What is Insomnia? What Causes Insomnia?

Insomnia, from the Latin "in" (not) and "somnus" (sleep), is a condition characterized by difficulty falling asleep and remaining asleep. It includes a broad spectrum of sleep disorders, from lack of quantity of sleep to lack of quality of sleep. Insomnia is often separated into three types. Transient insomnia occurs when symptoms last from a few days to a few weeks. Acute or short-term insomnia is when symptoms last for several weeks. Chronic insomnia is characterized by insomnia that lasts for months and years.

Insomnia can affect all age groups and is more common in adult women than adult men. The condition can lead to poor performance at work or school, obesity, depression, anxiety, poor immune system function, reduced reaction time, and an increased risk and severity of long-term disease.

What causes insomnia?

Insomnia can be caused by physical factors as well as psychological factors. There is often an underlying medical condition that causes chronic insomnia, while transient insomnia may be due to a recent event or occurrence. Causes of insomnia include:

• Drugs, alcohol, and medicines: caffeine, nicotine, alcohol, stimulants, antidepressants, heart and blood pressure medications, allergy medicines, decongestants, weight-loss medicines, antihistamines, cocaine, ephedrine, amphetamines, methamphetamine, fluoroquinolone antibiotic drugs


• Disruptions in circadian rhythm: jet lag, job shift changes, high altitudes, noisiness, hotness or coldness


• Psychological issues: stress, anxiety, depression, mania, schizophrenia


• Medical conditions: brain lesions and tumors, stroke, chronic pain, chronic fatigue syndrome, congestive heart failure, angina, acid-reflux disease (GERD), chronic obstructive pulmonary disease, asthma, sleep apnea, Parkinson's and Alzheimer's diseases, hyperthyroidism, arthritis


• Hormones: estrogen, hormone shifts during menstruation


• Other factors: sleeping next to a snoring partner, parasites, genetic conditions, overactive mind, preganancy

Who gets insomnia?

Some people are more likely to suffer from insomnia than others. These include:

• Travelers
• Shift workers with frequent changes in shifts
• The elderly
• Drug users
• Adolescent or young adult students
• Pregnant women
• Menopausal women
• Those with mental health disorders

What are the symptoms of insomnia?

Insomnia itself may be a symptom of an underlying medical condition. However, there are several signs and symptoms that are associated with insomnia.

• Difficulty falling asleep at night
• Awakening during the night
• Awakening earlier than desired
• Still feeling tired after a night's sleep
• Daytime fatigue or sleepiness
• Irritability, depression or anxiety
• Poor concentration and focus
• Being uncoordinated, an increase in errors or accidents
• Tension headaches
• Difficulty socializing
• Gastrointestinal symptoms
• Worrying about sleeping

How is insomnia diagnosed?

A sleep specialist usually will begin a diagnostic session by asking a battery of questions about your medical history and sleep patterns. A physical exam my be conducted to look for conditions that may be causing insomnia. Similarly, physicians may screen for psychiatric disorders and drug and alcohol use. It is not uncommon for a sleep specialist to request that you keep a sleeping diary.

More sophisticated tests may be employed such as a polysomnograph, which is an overnight sleeping test that records sleep patterns. In addition, actigraphy may be conducted, which uses a small, wrist-worn device called an actigraph to measure movement and sleep-wake patterns.

How is insomnia treated?

Some types of insomnia resolve themselves when the underlying cause is removed or wears off. In general, treating insomnia focuses on determining the cause of the sleeping problems. Once identified, this underlying cause can be properly treated or corrected. In addition to treating the underlying cause of insomnia, both medical and non-pharmacological (behavioral) treatments may be employed as adjuvant therapies.

Non-pharmacological apparaches to treating insomnia include:

• Improving "sleep hygiene" - don't over- or under-sleep, exercise daily, don't force sleep, try to maintain a regular sleep schedule, avoid caffeine at night, do not smoke, do not go to bed hungry, make sure the environment is comfortable


• Using relaxation techniques - such as meditation and muscle relaxation


• Cognitive therapy - one-on-one counseling or group therapy


• Stimulus control therapy - only go to bed when sleepy, refrain from TV, reading, eating, or worrying in bed, set an alarm for the same time every morning (even weekends), avoid long daytime naps


• Sleep restriction - decrease the time spent in bed and partially deprive your body of sleep so you are more tired the next night.

Medical treatments for insomnia include:

• Prescription sleeping pills (often benzodiazepines)
• Antidepressants
• Over-the-counter sleep aids
• Antihistamines
• Melatonin
• Ramelteon
• Valerian officinalis