Insomnia

Everyone has trouble sleeping sometimes, but if you find yourself consistently unable to fall or stay asleep, you may have insomnia. The term is sometimes used conversationally to describe a poor night of sleep, but insomnia is a recognized sleep disorder that affects as many as 33% of people worldwide at some point. Trusted Source American Academy of Sleep Medicine (AASM)AASM sets standards and promotes excellence in sleep medicine health care, education, and research.View Source

In this article, we’ll explain the clinical definition of insomnia, what may cause it, diagnosis and treatment, and how to know when to see a doctor.

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What Is Insomnia? 

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, even if you have ample time and a bedroom environment conducive to restful sleep. An insomnia diagnosis requires these sleep troubles to also cause daytime impairments, such as sleepiness or difficulty concentrating.

Insomnia that goes untreated, leading to long-term sleep deprivation, is linked with a number of harmful effects Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source , including lower quality of life and increased risk for substance abuse, chronic pain, heart disease, and diabetes.

What Are the Symptoms of Insomnia?

There are two types of insomnia — acute (short-term) and chronic (long-term) — though the symptoms are essentially the same. Generally, insomnia symptoms include both sleeping problems at night and fatigue and cognitive difficulty during the day. Symptoms at night include:

• Difficulty falling asleep
• Frequent wake-ups during the night
• Waking up early with the inability to fall back asleep
• Overall poor quality, non-restorative sleep

The lack of sleep then causes symptoms during the day including:

• Fatigue
• Irritability
• Poor memory and concentration
• Anxiety about sleep
• Headaches

What Causes Insomnia?

It can often be difficult to pinpoint the exact cause of insomnia. The disorder is affected by a combination of factors, and it may appear along with other medical conditions, mental health problems, or substance abuse disorders. Some factors that may trigger insomnia include:

• Changes in routine or sleeping habits
• Stress
• Intense emotional experiences, both positive and negative
• Overusing substances such as caffeine, nicotine, alcohol, or recreational drugs 
• Poor sleep hygiene or sleep environment
• Medical conditions that cause discomfort, like chronic pain or acid reflux

Risk Factors for Insomnia

Research has identified factors that can put a person at a greater risk for experiencing insomnia Trusted Source American Academy of Sleep Medicine (AASM)AASM sets standards and promotes excellence in sleep medicine health care, education, and research.View Source . These include, but are not limited to:

• Being a woman or assigned female at birth
• Older age
• Lower socioeconomic status
• Certain medical conditions like diabetes
• Other sleep disorders such as restless legs syndrome (RLS) and sleep apnea
• Mood disorders including depression and anxiety Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source  
• Having an immediatefamily member with insomnia

It’s important to note that not everyone who has one or more of these risk factors will have insomnia, and not everyone with insomnia will have one of these risk factors.

What Causes Insomnia?

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How Is Insomnia Diagnosed? 

Doctors generally diagnose insomnia by evaluating a person’s sleep habits and medical history. They’ll likely conduct a physical examination as well to check for medical conditions. 

Typically, a patient’s description of their symptoms informs their insomnia diagnosis. A doctor may instruct patients to keep a sleep diary for a week or more, which can provide insight about a person’s sleep duration, perceived sleep quality, and lifestyle choices that may contribute to sleep problems. Other self-reporting diagnostic tools, including the Pittsburgh Sleep Quality Index, may be used by medical professionals in a clinical setting to determine the severity of insomnia symptoms.  

Symptoms of insomnia can overlap with symptoms of other sleep disorders, so it’s important to work with a professional rather than attempting to self-diagnose. If a doctor needs to rule out other sleep disorders that could be causing a person’s symptoms, other assessments, such as asleep study, may be ordered. 

A sleep study, also known as polysomnography, is an overnight exam that monitors and records certain body and brain functions during sleep to help doctors diagnose sleep disorders. They are generally administered at a sleep lab, though at-home sleep studies may also be an option.

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What Are the Treatments for Insomnia?

Treatment for insomnia depends on how long a person has been experiencing sleep issues and what specific factors are contributing to their sleep loss. For example, if insomnia is being caused by another condition, such as sleep apnea or depression, the doctor may focus on the treatment of this condition. Otherwise, several treatment approaches are available for insomnia that persists for weeks or months.

Sleep Hygiene

Sleep hygiene refers to your sleep environment, behavior, and habits. While insomnia may occur despite good sleep hygiene, it’s a good idea to examine where you sleep, the consistency of your schedule, and your bedtime routine. There may be areas you could improve that could reduce or eliminate your sleeping problems. Your doctor can help you go over each aspect of sleep hygiene, discuss whether any might be related to your insomnia, and suggest improvements. 

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) involves exploring the connection between a person’s thoughts, actions, and sleep and has been shown to be effective for treating insomnia. Some research has found that CBT-I has led to improvements in as many as 70% to 80% of patients. Trusted Source JMIR Human FactorsView Source

Over six to eight weeks of weekly sessions, a trained provider helps identify and address factors that may contribute to trouble sleeping and works with you to restructure the way you think about sleep. They may also teach relaxation and mindfulness techniques you can use to become more receptive to sleep. 

Medications

In some cases, when adjustments to sleep hygiene, CBT-I, and relaxation techniques aren’t effective, a doctor may recommend or prescribe sleep aid medication. These may include prescription sleeping medications or over-the-counter medications such as antihistamines or melatonin supplements. Before taking any medication for sleep, be sure to consult with your doctor. 

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When to Talk to a Doctor

If you find that your difficulty sleeping is impacting your performance, mood, or other aspects of your day-to-day life, it’s most likely time to see a doctor. In the days leading up to your doctor visit, it’s helpful to keep a sleep diary about the amount of time you spend awake and asleep, and any problems you have. It’s also useful to note any alcohol or stimulants such as caffeine you use, along with the time of consumption. 

It’s important to get help with insomnia sooner rather than later. Over time, insufficient sleep can lead to more serious health problems such as heart disease, inflammation, and diabetes. Trusted Source National Heart, Lung, and Blood Institute (NHLBI)The NHLBI is the nation's leader in the prevention and treatment of heart, lung, blood and sleep disorders.View Source

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