Insomnia

Insomnia

Difficulty falling asleep or staying asleep throughout the night characterizes insomnia. It can be sporadic (episodic), short-term lasting up to 3 weeks, or persistent (chronic).

Causes, Frequency, and Risk Factors

The sleep behaviors we develop in childhood often persist into adulthood as habits, influencing our sleep patterns.

Common poor sleep or lifestyle habits contributing to insomnia include:

• Inconsistent bedtime
• Daytime napping
• Suboptimal sleep environment (e.g., excessive noise or light)
• Prolonged time in bed while awake
• Shift work
• Lack of physical activity
• Use of electronic devices in bed

Certain medications and substances may also disrupt sleep:

• Alcohol or illicit drugs
• Heavy smoking
• Excessive caffeine consumption, especially late in the day
• Habituation to specific sleep aids
• Certain cold medications and diet supplements
• Other prescribed or over-the-counter drugs, herbs, or supplements

Various physical, social, and mental health factors can impact sleep, including:

• Anxiety disorders
• Bipolar disorder
• Certain medical conditions like thyroid disorders
• Depression, often prompting individuals to seek medical help due to insomnia
• Physical discomfort or pain
• Stress, exacerbating sleep difficulties for some individuals

Aging commonly alters sleep patterns, leading to increased difficulty falling asleep and more frequent awakenings.

Symptoms

Typical symptoms of insomnia include:

• Difficulty falling asleep most nights
• Daytime fatigue or drowsiness
• Unrefreshing sleep
• Multiple awakenings during the night

Insomniacs often fixate on obtaining sufficient sleep, leading to increased frustration and difficulty sleeping.

Lack of restful sleep can impair daily functioning due to fatigue or concentration difficulties.

Diagnosis and Testing

A healthcare provider typically diagnoses insomnia through physical examination and medical history review. Occasionally, polysomnography may be necessary to rule out other sleep disorders like sleep apnea.

Treatment

It's essential to understand that not everyone requires 8 hours of sleep nightly; individual sleep needs vary. Treatment often begins with addressing underlying medical conditions or medications exacerbating insomnia.

Improving sleep hygiene, such as optimizing sleep habits, can significantly alleviate or resolve insomnia.

While medication may be beneficial, it carries potential risks:

• Antihistamines (commonly found in over-the-counter sleep aids) may lead to memory issues, particularly in older individuals.
• Sedatives should only be used under close medical supervision to prevent tolerance and dependence. Abrupt cessation can result in rebound insomnia and withdrawal.
• Certain antidepressants at lower doses may offer relief without the risks associated with sedatives.

Consulting a psychiatrist or mental health professional can help identify and address mood or anxiety disorders contributing to insomnia:

• Talk therapy, like cognitive-behavioral therapy, may aid in managing anxiety or depression.
• Psychiatrists may prescribe antidepressants or other medications to address sleep issues and underlying mood or anxiety disorders.

Prognosis

Most individuals can improve their sleep through good sleep hygiene practices. However, consult a healthcare professional if insomnia persists despite efforts to address it.