Insomnia (Sleeplessness)

Insomnia is defined as difficulty initiating or maintaining sleep, or both, despite adequate opportunity and time to sleep, leading to impaired daytime functioning. Insomnia may be a cause of or result of poor quality and/or quantity of sleep.

Insomnia is very common. Ninety percent of the general population has experienced acute insomnia at least once. Approximately 10% of the population may suffer from chronic (long-standing) insomnia.

Insomnia Facts

The problem affects people of all ages including children, although it is more common in adults and its frequency increases with age. In general, women are affected more frequently than men.

  • Insomnia is a condition characterized by poor quality and/or quantity of sleep, despite adequate opportunity to sleep, which leads to daytime functional impairment.
  • Many diseases, syndromes, and psychiatric conditions may be responsible for causing insomnia.
  • Some common signs and symptoms of include:
    • Waking up unrefreshed from lack of sleep
    • Daytime sleepiness and fatigue
    • Mood changes
    • Poor concentration and attention
    • Anxiety
    • Headaches
    • Lack of energy
    • Increased errors and mistakes
  • Sometimes insomnia may be unrelated to any underlying condition.
  • There are several useful non-medical behavioural techniques available for treating the problem.
  • Medications are widely used to treat insomnia in conjunction with non-medical strategies.
  • Sleep specialists are  doctors who can play an important role in evaluating and treating long-standing (chronic) insomnia.

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The causes of your insomnia will depend on the type of sleeplessness you experience.

Short-term insomnia may be caused by stress, an upsetting or traumatic event, or changes to your sleep habits.

Chronic insomnia lasts for at least three months and is usually secondary to another problem or a combination of problems, including:

  • medical conditions which make it harder to sleep, such as arthritis or back pain
  • psychological issues, such as anxiety or depression
  • substance use

Insomnia can occur at any age and is more likely to affect women than men.

According to the National Heart, Lung, and Blood Institute (NHLBI), people with certain risk factors are more likely to have insomnia. These risk factors include:

  • high levels of stress
  • emotional disorders, such as depression or distress related to a life event
  • lower income
  • traveling to different time zones
  • sedentary lifestyle
  • changes in work hours, or working night shifts

Certain medical conditions, such as obesity and cardiovascular disease, can also lead to insomnia. Menopause can lead to insomnia as well. Find out more about the causes of — and risk factors for — insomnia.

Insomnia can occur at any age and is more likely to affect women than men.

According to the National Heart, Lung, and Blood Institute (NHLBI), people with certain risk factors are more likely to have insomnia. These risk factors include:

  • high levels of stress
  • emotional disorders, such as depression or distress related to a life event
  • lower income
  • traveling to different time zones
  • sedentary lifestyle
  • changes in work hours, or working night shifts

Certain medical conditions, such as obesity and cardiovascular disease, can also lead to insomnia. Menopause can lead to insomnia as well. Find out more about the causes of — and risk factors for — insomnia.

Evaluation and diagnosis of insomnia may start with a thorough medical and psychiatric patient history taken by the doctor or other health care professional. As mentioned previously, many medical and psychiatric conditions can be responsible for insomnia.

A doctor will perform an examination on the patient to assess for any abnormal findings as well. Portions of the exam may include:

  • Assessment of mental status and neurological function
  • Heart, lung and abdominal exam
  • Ear, nose and throat exam
  • Measurement of the neck circumference and waist size.
  • Questions about any routine medications you are currently taking, and use of any illegal drugs, alcohol, tobacco, or caffeine.

Laboratory or blood work pertinent to these conditions can also be a part of the assessment.

Sleep patterns: The patient's family members and bed partners also need to be interviewed to ask about the patient's sleep patterns, snoring, or movements during sleep.

Sleep habits: Specific questions regarding sleep habits and patterns are also a vital part of the assessment. A sleep history focuses on:

  • Duration of sleep
  • Time of sleep
  • Time to fall sleep
  • Number and duration of awakenings
  • Time of final awakening in the morning
  • Time and length of any daytime naps
  • The typical sleep environment

Sleep logs or diaries: Sleep logs or diaries may be used for this purpose to record these parameters on a daily basis for more accurate assessment of your sleep patterns.

Sleep history: Sleep history also typically includes questions about possible symptoms associated with insomnia. You may asked about daytime functioning, fatigue, concentration and attention problems, naps, and other common symptoms of the condition.

There are both pharmaceutical and nonpharmaceutical treatments for insomnia.

Your doctor can talk to you about what treatments might be appropriate. You may need to try a number of different treatments before finding the one that’s most effective for you.

The American College of Physicians (ACP) recommends cognitive behavioural therapy (CBT) as a first-line treatment for chronic insomnia in adults.

Sleep hygiene training may also be recommended. Sometimes, behaviours that interfere with sleep cause insomnia. Sleep hygiene training can help you change some of these disruptive behaviours.

Suggested changes may include:

  • avoiding caffeinated beverages near bedtime
  • avoiding exercise near bedtime
  • minimizing time spent on your bed when you’re not specifically intending to sleep, such as watching TV or surfing the web on your phone

If there’s an underlying psychological or medical disorder contributing to your insomnia, getting appropriate treatment for it can alleviate sleep difficulties. Discover more treatments for insomnia.

Good sleep habits, also called sleep hygiene, can help you get a good night's sleep. For example:

  • Think positive. Avoid going to bed with a negative mindset, such as "If I don't sleep for 8 hours, I will feel terrible tomorrow."
  • Try to go to sleep at the same time each night and get up at the same time each morning. Try not to take naps during the day because naps may make you less sleepy at night.
  • Avoid caffeine, nicotine, and alcohol late in the day. Caffeine and nicotine are stimulants and can keep you from falling asleep. Alcohol can cause waking in the night and interferes with sleep quality.
  • Get regular exercise. Try not to exercise close to bedtime because it may stimulate you and make it hard to fall asleep. Experts suggest not exercising for 4 hours before the time you go to sleep.
  • Don't eat a heavy meal late in the day. A light snack before bedtime, however, may help you sleep.
  • Make your sleeping place comfortable. Be sure that it is dark, quiet, and not too warm or too cold. If light is a problem, try a sleeping mask. If noise is a problem, try earplugs or a fan.
  • Relax before going to bed by reading a book, listening to music, taking a bath, or enjoying another activity you find relaxing.
  • Avoid using your bed for anything other than sleep or sex.
  • If you can't fall asleep and don't feel drowsy, get up and read or do something that is not overly stimulating until you feel sleepy.
  • If you have trouble lying awake worrying about things, try making a to-do list before you go to bed. This may help you to not focus on those worries overnight.
  • Stop clock watching. Turn the clock around and only use the alarm.

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