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:
- Sleep-onset insomnia refers to difficulty falling asleep. This type of insomnia may occur with people who have a hard time relaxing in bed, as well as people whose circadian rhythm is not in sync due to factors like jet lag or irregular work schedules.
- Sleep maintenance insomnia refers to difficulty staying asleep after initially nodding off. This type of insomnia is common in elderly sleepers, as well as people who consume alcohol, caffeine, or tobacco before bed. Certain disorders like sleep apnea and periodic limb movement disorder can also cause sleep maintenance insomnia.
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 Causes and Symptoms
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:
- Ingestion or consumption of substances that negatively affect sleep. These include alcohol, nicotine, and other drugs, as well as caffeine. Certain medications can also hinder sleep, such as diet pills and cold remedies. People may also experience sleep-onset or sleep maintenance issues as their bodies acclimate to new medications or cope with withdrawal from medications after finishing use.
- Health problems. Physical pain and discomfort can make it harder to fall and/or remain asleep, leading to daytime impairments. Conditions that necessitate frequent trips to the bathroom at night, such as pregnancy or an enlarged prostate, can also cause insomnia symptoms. The same is true of sleep apnea, a disorder characterized by irregular breathing episodes known as apneas that occur throughout the night. Chronic pain, restless leg syndrome, heart, and lung diseases are also associated with insomnia.
- Behavioral and mental health disorders. Insomnia is a common symptom of depression. Stress and anxiety can also contribute to insomnia, which in turn may exacerbate stressful and anxious feelings. Mental health disorders like bipolar disorder can cause insomnia, as well. Excessive worrying about sleeplessness is known to cause insomnia.
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.
Insomnia by the Numbers
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.
Tips for Preventing Insomnia
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:
- Limiting or eliminating naps, especially late in the day
- Restricting the use of alcohol, caffeine, and tobacco products in the evening
- Avoiding late-night meals
- Limiting screentime prior to bedtime
- Maintaining a healthy diet and exercise regularly during the day
- Follow a consistent sleep schedule that includes the same bedtimes and wake-up times every day
- Use your bedroom, and mattress, for sleep and sex – avoid working, playing video games, and other stimulating activities
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