Insomnia: Difficulty falling or staying asleep

It is fairly likely that you have at some point experienced insomnia. Difficulty falling asleep and staying asleep is one of the most common complaints about sleep. This overview will define insomnia and detail the causes, symptoms and treatment options for this sleep disorder.

What Is Insomnia?

Insomnia refers to trouble falling or staying asleep. It can affect someone for a short time, such as a few nights or weeks. In other cases, the sleep disorder is chronic and can last for months or years.

Types of Insomnia

There are a few main types including primary and secondary. The sleep disorder is considered primary when it is not caused by or associated with a medical condition, psychiatric problem or medication. Secondary insomnia, on the other hand, is due to a medical condition, such as COPD or chronic pain, that is interfering with sleep.¹

“Insomnia is defined as difficulty falling or staying asleep and can be short-lived or long-term”

Causes of Insomnia

In some instances, the cause of difficulty falling asleep cannot always be easily identified. But in other cases, it might be apparent what is causing problems falling or staying asleep. Below are a few common causes.

• Medical conditions: Certain medical conditions can interfere with getting proper shuteye. For example, COPD, GERD and congestive heart failure can all make it difficult to fall asleep. But physical conditions are not the only culprit. Psychological and emotional issues, such as stress, anxiety and depression, can leave you tossing and turning.
• Medications: Side effects from certain medications can also make falling asleep difficult. SSRI antidepressants, ACE inhibitors and beta blockers may cause difficulty falling asleep in some people. Medications for emphysema, blood pressure and allergies can also sometimes lead to the sleep disorder. It’s also important to understand that people respond differently to medications. Even a drug that should not cause sleep disturbances may do just that in some people.
• Disruption in circadian rhythm: We all have a natural sleep-wake rhythm. For most people, their circadian rhythm involves sleeping at night and being awake during the day. When this rhythm gets disrupted, it can cause it. Working overnight shifts and traveling across time zones are two factors that can alter your circadian rhythm.
• Environmental Factors: Sometimes our environment makes it difficult to fall asleep. Most people sleep best in a cool, dark and quiet environment. When your bedroom is not conducive to sleep, it can leave you wide awake or cause you to wake several times a night.

Risk factors for developing insomnia

It can affect anyone at any time in their life. But certain factors may increase your risk. For example, women are more likely than men to develop the sleep disorder.²

According to the Mayo Clinic, people over the age of 60 are also at a higher risk, possibly due to changes in sleep patterns as you age. Having an irregular sleep schedule is also a risk factor. For instance, if you go to bed at all different times or work different shifts, which disrupts your regular sleep hours, it can increase your chance of developing the sleep disorder.

Symptoms of Insomnia

• Daytime sleepiness
• Irritability
• Problems concentrating
• Fatigue
• Forgetfulness

The severity of symptoms may also vary. The sleep disorder can have an accumulative effect, which means the longer it goes on, the more severe symptoms may be. For instance, not getting a good night’s rest may leave you a little tired the next day. But if you don’t sleep well for a week or a month, you might feel the effects of sleep deprivation more severely.³

Treatments for Insomnia

The treatment may depend on the cause. For example, treating an underlying medical condition may also cure it. Also, if a certain medication is to blame, switching to a different drug may help.

In other cases, over the counter or prescription medication may help treat it, especially in the short-term.⁴ Cognitive behavior therapy can also help some people overcome insomnia by decreasing anxiety and targeting the thoughts that cause poor sleep.

Self-Help Strategies for Treating Insomnia

In certain instances, self-help strategies may be all it takes to treat the sleep disorder. Following these non-medication-based actions is good first step to dealing with sleep problems.

Tips to treat your insomnia:

1. Keep a sleep journal: Consider recording your sleep patterns for a couple of weeks. Keeping a sleep diary can help you identify things that may be interfering with your sleep and make the needed changes.
2. Stick to a regular bedtime: Sticking to the same bedtime and waking the same time each day may help you get into a routine and improve your sleep.
3. Avoid caffeine several hours before bed. Caffeine is often a sleep stealer. Caffeine can stay in your system for several hours. Your best bet is to limit caffeine about four or five hours before bedtime.
4. Put away your cellphone, laptop and tablet: Your tech habits at bedtime may be preventing you from falling asleep. The light from your tech gadgets tricks your brain into thinking it’s daytime, so the production of melatonin is decreased. Less melatonin may make falling asleep more difficult. Consider making your bedroom a tech-free zone.
5. Relax before bed: With all the things on your plate, it can be hard to unwind. But relaxing before bedtime is essential to drift off to dreamland. It can be hard to fall asleep if you have a million things on your mind. Before hitting the sack, consider doing something that helps you relax, such as deep breathing, reading or listening to music.

If these actions don’t work, talk to your doctor as you may have issues that need to be addressed.

FAQ’s About Insomnia

1. How is insomnia diagnosed? It can be diagnosed by your symptoms. The cause is a little trickier to determine immediately. Your doctor may ask you to keep a sleep journal to determine if any environmental factors are affecting your sleep. Blood tests may be performed to rule out any medical conditions causing insomnia. A sleep study may also be recommended to determine the cause of your insomnia.
2. How long does insomnia last? It can last all different lengths of time. It may only last a few nights or it can last months or longer.
3. Do children get insomnia? People of all ages can develop insomnia including children. Children get the sleep disorder for many of the same reasons as adults including medical conditions, side effects of medication and even stress.
4. Can insomnia affect overall health? Sleep is essential to function. When you don’t get enough rest, it can affect your health and overall quality of life. The good news is, in most cases, insomnia can be successfully treated.
5. What should I do if I have insomnia? If you have these sleep problems, the first step is talking to your doctor. If you have tried self-help strategies and they have not worked, treatment is available that can help you get the restorative sleep you need.Oftentimes, the sleep disorder can be diagnosed by simply answering a few questions: Do you have trouble falling asleep at night? Do you wake frequently? Are you overly tired during the day? For confirmatory diagnoses, however, providers will often perform extensive interviews that include a history and physical exam, or they may order an overnight sleep study and EEG to properly gauge sleep cycles.

Keeping a sleep diary could be greatly beneficial in the identification and diagnosis of insomnia.

Sometimes, it is necessary to have sleep studies performed to determine if the sleep disorder and frequent awakenings throughout the night is caused by sleep apnea, as this sleep disorder is a common symptom of that condition.

Treatment for acute insomnia is relatively straightforward, and oftentimes does not require anything extensive. Usually, mild insomnia can be treated with practicing better sleep hygiene (going to bed and waking up at the same time every day, for example). If difficulty falling asleep is interrupting daytime functioning, then sleeping pills and sleep aids like melatonin are sometimes prescribed.

Insomnia Reference Resources

• National Heart, Lung and Blood Institute. How is Insomnia Treated? https://www.nhlbi.nih.gov/health/health-topics/topics/inso/treatment Retrieved April 2017
• University of Maryland Medical Center. Insomnia.

Chronic insomnia or secondary insomnia is a little more difficult to treat, as the provider will first need to discover and treat the underlying cause. For the most part, if the primary problem is under control, then the symptoms will resolve on its own; however, if insomnia continues after the primary conditions are treated, then behavioral techniques are then employed, which can include anything from lifestyle changes to learning pre-bedtime meditation techniques.

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Physician Reviewed M.D.

Sleep Physician at American Sleep Association Reviewers and Writers

Board-certified sleep physicians, scientists, editors and writers for ASA.

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