Does the idea of regularly getting a decent night’s sleep seem like a distant dream to you? Does your mind spring to life the minute your head hits the pillow?
Perhaps your relentless lack of sleep is affecting your personal and work life, and you can’t remember when you last began the day without wishing it was bedtime again already.
There are many different sleep disorders. The main sign that you have a form of insomnia is regularly experiencing one or more of these sleep disturbances:
- Difficulty getting to sleep.
- Difficulty staying asleep.
- Waking up earlier than you’d like to.
In addition, people with insomnia usually feel dissatisfied with their sleep. And it can lead to a wide range of daytime symptoms creeping into your life, such as tiredness, low mood, and concentration problems.
I’ve suffered from occasional bouts of insomnia myself for more than 20 years. I have it mostly under control nowadays, but am still prone to some bad patches, especially when stress, noise or major life changes come along.
In this article, I’ll be looking at some of the key points about insomnia that I’ve found useful and interesting as an insomniac.
Please note that the information here is not intended to be a medical guide to insomnia. It’s a collection of the key points I’ve personally found helpful to consider.
Sleep researchers believe that insomnia is “among the most common complaints in medical practice”.
According to the American Academy of Sleep Medicine, as many as 30 to 35% of adults say they have insomnia. However, it’s thought that a lower number of 10% will have ongoing, chronic insomnia.
In a large survey reported by the Centers for Disease Control and Prevention, 50–70 million Americans suffered from sleep disorders or sleep deprivation. And 4% had used prescription sleep aids in the month previous to the survey.
The definition and types of insomnia can be strangely confusing to understand. If you read widely about it, you’ll see insomnia described in different ways from one source to the next.
This seems partly because the way it’s diagnosed naturally changes over time as new research and ways of thinking influence the medical definition. And partly because different medical organizations and professionals just use different terminology.
So you might sometimes see insomnia described as ‘primary insomnia’ or ‘secondary insomnia’. Insomnia was split into these two main types for many years, and still is by some organizations and professionals.
However, the latest edition of the International Classification of Sleep Disorders (ICSD-3) made some changes to the way insomnia is classified. The ICSD is one of the key manuals used by sleep professionals to diagnose sleep disorders.
The changes mean that the revised types of ‘chronic insomnia’ and ‘short-term insomnia’ are now commonly used.
A key difference is about insomnia being caused by, or related to, another condition. So even if there’s another condition present, the change reflects the idea that it can be helpful to treat the insomnia in its own right, rather than just hoping that treating the other problem will make the insomnia stop too.
An example is depression – treating both the depression and insomnia at the same time might help both improve.
WebMD explains clearly the difference between primary and secondary insomnia, and also chronic insomnia and short-term insomnia.
And you can read more about the ICSD diagnostic system on wikipedia.
As well as having problems sleeping at night, insomnia also involves daytime symptoms.
There are many possible symptoms, but not everyone will experience the same ones. So two people could both be diagnosed with insomnia, yet have very different symptoms.
Symptoms which can occur with both chronic and short-term insomnia include:
- Generally feeling fatigued or unwell.
- Worsening mood or irritability.
- Problems with memory, attention or concentration.
- A drop in performance at school or work.
- Social, family or relationship difficulties.
- Less motivation and energy in general.
- Behavioral problems, such as impulsiveness.
- Making more mistakes or having accidents.
- Feeling worried or upset about your sleep problems.
- Anxiety about sleep.
The reason some people develop insomnia, while others don’t, continues to be investigated and debated by scientists.
Some researchers are focusing on finding genes common in people with insomnia. And as the National Sleep Foundation summarizes, others are thinking of insomnia in terms of the brain “being unable to stop being awake “. As in, there’s a problem either with the sleep or the wake cycle.
In many cases though, it’s possible to identify what first led to your insomnia. And it may be that the same, or similar cause, is there each time an episode occurs.
Causes of insomnia
- Life stress – for example, worrying about work, school, health, financial situation, or arguing with a partner, family or family. This can keep you awake at night as you ruminate on one or several stressful situations.
- Trauma – for example, death or illness of a loved one, an accident, divorce, job loss.
- Another sleep disorder – such as restless legs syndrome in which the discomfort felt in the legs makes it hard to fall asleep. And sleep apnea, which can wake you throughout the night due to breathing difficulties.
- A mental health condition – depression and anxiety, in particular, are often associated with insomnia.
- Pain or discomfort in bed
- Medical conditions – especially following a diagnosis or onset of an illness.
- Medications – both prescription and over the counter medications can cause sleep problems. For example: antidepressants, pain killers containing caffeine, medications to treat ADHD, asthma, allergies, high blood pressure, and sexual dysfunction.
- Substance use or abuse – caffeine can make it hard to fall asleep, and alcohol can increase nocturnal wakings. Some illegal drugs, such as cocaine and ecstasy, and other stimulants can make it difficult to sleep.
- Jet lag and shift work
- Environmental factors – too much noise or light, being too cold or hot in bed. Sleeping with a partner who snores, has a sleep disorder or health condition that disturbs your sleep.
- Poor sleep habits – often called ‘sleep hygiene’. These include factors like not having a regular sleep schedule, watching TV in bed, not doing exercise, or eating heavy meals late at night.
Many people will find that when the cause is no longer present, their sleep will improve. However, it’s not a definite, as insomnia can take root and remain even when the cause or a related condition is dealt with.
When to seek medical help
In some cases, it’s possible to tackle insomnia yourself. But it’s a good idea to speak to a medical professional if it becomes an ongoing problem.
For example, the National Sleep Foundation recommends:
You should seek help if your insomnia has become a pattern, or if you often feel fatigued or unrefreshed during the day and it interferes with your daily life.
The U.K. National Health Service recommends seeing your general practitioner if:
- changing your sleeping habits hasn’t worked.
- you’ve had trouble sleeping for months.
- your insomnia is affecting your daily life in a way that makes it hard for you to cope.
And the American Academy of Sleep Medicine advise:
If you have had insomnia for fewer than three months, you may have short-term insomnia. Try to follow good sleep hygiene, and if the problem does not go away in three months, talk to a sleep physician.
The idea behind the above advice is that many people can successfully improve their sleep without medical help. There are two main ways to do this:
Address any factors you feel might be causing you insomnia
- Try to tackle things that could be causing you stress or anxiety.
- Get professional help if you have a physical or mental health condition.
- Check if any medication, remedies or other substances you’re taking could be causing it.
Change your sleep habits
There are countless tips and strategies for improving your chances of sleep. Some important ones are:
- Stick to a consistent bedtime and waking up time.
- Do regular exercise.
- Don’t watch TV or surf the internet in bed.
- Take an hour before bed to unwind and do something quiet and relaxing.
- Only use your bed for sleep and intimacy.
- Have a warm shower before bed.
- Keep your bedroom dark, quiet and cool.
For more suggestions, have a read of my extensive list of good sleep habits to try.
What your doctor might do
Your doctor will try to work out what’s causing your sleep problem and help you find the right treatment.
In some situations, they might refer you to a specialist sleep center for a sleep study. They might also do further tests if they suspect another health condition.
They will probably offer you advice about changing your sleep habits, give you self-help resources, and ask you to try those first. If that still doesn’t help, they might suggest further treatment.
That treatment could involve psychotherapy for conditions like depression and anxiety. And it could also be a form of therapy that’s rapidly growing in popularity: Cognitive Behavioral Therapy for Insomnia (CBT-I).
In 2016, the American College of Physicians made a landmark announcement about sleeping pills.
They advised that Cognitive Behavioral Therapy for Insomnia (CBT-I) should be the first choice treatment, not medication:
Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting. Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. Sleep medications can be associated with serious adverse effects.
This shift away from the use of medication is gaining momentum globally, with other countries adopting a similar approach.
CBT-I is effective because it consists of a combination of practical treatments, such as:
- Cognitive behavioral therapy (helping you think and act about sleep better).
- Seep restriction (spending the right amount of time in bed).
- Relaxation training.
- Stimulus control (associating the bedroom with sleep).
- Sleep hygiene education (adopt healthy sleep habits, and eliminate bad ones).
It can be done through one to one or group sessions, online or by telephone, and even with self-help books. But the most effective method is thought to be with professional guidance.
You can find out more about CBT-I, along with information about available online programs, in my overview of CBT-I.
Note that it may be more useful for people with chronic insomnia, and isn’t available to everyone due to funding issues or lack of qualified therapists.
A doctors might prescribe sleeping pills if your insomnia is bad enough and other treatments haven’t helped. However, as the NHS recommends, they are only likely to prescribe them “for a few days, or weeks at the most”.
There are many different types of prescription and over the counter sleep aids. Both types can cause side effects, especially if used for too long.
Medical treatments include:
- Prescription sleeping pills, such as the ‘Z drugs’ – eszopiclone, zaleplon, and zolpidem
- Anti-depressants, such as amitriptyline, mirtazapine and trazodone.
- Over the counter sleep aids, often containing anti-histamines, melatonin, or herbal ingredients.
It’s important to carefully discuss taking sleeping pills of any kind with your doctor, and to use them for the shortest period of time possible.
The Mayo clinic have a useful article about prescription sleeping pills which highlights just how many of them can cause dependence.
There are many herbal remedies for insomnia available in pharmacies, supermarkets, health stores and online. The scientific evidence for their effectiveness varies from one ingredient to the next, and even between studies.
Some of the herbal ingredients commonly found in natural remedies include:
If you decide to try a remedy containing these, it’s good to discuss it with your doctor first, especially if you’re taking any other medication. And try to buy a reputable brand.
In addition, some people find that other complementary techniques help them sleep, such as:
- Meditation and mindfulness
- Tai Chi
My personal experience is that techniques like these can help with relaxation and increase overall well-being. And that in itself can help you switch off at night and sleep better.
Do you suffer from insomnia? Do you know what causes it, and what helps you sleep better?
Feel free to share your experience, or offer tips and advice in the comments below.