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Insomnia is a condition in which it is difficult to get to sleep, or to remain soundly asleep, resulting in too short and too low-quality sleep which affects normal functioning. It causes fatigue and daytime sleepiness. It may be classified as acute, lasting a few days or weeks, or chronic, when it lasts longer than a month.

The affected person feels as though he has not slept at all, or feels tired and unrefreshed on waking. Sleep may be disturbed, with frequent awakenings. Untimely waking in the early hours of the morning is another symptom. Other insomniacs may take a long time to get to sleep.

Many people with insomnia dread not being able to go to sleep when they want to. This causes a vicious cycle of worry-insomnia-worry. Such people may develop a fear of going to bed. 40-60% of people with insomnia have signs of depression.

Causes of acute insomnia

Stress, family or work problems, or traumatic events, may all cause insomnia in the short term.

Causes of chronic insomnia

• Certain illnesses, such as depression, stroke, heartburn, Alzheimer’s or arthritis.
• Medications
• Drugs or alcohol
• Sleep disorders such as sleep apnea.
• Disturbed sleep environment, such as other people in the bedroom who make noise or the presence of too much light.

Insomnia due to any of these causes is called secondary insomnia, and is more common. Primary insomnia is a distinct condition, but may follow chronic stress, or emotional imbalances. Some people are at higher risk for insomnia, and the risk factors include:

• Old age
• Female gender, especially during menopause, and pregnancy, or because of a higher incidence of sleep disorders, fibromyalgia, depression or arthritis.
• Stress
• Depression
• Adverse life events
• Economic difficulty
• Long flights over several time zones.
• Shift work
• Prolonged work at a computer.

Complications of insomnia

• Daytime drowsiness
• Tiredness
• Anxiety
• Depression
• Irritability
• Lack of concentration
• Cognitive difficulties
• Memory lapses
• Accidents due to impaired alertness or drowsiness.

Diagnosis

Insomnia is diagnosed by keeping a sleep diary, as well as by taking a medical history, and a history of lifestyle habits and medications, which may offer a cause for insomnia. A sleep test called polysomnography is useful to diagnose sleep apnea, restless legs syndrome, and similar sleep disorders.

Treatment

Treatment of secondary insomnia focuses on eliminating the causes, such as too much alcohol, caffeine, or exercise shortly before bedtime, and is most successful when started early. Chronic insomnia may require cognitive behavioral therapy, or medication. It is often possible to relieve acute insomnia by:

• Adopting a regular bedtime routine.
• Learning good sleep habits.
• Practicing relaxation techniques.
• Avoid tossing and turning in bed; rather, go to another room and engage in some quiet activity until you feel sleepy again.

Medications comprise prescription medicines, or over-the-counter medicines. Prescription medicines are best used over the short term, but may, however, become addictive, or cause rebound insomnia.  OTC medicines such as antihistamines are commonly used as sedatives, but have unpleasant side-effects in some people.

Melatonin is a dietary supplement which induces sleep. Light therapy is also useful to set your circadian clock to bedtime.

References

• http://womenshealth.gov/publications/our-publications/fact-sheet/insomnia.html
• https://www.nhlbi.nih.gov/health/health-topics/topics/inso/
• https://umm.edu/health/medical/altmed/condition/insomnia
• http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_problems_insomnia

Further Reading

• All Insomnia Content
• Insomnia Causes
• Insomnia Symptoms
• Insomnia Treatment
• Insomnia in Pregnancy

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.