When a person struggles to fall asleep or stay asleep, it is called insomnia. Symptoms of insomnia can include difficulty falling asleep at night, frequent awakenings during the night, waking up too early in the morning, and feeling tired or groggy during the day. It can also be a symptom of another underlying medical condition. In this article, we will discuss insomnia symptoms, diagnosis and treatment.
It is important to consult with a healthcare professional if you have insomnia or difficulty sleeping as it can have negative impact on overall health and may affect daily activities and quality of life.
Types of Insomnia
There are several different types of insomnia, each of which is characterized by specific symptoms and causes. The most common types of insomnia include:
- Acute insomnia: This type of insomnia is short-term and often caused by a specific event, such as a traumatic experience or a stressful situation. Acute insomnia usually lasts for a few days or weeks and resolves once the underlying cause is resolved or the individual learned to cope with it.
- Chronic insomnia: This type of insomnia is long-term and can have a significant impact on a person’s quality of life. Chronic insomnia is defined as difficulty falling asleep or staying asleep at least three nights per week for a period of three months or longer. Chronic insomnia can be caused by a variety of factors, including stress, anxiety, depression, and chronic pain.
- Primary insomnia: This type of insomnia is not caused by another medical condition or substance use, such as alcohol or medication. The cause is usually unknown. People with primary insomnia often have difficulty falling asleep, staying asleep, or both.
- Secondary insomnia: This type of insomnia is caused by another medical condition, such as asthma, chronic pain, or a sleep disorder like sleep apnoea. Secondary insomnia can also be caused by certain medications, including antidepressants and blood pressure medications, or substances such as alcohol or caffeine.
- Comorbid insomnia: This type is seen in people who have an underlying medical or psychiatric condition. It is seen in conditions such as depression, bipolar disorder, PTSD, and many more. Symptoms are similar to primary insomnia.
- Onset insomnia: This type of insomnia is characterized by difficulty falling asleep at the beginning of the night. This can be caused by a variety of factors, including anxiety, stress, or a stimulating environment.
- Maintenance insomnia: This type of insomnia is characterized by difficulty staying asleep during the night. This can be caused by factors such as pain, anxiety, or the need to use the bathroom.
Note that insomnia can have different causes, symptoms and severity and can be a combination of different types mentioned. Consultation with a healthcare professional is needed to identify the type of insomnia and make an accurate diagnosis, along with the best treatment plan.
Causes of Insomnia
A number of factors can contribute to insomnia. Among the most common causes of insomnia are:
- Stress and anxiety: These are two of the most common causes of insomnia. These emotional states can make it difficult for a person to relax and fall asleep.
- Depression: Depression can also cause insomnia. People with depression often have difficulty falling asleep or staying asleep and may wake up early in the morning.
- Chronic pain: Chronic pain, such as back pain or arthritis, can make it difficult for a person to fall asleep or stay asleep.
- Medications: Certain medications, such as antidepressants, blood pressure medications, and steroids, can cause insomnia.
- Caffeine, Nicotine and alcohol: The consumption of caffeine and nicotine close to bedtime can make it difficult for a person to fall asleep. Drinking alcohol can make a person feel drowsy, but it can disrupt sleep patterns later in the night.
- Medical conditions: Certain medical conditions, such as asthma, sleep apnoea, and acid reflux, can cause insomnia.
- Environmental factors: Noise, light, and temperature can all affect a person’s ability to fall asleep and stay asleep.
- Poor sleep habits: A irregular or irregular sleep schedule, use of electronic devices in the bedroom, or having a comfortable bed could be a contributing factor to insomnia
- Jet lag, shift work, and travel: These can disrupt a person’s natural sleep-wake cycle, which can cause insomnia.
It’s worth noting that insomnia can also be caused by a combination of factors. Additionally, some people may have a genetic predisposition to insomnia, which can make them more susceptible to developing the disorder.
Symptoms of Insomnia
Major symptoms of insomnia include;
- Difficulty falling asleep: This is one of the most common symptoms of insomnia and can be caused by a variety of factors, including stress, anxiety, and chronic pain.
- Frequent awakenings during the night: People with insomnia often wake up several times during the night and have trouble falling back to sleep.
- Waking up too early: Some people with insomnia wake up very early in the morning, well before they need to, and can’t fall back asleep.
- Daytime fatigue: Insomnia can cause fatigue, grogginess, and a general lack of energy during the day.
- Difficulty concentrating: Insomnia can make it difficult to focus and pay attention and can lead to problems with memory and cognitive function.
- Irritability: Lack of sleep can make a person moody, easily angered, or even anxious.
- Tension headaches: Insomnia can lead to tension headaches, which can cause pain or discomfort in the head, neck, and shoulders.
- Increased risk of accidents: Insomnia can impair a person’s ability to function properly during the day, which can increase the risk of accidents, especially if the individual is doing a task that requires attention, such as driving.
The diagnosis of insomnia typically begins with a visit to a healthcare professional, such as a primary care physician or a sleep specialist. The healthcare professional will take a detailed history of the patient’s symptoms, including the duration and severity of the insomnia and any other symptoms that the patient may be experiencing.
During the appointment, the healthcare professional may ask questions about the patient’s sleep habits, including their sleep schedule, their bedtime routine, and their environment while they sleep. They may also ask about any underlying medical conditions, medications, or substances the patient is using, and any recent life changes that could be contributing to the insomnia.
The healthcare professional may also conduct a physical examination and order certain tests to rule out any underlying medical conditions that could be causing the insomnia. These tests may include blood tests, urinalysis, or a sleep study.
The most common sleep study used for insomnia is called polysomnography, which is done overnight in a sleep lab. It involves monitoring brain activity, eye movement, heart rate, breathing, and muscle activity. This test can help to identify other sleep disorders such as sleep apnoea.
Another test that might be done is a home sleep apnoea test (HSAT) which can help diagnose sleep apnoea, a disorder that affects breathing during sleep.
Based on the patient’s symptoms and the results of any tests that are conducted, the healthcare professional will be able to make a diagnosis of insomnia. In some cases, a healthcare professional may recommend a referral to a sleep specialist for further evaluation and treatment.
Insomnia can be a symptom of an underlying condition, so your healthcare provider will also try to identify and treat any underlying conditions that might be contributing to insomnia.
The treatment for insomnia typically begins with lifestyle changes and behavioural therapies. These can include:
- Sleep hygiene: This involves making changes to your sleep environment and habits. This includes going to bed and waking up at the same time every day, avoiding caffeine and nicotine close to bedtime, avoiding screens for an hour before going to bed, and creating a comfortable sleep environment.
- Relaxation techniques: These can include deep breathing exercises, meditation, yoga, or progressive muscle relaxation. These techniques can help to relax the body and mind, making it easier to fall asleep.
- Cognitive Behavioural Therapy for Insomnia (CBT-I): This is a form of therapy that focuses on addressing any negative thoughts and behaviours that may be affecting sleep. It can help to identify and change any patterns that could be contributing to insomnia, such as excessive worry about sleep.
- Stimulus control therapy: This therapy involves strict adherence to a set sleep schedule and avoiding activities that can be stimulating or alerting, like watching TV or using the computer in the bedroom.
- Sleep restriction therapy: This therapy involves limiting time in bed to the amount of time a person is actually able to sleep in order to increase the pressure to sleep.
If these lifestyle changes and behavioural therapies are not effective, medications may be prescribed to help with insomnia. These include:
- Non-benzodiazepine hypnotics: these medications, also called “Z-drugs” (example: Zolpidem), are used to help with sleep onset, they can have side effects like grogginess, and they are not recommended for long term use.
- Benzodiazepines: these medications, examples like diazepam and lorazepam, are sedative-hypnotics that can be effective for insomnia but also have risks of dependence and tolerance, and they are also not recommended for long term use.
- Melatonin receptor agonist: Ramelteon is a medication that works by mimicking the effects of the naturally occurring hormone melatonin, which helps regulate sleep.
Not all medications will work for everyone, and medication should be used along with behavioural therapy. Your healthcare provider will help you determine the best treatment plan for your specific case and take into account any other medical conditions you may have and any other medications you may be taking.
It’s also important to address any underlying conditions that may be contributing to insomnia, such as depression, anxiety, or chronic pain, so as to improve the overall treatment outcome.
It’s worth noting that insomnia symptoms can vary depending on the type of insomnia an individual has and can have varying degree of severity. Also, some people may have insomnia for a short period of time, while others may experience chronic insomnia. Consulting with a healthcare professional is important if you have any concerns about your sleep. They can help determine the underlying cause and suggest appropriate treatments to help alleviate your symptoms.