Insomnia: What It is, Symptoms, Causes And Treatment

What is insomnia?

A common sleep disorder where you face issues with falling or staying asleep is insomnia. Difficulties in getting back to sleep or early morning awakenings are important parts of this sleep disorder. It can be an acute, short-term or chronic, long-term issue that may also keep coming and going. The most common causes of the condition include family pressures, traumatic events or stress at work. It can last for months and even longer.

As per studies, approximately 93% of Indians do not get sufficient sleep because of the intrusion of modern devices and changing lifestyles. Most cases of long-term insomnia are secondary, which means they are a side effect or symptom of some other issue, like a certain medical condition, other sleep disorders or certain medicines. Substances like alcohol, tobacco and caffeine can also cause this condition. 

Sometimes chronic insomnia is primary, which means any other condition has not caused it.

Types of insomnia

There are two main types of insomnia: acute and chronic. Acute insomnia is short-term, lasting from a few days to a few weeks. It's often triggered by stress, a traumatic event, or changes in sleep environment. Chronic insomnia, on the other hand, lasts for three months or longer. It may be caused by underlying health conditions, medications, or long-term stress.

Other types of insomnia

Here are some other ways to categorise insomnia:

• Comorbid insomnia: Occurs alongside other health issues like depression, anxiety, or chronic pain.
• Onset insomnia: Difficulty falling asleep at the beginning of the night. More common in younger people.
• Maintenance insomnia: Trouble staying asleep, with frequent awakenings during the night. Often affects older adults.

Symptoms of Insomnia

Major signs of the condition include:

• Fatigue
• Daytime sleepiness
• Memory and concentration problems
• Grumpiness

Chronic or long-term insomnia may show symptoms like:

• Difficulty falling asleep
• Difficulty getting back to sleep after waking up at midnight
• Depressed mood
• Irritability
• The trouble with school, work or social performance
• Decreased motivation
• Sleepiness
• Increased mistakes or accidents
• Behavioural problems, such as aggressiveness or hyperactivity
• Discontent with or worries about sleep
• Not feeling refreshed or recharged after sleep

Causes of Insomnia

Stress is one of the most common insomnia causes along with habits or life events that disrupt sleep. Treating the underlying insomnia causes can resolve the condition, but it may take several years. The most common insomnia causes include:

• Stress: 

Concerns about school, work, finances, family and health can keep you from sleeping at night. Trauma and stressful life events like illness or death of a known person, job loss or divorce may also cause insomnia.

• Work or Travel Schedule: 

Your circadian rhythms are your internal clock that guides your metabolism, body temperature and sleep-wake cycle. Disturbing your body’s circadian rhythms can also cause insomnia. Significant causes of circadian rhythm disruption include working early or late shifts, changing shifts frequently, and travelling across different time zones.

• Overeating Late in the Evening: 

It’s fine to have a light snack at bedtime, but excessive eating in the evening may make you feel physically uncomfortable when you lie down. You may also experience backflow of food and acid from your stomach into the oesophagus after eating and heartburn that can keep you awake.

• Poor Sleeping Habits: 

Things like stimulating activities during bedtime; irregular bedtime schedule; uncomfortable sleep environment; using your bed for eating, watching TV and work, and naps are poor sleeping habits that can lead to insomnia over time. Playing video games or using TVs, computers and smartphones before bed can also disturb your sleep cycle.

Other common insomnia causes include:

• Mental Health Problems: Other mental health problems like depression, anxiety and post-traumatic stress disorder may disturb sleep and cause early morning awakenings.

• Medical Conditions: Common medical conditions associated with insomnia include cancer, chronic pain, heart disease, diabetes, asthma, overactive thyroid, Alzheimer’s disease, GERD or gastroesophageal reflux disease and Parkinson’s disease.

• Medicines: Different prescription medicines can also disrupt your natural sleep cycle. These include medicines for blood pressure or asthma and antidepressants. Many over-the-counter medicines for pain, allergies and colds, and weight loss products, can also disrupt sleep because of their caffeine content.

• Alcohol, Nicotine and Caffeine: Cola, tea, coffee and other caffeinated beverages are stimulants that can disturb your sleep if you have them late in the evening or afternoon. Tobacco contains nicotine which is also a stimulant that can disturb your sleep. Alcohol induces sleep but prevents the deeper sleep stages and causes midnight awakenings.

• Sleep-Related Conditions: You may feel uncomfortable sensations in the legs because of restless leg syndrome and an urge to move them, which may prevent you from getting proper sleep. Sleep apnea is another condition that hinders you from breathing periodically throughout the night, thus causing sleep disturbances.

How is insomnia diagnosed?

Insomnia is diagnosed based on a patient's reported symptoms and sleep history. Your doctor may ask you to keep a sleep diary to track your sleep patterns, including bedtime, wake time, and any nighttime awakenings. They may also enquire about your daytime functioning, mood, and any medications you're taking.

Treatment of Insomnia

Acute or short-term insomnia heals on its own. Chronic insomnia treatment includes:

1. Sleep Hygiene Education:  

This can help you develop a healthy lifestyle through proper exercise and diet. A doctor may provide information about insomnia treatment, its causes and symptoms, and the stressors that may trigger sleeplessness. You may also learn about different methods to reduce environmental factors like noise, light, mattress and temperature that may disturb your sleep.

2. Cognitive Behavioural Therapy: 

The therapy involves stimulus control, which aims to change wrong beliefs about sleeping. The therapy also suggests actions that may trigger sleep, like:

• Avoiding daytime naps
• Hitting to bed only when you feel sleepy
• Using the bedroom only for sleeping
• Working out regularly for a minimum of 20 minutes but 4 to 5 hours before bedtime
• Maintaining a regular wake and sleep routine
• Avoid caffeinated beverages like soft drinks and coffee and test them later during the day.
• Creating the ideal sleep environment in your bedroom. Working on noise, temperature and avoiding the use of high-intensity lights.

3. Sleep Restriction Therapy: 

It involves limiting the amount of time you spend in bed, and this further prevents excessive daytime sleepiness and induces sleep early on.

4. Behavioural Intervention:

 This can help you adopt good sleep hygiene while eliminating behaviours incompatible with sleep, like worrying and lying in bed.

5. Relaxation Therapies: 

Therapies like biofeedback techniques and progressive muscle relaxation reduce arousal. Attention focusing and imagery training can also help reduce pre-sleep cognitive arousal. These procedures can also help you with sleep disruption caused due to stress.

6. Medicines: 

Medicines like Benzodiazepines, Zaleplon, Zolpidem and Zopiclone, Ramelteon, Eszopiclone, TCAs or Tricyclic antidepressants and antihistamines can alleviate sleeplessness by improving hormonal imbalance and treating underlying psychological conditions.

What are the risk factors for insomnia?

Certain factors can increase your insomnia risk, such as:

• Age: Insomnia is more common in older adults.
• Gender: Women are more likely to experience insomnia, possibly due to hormonal changes.
• Stress: Persistent stress or anxiety can disrupt sleep.
• Irregular sleep schedules: Shift work or jet lag can throw off your body's internal clock.
• Poor sleep habits: Watching TV or using electronic devices in bed can make it harder to fall asleep.

What are the complications of this condition?

If left untreated, insomnia complications can be serious and may include:

• Daytime fatigue and sleepiness
• Mood disturbances, such as irritability, anxiety, or depression
• Difficulty concentrating and decreased performance at work or school
• Increased risk of accidents and injuries
• Weakened immune system, making you more susceptible to illnesses
• Increased risk of developing chronic health conditions, such as obesity, diabetes, and cardiovascular disease

What tests will be done to diagnose insomnia?

To diagnose insomnia, your doctor may recommend one or more of the following tests:

• Sleep diary: You'll be asked to record your sleep patterns, including bedtime, wake time, and any nighttime awakenings, for 1-2 weeks.
• Actigraphy: This involves wearing a small device on your wrist that tracks your sleep-wake cycles by measuring your movement.
• Polysomnography (sleep study): This is an overnight test that records your brain waves, heart rate, breathing, and leg movements while you sleep. It can help rule out other sleep disorders, such as sleep apnoea.
• Multiple Sleep Latency Test (MSLT): This test measures how quickly you fall asleep during the day and can help diagnose narcolepsy or excessive daytime sleepiness.

What can we expect if we have insomnia?

If you have insomnia, you may experience:

• Difficulty falling asleep at night
• Waking up frequently during the night
• Waking up too early and being unable to fall back asleep
• Feeling unrefreshed or tired upon waking
• Daytime fatigue, sleepiness, or irritability
• Difficulty concentrating or remembering things

These symptoms can significantly impact your quality of life and daily functioning.

What's the outlook for this condition?

The outlook for insomnia varies depending on the underlying cause and the individual's response to treatment. In many cases, insomnia can be effectively managed with lifestyle changes, good sleep hygiene practices, and cognitive-behavioural therapy for insomnia (CBT-I). Some people may require medication to help them sleep, but this should be used under the guidance of a doctor. With proper treatment and management, most people with insomnia can achieve improved sleep quality and daytime functioning.

How do I take care of myself?

If you're struggling with insomnia, there are several steps you can take to improve your sleep quality:

1. Stick to a consistent sleep schedule, even on weekends. Go to bed and wake up at the same times each day to regulate your body's internal clock.
2. Create a relaxing bedtime routine. Take a warm bath, read a book, or practice gentle stretching to unwind before bed. Avoid screens for at least an hour before sleep.
3. Make your bedroom a sleep-friendly environment. Keep it dark, quiet, and cool. Use comfortable bedding and pillows. Reserve the bed for sleep and intimacy only.
4. Limit caffeine, alcohol, and heavy meals in the evenings. These can interfere with your ability to fall asleep and stay asleep.
5. Exercise regularly, but not too close to bedtime. Aim for at least 30 minutes of moderate exercise most days of the week, finishing a few hours before bed.
6. Manage stress with relaxation techniques. Deep breathing, progressive muscle relaxation, and mindfulness meditation can help calm your mind and body.
7. Avoid napping late in the day. If you must nap, keep it short (15-20 minutes) and before 3pm.

If lifestyle changes alone don't improve your insomnia, talk to your doctor. They may recommend other treatments like cognitive-behavioural therapy for insomnia (CBT-I) or prescription sleep medications.

When to see a doctor?

It's important to see a doctor if your insomnia persists or significantly impacts your daily life. Your doctor can help identify any underlying causes and recommend appropriate treatment. You should also consult a doctor if you experience:

• Insomnia that lasts more than a month
• Daytime sleepiness that interferes with work or daily activities
• Waking up feeling unrefreshed, even after a full night's sleep
• Snoring loudly or waking up gasping for air (signs of sleep apnea)

Your doctor can help identify underlying causes of insomnia and recommend appropriate treatment. They may refer you to a sleep specialist for further evaluation.

Conclusion

Sleep is as crucial as regular exercise and a balanced diet for your health. Regardless of the reason for sleeplessness, insomnia may affect you both physically and mentally. The best is to contact an expert. They will guide you to manage the issues that disrupt your sleep.

FAQs

How long does insomnia last?

The duration of insomnia varies from person to person. Acute insomnia typically lasts for a few days to a few weeks, while chronic insomnia persists for three months or longer. In some cases, insomnia may come and go over time, with periods of good sleep followed by periods of poor sleep.

How do I beat insomnia?

To beat insomnia, start by establishing good sleep hygiene practices, such as maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and making your sleep environment comfortable. Avoid caffeine, alcohol, and large meals close to bedtime, and limit exposure to screens before sleep. Regular exercise and stress management techniques can also help improve sleep quality. If these strategies don't work, consider cognitive-behavioural therapy for insomnia (CBT-I) or consult a doctor for further guidance.

How to cure insomnia in 12 minutes naturally?

There is no guaranteed way to cure insomnia in 12 minutes naturally. However, practicing relaxation techniques, such as deep breathing, progressive muscle relaxation, or guided imagery, for 10-15 minutes before bed may help you unwind and prepare for sleep. It's important to remember that managing insomnia often requires a combination of lifestyle changes, good sleep hygiene practices, and sometimes professional treatment.

Will my insomnia go away?

Whether your insomnia will go away depends on the underlying cause and your individual circumstances. In some cases, acute insomnia triggered by a specific event or stressor may resolve on its own once the triggering factor is addressed. However, chronic insomnia often requires a combination of lifestyle changes, good sleep hygiene practices, and sometimes professional treatment, such as cognitive-behavioural therapy for insomnia (CBT-I) or medication. Working with a doctor can help you develop an effective treatment plan tailored to your needs.