Insomnia is a persistent disorder that effects a person’s ability to fall asleep, stay asleep, or both and includes a poor quality of sleep. A person with insomnia will generally wake up not feeling rested, which negatively impacts their ability to function throughout the day. The lack of restful sleep impacts mood and health as well, at times leading to depression or worsening anxiety. Most people will experience insomnia at some point in their life; however, some experience long-term or chronic insomnia which could be caused by another factor or be the primary problem. In general a person with insomnia will take a minimum of 30 minutes to fall asleep and/or consistently get less than six hours of consecutive restful sleep.Insomnia can be described and differentiated in different types including:
Acute: A brief episode of difficulty sleeping, most commonly triggered by increased stress or lifestyle changes.
Chronic: A long term pattern of difficulty sleeping including difficulties falling asleep or staying asleep or waking too early; generally for a minimum of three nights as week for at least three months.
Comorbid: Insomnia that occurs with another condition, either psychiatric or medical.
Onset: Difficulty falling asleep initially.
Maintenance: The inability to stay asleep.
Symptoms of Insomnia:
- Difficulty falling asleep at night
- Awakening throughout the night
- Awakening too early in the morning
- Not feeling rested or restored upon waking
- Tiredness during the day
- Irritability, Depression, or Anxiety
- Troubles paying attention or decreased focus
- Gastrointestinal distress
- Anxiety or worry directly about sleep
What causes Insomnia?
There are a number of potential causes of insomnia. Excessive stress is the most common cause of short term or temporary insomnia. Most chronic insomnia can be caused by anxiety, depression, medical conditions, lifestyle changes, poor sleep habits, medications, substance use, poor diet, lack of physical exercise, or over stimulation. The prevalence of insomnia becomes greater as people age, most often because of changes in sleep patterns, activity, health, or lifestyle. The populations most at risk for insomnia are women, elderly, people with a mental health diagnosis, night shift or rotating shift workers, or people who travel long distances frequently.
How is Insomnia diagnosed?
Insomnia is most commonly diagnosed by a physician; however, can be diagnosed by other mental health and medical professionals. In most cases a questionnaire is used to asses sleep patterns and habits, as well as symptoms or complications from sleep or lack of. A sleep diary is also a useful diagnostic tool. Physical exams, blood tests, and sleep studies can also be used to rule out other medical conditions that could cause or mimic insomnia.
How is Insomnia Treated?
Behavioral therapy is a very common tool used to treat insomnia, especially when medications are not a good option. The focus of therapy is to change behaviors that negatively impact sleep and create healthy sleep patterns; as well as addressing the underlying causes such as stress or mental health issues. These therapies generally include education about healthy sleep habits, Cognitive Behavioral Therapy, Relaxation and Mindfulness techniques, Environmental changes to reduce factors and stimulation that impacts sleep, sleep restriction, paradoxical intention or remaining passively awake, and light therapy. Initial treatment will almost always focus on changing sleep habits, including:
- Reducing stimulation in the place of sleep, removing electronics
- Creating a comfortable environment
- Reducing time spent in bed, only spending time for sleep or intimacy in bed
- Creating a regular sleep schedule with consistent sleep and wake times seven days a week
- Initially reducing time sleeping in order to create increased tiredness and successful sleep
- Increase activity, improve diet, reduce or stop substance use
- Address underlying mental health or medical conditions with appropriate treatment
If behavioral therapy techniques are not successful, both over-the-counter and prescription medication options are available.