Insomnia can be defined as trouble falling or staying asleep. Insomnia afflicts people of all ages, most often for a night or two, but sometimes for weeks, months or even years. It’s estimated that 35% of American adults suffer from insomnia. If you suffer from insomnia, it affects both your waking and sleeping hours. Understanding insomnia poses an interesting question: If you have trouble sleeping at night and you are sleepy during the day, why can’t you fall asleep easily at bedtime or remain asleep through the night?
Three Types of Insomnia
- Transient insomnia – trouble sleeping over a period of a few nights.
- Short-term insomnia – trouble sleeping for two or three weeks.
- Chronic insomnia – poor sleep every night or most nights.
What causes insomnia?
Insomnia may be a symptom of another problem, for example obstructive sleep apnea syndrome, a fever or another underlying medical conditions. It can be caused by any number of factors.
Psychological factors
- Susceptibility to insomnia: Some people are more likely to experience insomnia than others, depending of their environment.
- Persistent stress: Problems such as an unsuccessful career, marriage problems, or a chronically ill relative may contribute to poor sleep.
- Psychiatric problems: People with depression, anxiety, schizophrenia and other psychiatric disorders have frequently disrupted and unrestful sleep.
- What helps: Treatment of underlying conditions, possibly involving several types of treatment, often improves sleep.
Lifestyle
- Use of stimulants: The use of caffeine too close to bedtime, though it doesn’t interfere with the onset of sleep, can trigger numerous awakenings during sleep. Another stimulant is nicotine; studies show that smokers sometimes take longer to fall asleep than non-smokers. Ingredients of many commonly used medications, including nonprescription drugs for weight loss, asthma, and colds often interfere with sleep continuity.
- Use of alcohol: A “nightcap”, while it may help promote sleep onset, it is likely to make sleep more fragile throughout the night.
- Erratic hours: Those workers that have frequent changes in their sleep/wake patterns due to their job, often experience sleep problems. This also includes those that may work longer hours on certain days or weekends.
- Inactive behavior: People whose lifestyles are quiet and less active tend to find it difficult sleeping at night due to the lack of activity during the day.
- Learned insomnia: People who sleep poorly because of stress are more prone to worry about not being able to function efficiently the following day. Usually this results in the increased attempt to fall asleep, and unfortunately this determined effort increases alertness and resets the cycle.
- Misuse of sleeping pills: When used every night, sleeping pills may stop being effective after about a month. When use is stopped suddenly; sleep can be temporarily worsened. This can be corrected by cutting back gradually on the use of sleeping pills. A health care provider should oversee this process.
- What helps: See Sleep Hygiene for useful tips on how to help sleep related problems.
Environmental factors
- Noise: Although television and other noises may not cause the sleeper to wake up, they can disturb the quality of your sleep.
- Light: Bright lights from a nearby room, the window or elsewhere is often a source of frequent arousals from sleep. Light can penetrate through the eyelids even while the eyes are completely closed.
Physical illness
- Disordered breathing: Certain disorders can cause repeated interruptions in breathing during sleep which can arouse the sleeper up to hundreds of times a night. These pauses in breathing range from a few seconds to beyond two minutes and may not be remembered in the morning. Typically near the end of each event the sleeper awakens briefly (called microarousals) and returns to sleep without realizing anything has happened. These numerous arousals can result in excessive daytime sleepiness. Severely disrupted breathing during sleep called sleep apnea can affect people who breathe without difficulty while they are awake. For further information on sleep apnea.
- Periodic leg movements: Brief muscle contractions can cause leg jerks that occur approximately every 30 seconds. These movements can cause hundreds of microarousals each night, resulting in restless sleep and daytime fatigue. Periodic limb movements become more frequent with age and are seen more commonly in the first half of the night.
- Waking brain activity that persists during sleep: Studies show that during the night some people who complain of light or unrestful sleep fail to sink fully into sleep.
- Pain: Conditions such as arthritis, back pain, fibromyalgia and even headache may disrupt sleep and waking hours.
- What helps: Sometimes a change in the positioning of pillows, the correct mattress and pre-sleep behavior can make a difference. A healthcare provider can provide guidance and assistance.
- Gastroesophageal reflux: The back up of stomach contents into the esophagus (commonly called heartburn) can awaken a person several times a night. During the day you can ensure and upright position and take a few swallows to relieve the symptoms. During sleep however, less-frequent swallowing and a lying down position can lead to frequent reflux episodes, resulting in waking up coughing or choking.
- What helps: Try elevating the head of the bed by 6 to 8 inches, this can help prevent reflux. See your health care provider about prescription and OTC medications to effectively treat reflux.
When to seek help?
If you have had difficulty falling or staying asleep for more than a month and it is interfering with the way you feel or function during the day, see your healthcare provider or ask for a referral to a sleep disorders specialist. Sometimes insomnia can be lessened through education of good sleep habits. Keep in mind some people naturally sleep less than others, and should understand that not everybody needs eight hours of sleep.
Counseling can sometimes help people whose insomnia is a result of poor sleep habits. In other cases, medication or evaluation at a sleep disorders center may be the answer.