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Insomnia (A 7 point guide)

Insomnia is a sleep disorder bringing persistent difficulties with falling, and staying, asleep.

What is insomnia?

Insomnia is a sleep disorder that is characterized by having difficulty falling and/ or staying asleep. People with this condition usually have difficulty falling asleep, wake up often during the night, and have trouble going back to sleep. The condition can be short-term (acute) or can last a long time (chronic). It may also come and go. Acute insomnia lasts from one night to a few weeks. Insomnia is chronic when it happens at least three nights a week for three months or more.

Acute insomnia lasts from one night to a few weeks. 

What are the different types of insomnia?

Primary insomnia: This means your sleep problems aren’t linked to any other health condition or problem.

Secondary insomnia: This means you have trouble sleeping because of a health condition like asthma, depression, arthritis, cancer or heartburn, or some other contributor like pain, medication or substance use (e.g. alcohol).

What are the signs and symptoms of insomnia?

Symptoms of insomnia include sleepiness or drowsiness during the day, fatigue, grumpiness and problems with concentration or memory.

Other things which point to insomnia are trouble falling asleep in the first place, failure to sleep through the night, waking up earlier than usual and irritability.

Insomnia itself can often be a symptom of another problem. You should call your doctor if you experience disturbed sleep for more than a month without an apparent cause. Also if you never seem to get enough sleep or fall asleep suddenly during the day. 

If you have sleep medication that is no longer working, or you have been taking medication for more than a few nights with no discernible success you should also seek out a medical professional.

Stress like a job loss or change of role can cause primary insomnia.

How is insomnia diagnosed?

Once symptoms have been reported as above, which could indicate a sleep disorder, sleep disorder specialists can use sleep disorder tests to investigate the problem. A doctor would perform a physical exam, then take a medical and sleep history. During the exam the doctor would be looking for any medical or psychological ailment that may be contributing to the lack of sleep. For example, they may ask about chronic snoring, or sleep apnea. You may be asked whether you are suffering from anxiety, depression or any other potential cause for your sleeplessness.

Tests used to diagnose insomnia can include:

• sleep diary – tracking sleep patterns over a period of time

• Epworth sleepiness scale – a validated questionnaire that is used to assess daytime sleepiness

• polysomnogram – a test which measures activity during sleep

• actigraphy – a small, watch-sized instrument worn on the wrist to assess sleep/wake patterns over time

• mental health exam – since insomnia can be directly connected with depression, anxiety or another mental health disorder.

What are the causes of insomnia?

Causes of primary insomnia include:

• stress related to big life events, like a job loss or change of role

• the death of a loved one

• divorce or moving house

• things around you like noise, light, or temperature changes

• changes to your sleep schedule like jet lag, a new shift at work, or bad habits you picked up when you had other sleep problems.

Causes of secondary insomnia include:

• mental health issues like depression and anxiety

• medications for colds, allergies, depression, high blood pressure or asthma

• pain or discomfort at night

• caffeine, tobacco or alcohol

• hyperthyroidism and other endocrine problems

• other sleep disorders, like sleep apnea or restless legs syndrome.

Secondary insomnia can be caused by mental health issues.

How is insomnia treated?

It is possible your doctor will refer you to a sleep disorder specialist. Sleep patterns can be monitored either at home or in a controlled environment and anomalies can point to an underlying sleep disorder.

Behavioral therapy is another approach your doctor may pursue. This would be conducted by a psychologist, psychiatrist or other medical professional with specialized training. Several visits would usually be required to learn and implement the techniques of specific behavioral therapies. Some of the more common behavioral approaches include:

• stimulus control, which trains people to use their bed and bedroom for sleep and sexual activity only. Persons with insomnia are encouraged to go to another room and engage in a relaxing activity, such as reading a book or meditating, until they are sleepy and ready to return to bed.

• cognitive behavioral therapy (CBT), which is conducted with a therapist who helps the patient examine and process attitudes and beliefs that may contribute to poor sleep

• relaxation training, which often involves reducing tension and muscular relaxation techniques

• hypnotherapy, which can transform a person into a deep state of relaxation, and also teach self-hypnosis techniques to self-relax

• over-the-counter (OTC) or prescription sleep aids may also help with insomnia. Medications differ by dose and duration of action. Most individuals take sleep aids for a few nights or a few weeks at a time. OTC sleep aids are available at your local pharmacy. 

Bed and bedroom should be used for sleep and sex only.

Frequently asked questions (FAQs) about insomnia:

What is the main cause of insomnia?

There are several potential causes of insomnia. These include stress, concerns about school, work, health, finances or family. These things can keep your mind active at night which makes it difficult to sleep. Stressful life events or trauma, including the death or illness of a loved one, divorce, or job loss, can also lead to the development of insomnia. Underlying health issues or mental disturbance can also be triggers.

How can I stop my insomnia?

Tips for improving insomnia include the following:

• wake up at the same time each day
• eliminate alcohol and stimulants such as nicotine and caffeine
• limit naps during the daytime
• exercise regularly
• limit stimulating activities in bed such as the use of electronic devices
limit eating or drinking right before bedtime
• make your sleep environment as comfortable and relaxing as possible.

How do I know if I have insomnia?

You may have insomnia if you experience any of the following symptoms: 

• difficulty falling asleep
• difficulty staying asleep
• waking up during the night and having trouble returning to sleep
• waking up too early in the morning
• waking up feeling unrested or unrefreshed (non-restorative sleep)
• fatigue or low energy
• cognitive impairment, such as difficulty concentrating.

Can you die from insomnia?

In an extremely rare number of cases, chronic insomnia has been a direct cause of death. People who have the genetic disease called fatal familial insomnia (FFI) develop symptoms of exhaustion, dementia and coma and will eventually die.

What foods cause insomnia?

Food and drink that can cause insomnia and anxiety include the following:

• caffeine
• alcohol
• nightshades (potatoes, tomatoes, eggplant, peppers and gogi berries)
• aged, fermented, smoked, cured or cultured foods such as salami, cheese, sauerkraut or red wine
• sugar, flour and other refined carbohydrates.

Is insomnia a sign of cancer?

Insomnia itself is not a sign of cancer. The risk of insomnia increases with age and with serious illnesses such as cancer. Insomnia can also worsen other cancer-related conditions such as pain, fatigue, depression or anxiety. 

What helps you sleep with insomnia?

Melatonin, which is a natural chemical produced by the body, can be taken as supplements to help with symptoms of insomnia. If you are a night owl which a natural tendency to go to bed later and wake up later than others, melatonin may be an effective treatment for insomnia. Valerian may also be an effective treatment for insomnia. Valerian is a herb with mild sedative effects and thus may help you fall asleep and stay asleep better.  

Is insomnia a mental illness?

Insomnia is not a mental illness itself, however it is a common symptom of many mental disorders such as anxiety, depression, schizophrenia, bipolar disorder and attention deficit hyperactivity disorder (ADHD). 

What will happen if insomnia is not treated?

If insomnia is left untreated, it can increase the risk for developing anxiety, depression, and heart failure. Insomnia that is not treated will also perpetuate the daytime symptoms of fatigue, trouble concentrating and mood disturbances. 

Is insomnia a sign of a brain tumor?

Insomnia itself is not a sign of a brain tumor, however sleep-wake disturbances often occur in patients with brain tumors. 

Can insomnia be a sign of something serious?

Insomnia in itself, with no other indications or diagnoses, is unlikely to be a sign of a more serious condition. Conversely, serious conditions can be a cause of insomnia. Examples of medical conditions that can be accompanied by insomnia are:

• nasal/ sinus allergies
• gastrointestinal problems such as reflux
• endocrine problems such as hyperthyroidism
• arthritis
• asthma
• neurological conditions such as Parkinson’s disease
• chronic pain
• low back pain.

How do I get checked for insomnia?

There is no definitive test for insomnia. Doctors use many different tools to examine, measure and diagnose insomnia which will involve a lot of questions, filling in diaries and questionnaires, examining sleep patterns over a period of time, blood tests and possibly an overnight sleep study.

Want to learn more about how to tackle insomnia? Try these books!

End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep

Everyone struggles with sleep from time to time, but when sleepless nights and overtired days become the norm, your well-being is compromised, and frustration and worry increase—including concerns about what’s stopping you from getting the sleep you need, and what can be done about it. End the Insomnia Struggle offers a comprehensive, medication-free program that can be individually tailored for anyone who struggles with insomnia.

The 4-Week Insomnia Workbook: A Drug-Free Program to Build Healthy Habits and Achieve Restful Sleep

Counting sheep, doing a headstand or wearing socks won’t get you to sleep. Good news—addressing the root causes of your insomnia can. This book will get you from stressed to sleep in just four weeks with a range of proven drug-free strategies. With The 4-Week Insomnia Workbook as your guide, you’ll learn the latest CBT-I (Cognitive Behavioral Therapy for Insomnia) and mindfulness practices to get to the bottom of your sleepless nights. Throughout this program, you’ll tackle the thoughts and feelings that keep you up at night and establish a sleep-hygiene routine that works for you.

The Book of Sleep: 75 Strategies to Relieve Insomnia

Make your bed and actually sleep in it. The Book of Sleep provides dozens of quick, easy, and evidence-based strategies that are more effective and sustainable than sleep medication for people who suffer from insomnia.

Based in CBT-I (cognitive behavioral therapy for insomnia), the techniques in this book were developed by a clinical psychologist who specializes in insomnia treatment. Find the relief you need and wake up feeling truly restored. A good night’s sleep isn’t just a dream anymore.

References

Insomnia is Treatable Sleep Foundation.org – January 2020

Insomnia NHS.uk – January 2018

Diagnosing Insomnia – WebMD – October 2018

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