According to the American Academy of Sleep Medicine’s ICSD-3 manual, insomnia is defined as “persistent difficulty with sleep initiation, duration, consolidation or quality.” Insomnia has many potential contributing factors and symptoms, but its diagnosis hinges on two essential components: sleep difficulties that occur despite adequate opportunities for normal sleep, and daytime impairment that directly results from poor sleep quality or duration.
Chronic insomnia is characterized by symptoms that occur at least three times per week for at least three months. Insomnia that lasts or less than three months is known as short-term insomnia. In rare cases, patients may exhibit insomnia symptoms without meeting the criteria for short-term insomnia and may warrant some form of treatment. This is known as other insomnia.
While insomnia can manifest in different ways, most diagnoses fall into one of two categories:
Some people may have mixed insomnia that involves both sleep-onset and sleep maintenance difficulties, and people with chronic insomnia may find that these symptoms shift over time.
Insomnia is believed to originate due to a state of hyperarousal that can impact sleep-onset and sleep maintenance. Hyperarousal can be mental, physical, or a combination of both. Environmental, physiological, and psychological factors can all play a role in insomnia. These include the following:
Insomnia has also been linked to unhealthy lifestyle and sleep habits. Many people adopt these habits when they are younger, making them hard to break as adults. These habits can include going to bed at a different time each night or napping too long during the day. Exposure to “screen” devices like computers, televisions, and cell phones can also cause sleep problems, as can working evening or night shifts. Other factors can cause difficulty falling or staying asleep, such as inadequate exercise during the day or excessive noise and/or light in the sleeper’s bedroom.
The most common symptoms among chronic insomnia patients include difficulty falling and/or staying asleep, waking up earlier than planned, and not feeling tired or ready for bed at scheduled times. Daytime impairment is a necessary component of insomnia, and this can also manifest in different ways. Common impairments include fatigue and malaise, memory and concentration difficulties, mood disturbances and irritability, and behavioral problems such as hyperactivity and aggression.
Various sleep surveys and studies have yielded mixed results about the prevalence of insomnia among different sleeper groups. Some conservative estimates show that 10% to 30%of adults live with chronic insomnia. For other studies, this figure is closer to 50% to 60%.
Insomnia is more prevalent in certain demographic groups, as well. Studies have shown insomnia affects 30% to 48% of older people. This may be attributed to chronic medical conditions, social isolation, and higher use of prescription medications, as well as factors like unhealthy sleep habits and stress that cause insomnia across all age groups. Other studies have found insomnia may occur in up to 23.8% of teenagers. More than 50% of pregnant women experience sleep issues that may be insomnia symptoms, as well.
Insomnia rates among different racial and ethnic groups are a bit harder to pin down. Some studies show a higher prevalence rate for insomnia among minority groups compared to Whites. Other studies have yielded contrasting results, which suggest Whites struggle with sleep-onset and sleep maintenance more than Blacks and Hispanics.
Chronic insomnia may necessitate prescription medication, cognitive-behavioral therapy, and other types of formal treatment. For some people, practicing healthy lifestyle habits and good sleep hygiene can alleviate insomnia symptoms and help them sleep more soundly. The following sleep hygiene measures can be beneficial for people with insomnia: