Overview of Insomnia

What is insomnia?

Sleep plays an important role in every person’s life, helping people rest after periods of work and study.

Insomnia is a common sleep disorder that can include not sleeping deeply, having difficulty falling asleep, waking up too early and not being able to go back to sleep, and still feeling tired when waking up. Insomnia can cause uncomfortable fatigue that seriously affects work performance and quality of life.

On average, a normal person sleeps 7-8 hours/day, in which sleep must be long enough, deep enough, and feel comfortable and healthy after waking up.

Insomnia includes: Acute insomnia and chronic insomnia. Chronic insomnia is insomnia that lasts for at least 1 month. Acute insomnia is insomnia that lasts less than 1 month.

Insomnia is a common condition that affects not only the elderly but also young people due to many different causes. Changes in daily habits can help improve sleep in some subjects.

Causes of Insomnia

Common causes of insomnia include:

• Stress about work, school, health, finances, or family can keep your mind active at night, making it difficult to fall asleep. Stressful or traumatic life events — such as the death or illness of a loved one, divorce, or job loss — can also lead to insomnia.
• Poor sleep habits. Poor sleep habits include an irregular sleep schedule, napping, stimulating activities before bed, an uncomfortable sleep environment, and using your bed to work, eat, or watch TV. Computers, TVs, video games, smartphones, or other screens right before bed can interfere with your sleep cycle.
• Eating too much in the evening. Having a snack before bed is fine, but eating too much can make you feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which can keep you awake.
• Travel or work schedule. Your circadian rhythm acts as an internal clock, guiding things like your sleep-wake cycle, metabolism, and body temperature. Disrupting your body’s circadian rhythm can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working late or early, or changing shifts frequently.

Other common causes of insomnia include:

• Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, can disrupt your sleep. Waking up too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
• Medications. Many prescription medications can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. Many over-the-counter medications—such as some pain relievers, allergy and cold medications, and weight-loss products—contain caffeine and other stimulants that can disrupt sleep.
• Medical conditions. Examples of conditions associated with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease, and Alzheimer’s disease.
• Sleep-related disorders. Sleep apnea causes you to stop breathing periodically throughout the night, disrupting your sleep. Restless legs syndrome causes an uncomfortable feeling in your legs and a nearly irresistible urge to move them, which can keep you from falling asleep.
• Caffeine, nicotine, and alcohol. Coffee, tea, colas, and other caffeinated drinks are stimulants. Drinking them in the late afternoon or evening can keep you from falling asleep at night. The nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol can help you fall asleep, but it suppresses the deeper stages of sleep and often causes waking in the middle of the night.
• Age. Sleep often becomes less restful as you age, so noises or other changes in your environment are more likely to wake you up. With age, tiredness occurs earlier in the evening and waking up earlier in the morning. But older people generally still need as much sleep as younger people.
• Lack of physical or social activity. Lack of activity can interfere with good sleep. Also, the less active you are, the more likely you are to take naps during the day, which can interfere with sleep at night.
• Health problems. Chronic pain from conditions like arthritis or back problems, as well as depression or anxiety, can interfere with sleep. Problems that increase the need to urinate at night due to prostate or bladder problems – can disrupt sleep. Sleep apnea and restless legs syndrome become more common with age. Also include thyroid disease, heart disease
• Medications. Older adults often take more prescription medications than younger adults, which increases the risk of medication-related insomnia.
• Insomnia in children and teens: Sleep problems can be a concern for children and teens. However, some children and teens simply have trouble falling asleep or resist their normal bedtime because their internal clocks are more delayed. They want to go to bed later and sleep later in the morning
  Insomnia associated with trauma, prolonged hospitalization, symptoms of mental illness: depression, mania, anxiety disorders, substance abuse.

Symptoms of Insomnia

Symptoms of insomnia may include:

• Difficulty falling asleep at night
• Waking up during the night
• Waking up too early
• Not feeling rested after a night’s sleep
• Daytime fatigue or sleepiness
• Irritability, depression, or anxiety
• Difficulty paying attention, concentrating on tasks, or remembering
• Increased errors or accidents
• Continuous worries about sleep

When to see a doctor?

If insomnia makes it difficult for you to function during the day, see your doctor to determine the cause of your sleep problems and how to treat them. If your doctor thinks you may have a sleep disorder, you may be referred to a sleep center for special testing.

Complications of sleep loss can include:

• Lower performance at work or school
• Slower reaction times while driving and higher risk of accidents
• Mental health disorders, such as depression, anxiety disorders, or substance abuse
• Increased risk and severity of long-term illnesses or conditions, such as high blood pressure and heart disease

Who is at risk for Insomnia

• Female gender. Hormonal changes during the menstrual cycle and during menopause may play a role. During menopause, night sweats and hot flashes often disrupt sleep. Insomnia is also common with pregnancy.
• Age over 60. Because of changes in sleep and health, insomnia increases with age.
• Mental health disorders or physical health conditions. Many problems that affect your mental or physical health can disrupt sleep.
• Mental stress. Stressful times and events can cause temporary insomnia. And major or long-term stress can lead to chronic insomnia.
• Changes in work hours. For example, changing shifts or traveling can disrupt the sleep-wake cycle.

Preventing Insomnia

Good sleep habits can help prevent insomnia and promote good sleep:

• Keep a consistent bedtime and wake time from day to day, including weekends.
• Stay active – regular activity helps promote good sleep.
• Check medications to see if they may be contributing to insomnia.
• Avoid or limit naps.
• Avoid or limit caffeine and alcohol, and do not use nicotine.
• Avoid large meals and drinks before bed.
• Create a relaxing bedtime ritual, such as taking a warm bath, reading, or listening to soft music.

Diagnostic Measures for Insomnia

Diagnosing insomnia and looking for its cause may include:

• A physical exam. If the cause of insomnia is unknown, your doctor may perform a physical exam to look for signs of medical problems that may be related to insomnia. Occasionally, blood tests may be done to check for thyroid problems or other conditions that may be related to poor sleep.
• A review of your sleep habits. In addition to asking you questions about your sleep, your doctor may determine your sleep patterns and your level of daytime sleepiness.