heat or cold)
- Life pressure and stress such as preparation for exams, unemployment, loss of a loved one, separation, or divorce.
- Hospitalization
- Acute medical or surgical illness
- Withdrawal from drug, sedative, alcohol, or stimulant.
- Altitude-related insomnia
- Uncontrolled physical symptoms such as nasal congestion, fever, pain, cough, breathing problems, and diarrhea.
Insomnia may be resolved by bringing these symptoms and their underlying causes under control.
What is the cause of long term or chronic insomnia?
Chronic or long-term insomnia is commonly caused by an underlying physiologic or psychiatric condition.
Mental conditions that cause insomnia
Popular mental health conditions that may cause insomnia include:
- Anxiety
- Depression
- Mental stress
- Situational stress
- Emotional stress
- Schizophrenia
- Mania (bipolar disorder)
Physical health causes of insomnia
Some physical health causes of insomnia are listed below. However, it may vary from circadian rhythm disorders which is disturbance or alteration to the body clock, and sleep-wake imbalance. Medical conditions that may cause insomnia are:
- Chronic pain syndromes
- Chronic fatigue syndrome
- Congestive failure of the heart
- Acid reflux disease (GERD)
- Night time angina (chest pain) from heart disease
- Chronic obstructive pulmonary disease (COPD)
- Nocturnal asthma (asthma with night time breathing symptoms)
- Obstructive sleep apnea (OSA)
- Brain tumors, strokes, or brain trauma
- Degenerative diseases, such as Parkinson’s disease and Alzheimer’s disease
Medications that cause insomnia
Insomnia medications have side effects such as
- Medications that treat asthma
- Steroid medications for treatment of inflammation
- Medications that treat high blood pressure
- Medications for correcting upper respiratory congestion
- Certain preparations for cold and asthma
- Medications that treat depression, anxiety, and schizophrenia.
Other causes of insomnia
- Common stimulants that may alter your pattern of sleep include nicotine and caffeine. Work towards limiting your total daily intake of nicotine.
- Alcohol. This is a wrong choice of sleep-inducing substance. Many people don’t know this but alcohol disrupts sleep.
- Distraction from a snoring bed partner or one who moves leg periodically.
People at risk of insomnia
It isn’t only people with the aforementioned medical conditions that are in danger of insomnia, other groups of people with a high risk of developing insomnia are:
- Seniors
- Travelers
- Alcoholics
- Pregnant women
- People that abuse drugs
- Shift workers who change shifts frequently
- Women in menopause
- Adolescents or young adult students
What is a primary sleep disorder?
In the absence of an underlying condition, there are a few other conditions associated with insomnia. These conditions are referred to as primary sleep disorders. It occurs when the sleep disorder is the lead cause of insomnia. These conditions lead to long-term or chronic insomnia. These diseases include:
- Idiophatic insomnia: The cause of this is unknown. It is also called childhood insomnia as it starts early in life. It causes lifelong issues with sleep and it may run in families.
- Central sleep apnea: This is a complex issue. It may be the root cause of insomnia and it is caused by conditions such as heart failure, brain injury, low oxygen levels, and high altitude.
- Restless legs syndrome: This condition is associated with creeping sensations in the leg when a person is asleep. To relieve it, the legs have to be moved.
- Periodic limb movement disorder: This condition is associated with involuntary repeated movement of the leg when a person is asleep.
- Circadian rhythm disorders: This refers to when the biological clock has been altered and it is a condition peculiar to unusual sleep timing such as sleeping later and waking up late or sleeping very early and getting up very early. It confuses the body.
- Sleep state misperception: This causes a person to have a feeling or perception of not having sufficient sleep without any objective findings of alterations to sleeping pattern.
- Insufficient sleep syndrome: This occurs when a person is unable to get adequate sleep because of lifestyle choices and environmental factors such as noise in a room or bright light.
- Inadequate sleep hygiene: Here, the person has poor sleep habits. It could also mean that the person has poor sleep preparation habits.
When should I seek medical care for insomnia
When should I call the doctor?
- If insomnia lasts longer than three weeks or a month, the patient needs to speak with a doctor. You may also speak with a physician before this timeframe if your daytime activities and ability to function is affected.
When to go to the hospital
- Generally, people do not get admitted into medical facilities for most types of insomnia. However, when insomnia starts to cause bodily harm, the patient may be retained in the hospital so that the condition resulting from insomnia can be treated.
- Emergency medical care should be sought as soon as the patient finds it difficult to breathe at night or starts to experience pains. Although chronic insomnia doesn’t belong in the emergency department, you should have discussions about it with a psychiatrist or primary care physician.
Diagnosis of insomnia
To evaluate insomnia, the doctor or physician will carry out a thorough assessment of the patient’s medical history. Physical examination will also be conducted.
It is the duty of the healthcare professional to check for any psychological or medical condition that may contribute to insomnia. The patient should be screened for psychiatric disorders and abuse of drugs and alcohol. The focus of the physical evaluation would be on the heart and lungs. The size of the neck will also be measured and oral and nasal passages visualized.
- An insomnia patient would be asked questions about weight gain and chronic snoring. This will give the physician a guide on how investigations should be conducted. The physician will look into the possibility of obstructive sleep apnea. This may involve conducting an overnight sleep test (polysomnogram).
- A patient’s sleep history helps with evaluation of insomnia. Clues can be gotten from the patient’s daytime symptoms, sleep habits, sleep schedule, timing and quality of sleep, and insomnia duration. When preparing to visit a physician or doctor for assessment of insomnia, you should go with a journal or diary of your sleep. You should be able to provide answers to questions such as when you go to bed? How long it takes you to fall asleep? Are you awake after some hours? Is this something that happens every night? Is your sleeplessness caused by a particular activity? What are your activities on the nights you find it hard to fall asleep? How many nights per week do you experience this sleeplessness?
- Some probable topics of discussion during insomnia assessment and evaluation include routine medications, drug use, use of alcohol, your partner’s sleeping habit, stressful occupational situations, and work schedule.
- Daytime sleeplessness can be assessed with the Epworth Sleepiness Scale.
- Sleep-wake patterns can be assessed with actigraphy. An actigraph is a small device worn on the wrist for measuring movement. It is made up of an on-board memory and microprocessor and the data retrieved provides a clue on daytime activities.
- A record of your sleep for a 2-week period should be filled in a diary. The patient would be required to note down their sleeping times, when they wake, and how long they spend in bed before falling asleep. A record of daily alcohol intake, caffeine intake, medication, and exercise are also needed.
How to treat insomnia
Generally, transient insomnia should vanish as soon as the root cause is addressed or corrected. However, it is not uncommon to see people seek medical solution to insomnia when it becomes chronic.
When trying to treat insomnia, energy should be channeled towards finding the root cause. Once the cause is unraveled, it should be addressed and managed. This singular action may lead to the disappearance of insomnia. You wouldn’t achieve much success if you proceed with the treatment of insomnia symptoms while abandoning the root cause. In most cases, chronic insomnia can be corrected by conducting a thorough evaluation of its medical or psychiatric causes.
There are pharmacologic (medical) and non-pharmacologic aspects for insomnia treatment. Research has confirmed that a combination of these two is typically more successful than either one alone.
How long does insomnia last?
The time needed to recover from insomnia is not fixed, it varies.
- If insomnia is caused by jetlag, the symptoms should not last more than a couple of days.
- If insomnia is depression-induced, the symptoms will not likely disappear on their own. Further treatment and evaluation will be needed.
- Coexisting medical conditions also have a role to play in how long insomnia will last.
How to prevent insomnia
Recommendations for preventing insomnia include the following:
- Environmental control: This includes avoiding excessive temperatures, noise, and bright light. Do not use the bed for reading or watching the television. Sexual activity is however exempted.
- Have a bedtime routine and a fixed wake time.
- Practice relaxation.
- Do not take in too much fluid or perform strenuous exercise. Also, try to avoid large meals and minimize your use of stimulants such as nicotine and caffeine.
- If you are unable to fall asleep within 20 to 30 minutes. A relaxing activity such as reading or listening to soothing music.
- Try not to sleep for more than fifteen minutes during daytime except the doctor says otherwise.
OTC or Prescription Medications for curing insomnia
There are a lot of prescription medications for insomnia treatment. It is usually recommended that they are not used as standalone therapy and the chances of successful treatment is higher if it is used in combination with non-medical therapies. Sleeping pills that are commonly used are listed below. This included natural sleep aids and over-the-counter medications.
Prescription Sleep Aids
- Benzodiazepine sedatives: About six of these drugs have helped with the correction of insomnia. Reports have it that patients improve subjectively in their sleep quality and quantity when taking these medications. Some of these drugs are temazepam (Restoril), lorazepam (Ativan), triazolam (Halcion), flurazepam (Dalmane), estazolam (ProSom, Eurodin), and clonazepam (Klonopin).
- Nonbenzodiazepine sedatives: Common examples are zolpidem (Ambien or Intermezzo), eszopiclone (Lunesta), and zaleplon (Sonata).
- Ramelteon (Rozerem): This prescription drug helps with the stimulation of melatonin receptors. It is also useful for the normalization of circadian rhythm disorders and for promoting sleep. The US Food and Drug Administration (FDA) approves this drug for the treatment of insomnia.
- Antidepressants such as trazodone (Desyrel), and amitriptyline (Elavil, Endep) helps to correct insomnia in patients battling depression as a result of some sedative properties.
Over-the-counter (OTC) medications
- Antihistamines with sedative properties such as diphenhydramine (Benadryl) or doxylamine helps with the correction of insomnia because they induce drowsiness. However, they do not improve overall sleep quality and are not ideal for treatment of chronic insomnia.
- Melatonin: The pineal gland (a pea-sized structure in the middle of the brain) secrets this. This is produced during the dark hours of the circadian rhythm (day-night cycle). During daylight hours, the level of melatonin in the body is low. It is believed that this is an important process for circadian rhythm maintenance. Production of melatonin takes place in the night so that the body can regulate sleep-wake cycles effectively. Melatonin production decreases with age and this explains why physicians recommend the use of melatonin supplements in seniors who find it difficult to fall asleep.
Natural treatments for curing insomnia
Herbal remedies
- Valeriana officinalis (Valerian) is commonly used for treating insomnia in the Unites States of America. It is also beneficial to patients battling with chronic insomnia.
- St. Johns Wort and chamomile
- Natural sleeping aids like dogwood, L-tryptophan, and kava kava. They may however produce some side effects when used for correction of insomnia.
Sleep hygiene
This is part of behavioral therapy for insomnia. The quality and quantity of a patient’s sleep can be improved by taking one or two deliberate steps. They include:
- Avoid forcing yourself to sleep
- Don’t go to bed hungry
- Don’t smoke particularly in the evening/night.
- Make some adjustments to the room environment (temperature, lights, noise, etc.)
- Avoid going to bed with worries
- Exercise your body for at least 20 minutes every day. This should be at least 4-5 hours before you go to bed.
- Rent an adjustable bed or buy one. A home hospital bed may also work.