Do you often struggle to fall asleep, or keep waking up in the middle of the night or early morning?
Maybe it’s affecting your daily life too, and you’re increasingly worried about your lack of sleep.
If this sounds familiar, it’s possible you’re suffering from insomnia. The main sign that it’s 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.
As well as having disturbed sleep, insomnia also leads to daytime symptoms, such as tiredness, low mood and concentration problems. We’ll take a closer look at all the possible symptoms later.
In this article, you’ll discover key facts and guidance about insomnia. If it’s something you know, or think, you have, you’ll find out what you can do about it yourself, and when to seek medical help.
- How common is insomnia
- Types of insomnia
- Diagnosis and treatment
- What you can do yourself
- Cognitive behavioral therapy before sleeping pills
- Medical treatment
- Complementary and alternative treatment
Sleep researchers believe that insomnia is one of the most common complaints in medical practice.
According to the American Academy of Sleep Medicine, 30 to 35% of adults say they have insomnia. However, it’s thought that a lower number of 10% will have ongoing, chronic insomnia.
And in a large survey reported by the Centers for Disease Control and Prevention, 50–70 million Americans suffered from sleep disorders or sleep deprivation.
Additionally, it’s thought that certain people are more at risk of developing insomnia:
- Women are more likely than men to have insomnia, especially during menstrual periods, pregnancy and menopause.
- Older adults.
- Those with certain mental or physical health conditions.
- If you suffer from a lot of stress.
- If your schedule changes, such as with shift work or jet lag.
There are two main types of insomnia. A key difference is in how often and for how long you experience sleep problems.
1. Chronic insomnia
- Sleep disturbance and daytime symptoms present for at least three months.
- Occurs at least three times per week.
2. Short-term insomnia
- Sleep disturbance and daytime symptoms present for less than three months. So it could be as little as a few nights, or as much as a couple of months.
As the Mayo Clinic point out, many adults suffer from short-term insomnia from time to time, such as when stressed or following a traumatic event. It’s usually when it lasts longer and affects you daily functioning that it becomes more of a problem.
Note that there can be exceptions to these time frames. Some people experience insomnia for weeks at a time over many years, for example. Even if they don’t reach three months each time, it could still be chronic insomnia.
Did you know?
The way insomnia is classified has changed in recent years
You might sometimes see insomnia described as ‘primary insomnia’ and ‘secondary insomnia’. Insomnia was split into these two main types for many years, and still is by some organisations and professionals.
However, the latest edition of the International Classification of Sleep Disorders (ICSD-3) made important changes to the way insomnia is classified. The ICSD-3 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 more commonly used.
A key difference is about insomnia being caused by, or related to, another condition. Even if there is another condition present, it’s thought to be more helpful to treat the insomnia in its own right.
An example is depression – treating both the depression and insomnia at the same time might help both improve.
You can read more about this diagnostic system on wikipedia.
As well as having problems sleeping at night, insomnia also involves daytime symptoms.
There are many possible symptoms of insomnia, 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:
- Feeling sleepy during the day.
- 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 hyperactivity, impulsiveness or aggression.
- Making more mistakes or having accidents.
- Feeling worried or upset about your sleep problems.
- Anxiety about sleep.
When not worrying means it’s not insomnia
The ICD-3 makes an interesting point about insomnia not always being an appropriate diagnosis.
Conditions like grief and acute pain can cause the same sleep problems as seen in insomnia. But it might not warrant a diagnosis of insomnia if you aren’t actually distressed by the sleep problem.
The reason some people end up with insomnia, while others don’t, has been hotly debated for many years, and probably will be for some time to come.
Some interesting research in 2017 found found seven genes common in people with insomnia. So perhaps it’s not all ‘in the head’ as many people suggest!
But in many cases, especially short-term insomnia, 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.
Some of the main causes are:
- 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. Older adults are more likely to have this as a cause, due to an increased number of health conditions and medication.
- 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, or 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
Most medical organisations now recommend trying to deal with the sleep problem yourself first. And only speaking to a doctor/physician or sleep specialist if it becomes an ongoing problem.
For example, the National Sleep Foundation recommend:
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 belief is that many people can successfully improve their sleep without medical help. There are two main ways to do this:
Try to tackle any factors you know might be causing insomnia
- Try to tackle things that could be causing you stress or anxiety.
- See the right kind of professional if you do 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 regular sleep schedule seven days a week.
- Do regular exercise.
- Don’t watch TV or surf the internet in bed.
- Take an hour before bed to unwind and do something quietly relaxing.
- Only use your bed for sleep and intimacy.
- Have a warm (not hot) shower before bed.
- Keep your bedroom dark, quiet and cool.
For more suggestions, have a read of this extensive list of helpful sleep habits.
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 (such as simple relaxation techniques and mindfulness)
- 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 the overview of CBT-I.
A growing number of doctors will only prescribe sleeping pills if your insomnia is very bad and other treatments haven’t helped. And even then, as the NHS recommends, 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 Mayoclinic have a useful article about prescription sleeping pills which highlight just how many of them can cause dependence.
There are many herbal remedies for insomnia, and they are often easily available in shops and online. The scientific evidence for their effectiveness varies from one ingredient to the next, and even between studies.
Some others which are thought by some to help with relaxation and sleep include:
- Passion flower
- Lemon balm
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. Look for reputable brands, and try those with just one main ingredient rather than mixtures with many.
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.